Doctors and their Good Intentions: The Blood Test Fiasco Continues

"I suggest you stop taking vitamin D."

Such was the well-intentioned advice of my consultant haematologist recently. He was concerned about my kidney function.

It all started when I turned up for my regular blood test about an hour after a savage workout in the gym. These tests are to monitor a condition called 'aplastic anaemia'. My view is that there is nothing wrong with me – but that’s another story.

On the day of the blood test, my haematologist was upbeat. For several years I've had very stable blood counts, albeit that they are at the 'lower end of normal'. Not low enough to require action, not high enough for me to be left alone. Hence, I’ve been on the blood test merry-go-round since about 2004.

This time I took a photo of the blood being taken:


Every 6 months, this is is the conversation:

"How are you feeling?"
"Fine"
"No symptoms?"
"No."
"Okay, see you in 6 months."

I have always been deeply suspicious of these 'normal' ranges, given the things 'normal' people do, diet and exercise-wise. Yet all kinds of changes have taken place in my life since 2004, not least turning Paleo and starting vitamin D supplementation. I have even deliberately eaten wheat to see whether that would change the numbers. Yet they have scarcely changed. Until now.

My suspicion is that some people simply have lower blood counts that others, yet function fine. I think low counts can be caused by many factors - and depending on the cause, health may or may not be affected.

This time, two of the key numbers had rocketed. The white cell count had gone from 3.0 to 7.7 and the neutrophil count from 1.3 to 6.7. The other numbers had not really changed.

As far as the consultant was concerned, this was great news. He even wondered whether they had mixed up my sample with someone else, before quickly waving the idea away with his hand in case I thought he was being serious.

Should I be pleased? I am not sure – forgive me if I don’t start arranging a party. After all, I feel just as healthy as I always have and, no, I do not have any symptoms. Whilst I accept it's possible to feel fine but not be well, one has to assume some significance from 6 unbroken years of feeling fine, during which the sum total of my illness has been two, short, mild colds.

If anything, I ought to worried. It will not be possible to untangle the multiple and no doubt interdependent factors behind my blood counts - but surely common sense should raise alarm bells when there are changes to a system that aint broke.

Have I pummelled my body into having normal counts by my too-frequent forays into a ‘normal’ lifestyle? A look at the flagged points and associated posts on my body composition graph are enough to give you an idea of what I’ve been up to since the start of 2009.

On the other hand, perhaps there really was a problem, and either the vitamin D, the Paleo diet or both have helped cure it – but it just took a year or more for the benefits to filter through to the blood counts.

We will never know.

Three days later, I got a call from my haematologist. He wanted to talk about creatinine. I had forgotten they were even testing my creatinine levels. The creatinine tests take a few days to come through, which was why he had not mentioned them on the day.

Creatinine is one of the by products of muscle activity. Since the kidneys are responsible for removing the creatinine from the blood, high levels are taken as a sign of poor kidney function. Of course it rather depends on how long the kidneys have had to do their job. If you’ve recently generated a lot of creatinine then even a fine pair of kidneys may not have got rid of it all when the test is done.

“I can probably clear this up straight away”, I told him.

Pleased with myself for having worked hard enough at the gym to affect a blood test, I recounted my activities with relish.

“Yes I suppose that could have had some effect”, he conceded.

I was also pleased with myself for knowing also that vitamin D toxicity can effect kidney function, so I mentioned my daily winter dose of 4000 IU, swelling even further with pride at my savvy decision to supplement.

This, on reflection, was a bad idea. First, because I was expecting a member of the medical profession to be impressed by my decision to supplement something which based on official guidelines, I do not need to. Second, because I was bringing into the discussion something about which I probably know more than he does.

Was I prepared to explain the research that had convinced me that the official healthy range is wrong? Would I try to convince him of the credentials of the organisation I get the test kit from? He’s a nice guy, but he’d have to be a lot nicer to let some upstart armchair pseudo-medic tell him what’s what.

When he had finished politely listening, he suggested the following:

1. Stop taking vitamin D
2. Avoid intense exercise for a few days before my next blood test
3. A visit to the kidney specialist

A week later, I found myself once again amongst the unwell, as I sat in the ultrasound department waiting to have my kidney function checked. I had mixed feelings about this. On the one hand, I applauded his caution and was glad to be the subject of such careful scrutiny. I can see why people develop Münchausen syndrome.

On the other hand, the evident poor health of the people who invariably surround me when I am waiting for these tests leaves me with an abiding sense of misplaced attention.

While the ultra scan doctor glided her device around my gel-lubed abdomen and I dutifully breathed in and out when bidden, I noticed the nurse at the end of the bed eying my Vibram Five Fingers curiously.

"What are they?!" she half asked, half laughed.

"Vibram Five Fingers," I said. They allow you to go barefoot without being barefoot."

She pondered this information, then appeared to come to a conclusion. "Very cool," she declared. End of conversation.

When the scan was over, the expected news was delivered. "Your kidneys are working fine."

Nevertheless, procedure dictates that I must pay a separate visit to the kidney specialist, with whom I will discuss this and the creatinine readings. By then it will be less than a month before my next regular blood test. The merry-go-round continues.

In case you were wondering, I will not stop taking vitamin D. I will, however, avoid intense exercise on the morning of the next blood test.

-------------

Meanwhile, elsewhere, the medical establishment was potentially threatening the vitamin D levels of someone else.

One of my relatives was recently prescribed drugs to treat high blood pressure. Not particularly high, you understand - but high enough, in the opinion of the doctor, to merit treatment.

A few weeks later, she noticed her asthma was a little worse than usual, but paid no attention. By chance, she later came across information on the Internet suggesting the drug she was taking could cause coughing symptoms.

Back at the doctor’s, she was told this is a common symptom of the drug she was taking, and she was duly put on different drug instead. Two things bugged me about this. First, that she was not warned about the potential side effect. Should thing like that be left up to the patient to notice? Second, what are the potential side-effects of the new drug? And could there be side effects that don't make themselves known so conspicuously?

So I did a little digging of my own. The new drug is what’s called a calcium blocker. This family of drugs acts by blocking the calcium channels, which apparently has a blood pressure-lowering effect. But guess what? It also affects the ability of the body to produce vitamin D. The fact that calcium blockers are said to have 'interactions' with vitamin D, means doctors may recommend against vitamin D supplementation for people taking them.

Ironically, my relative has reduced the vitamin D dose she takes based on the information I drew her attention to, not on the advice the doctor, who is not aware of the vitamin D.

I have not read enough about this to be sure - but instinctively I am not comfortable. If calcium blockers inhibit the body's production of vitamin D then presumably sunlight becomes a less potent source and so more, not less supplementation is needed in our sun-starved UK climate. If any readers have knowledge in this area, your thoughts would be appreciated.

I don’t wish to paint an unduly bleak picture, nor to denigrate the efforts or intentions of doctors. I know one or two personally and they are amongst the most genuinely caring people I know.

One of them sent me an article recently, featured on the front page of a prominent medical publication, covering the potential importance of vitamin D. So things are changing. I just hope they change quickly enough so that my relative and others I care about can avoid being sucked into the downward vortex of prescription drugs.

See Also:

My Yellow Skin Mystery
My Wheat Experiment
My Wheat Experiment Blood Test Update
[Blood Test Update in Post on Weight Loss]
My Vitamin D Defficiency
How I Got My Vitamin D into the Sweet Spot... Read more

The Overpowering Stench of the Pharmaceutical Industry

Many corporations, lobbyists and establishments favour the pursuit of money over the health of human beings. I don't often write about it because it's too depressing - but I got a little out of my system in the first Nutshell video and last year's article about HFCS.

I listened to a radio programme on the BBC last week which so effectively exposes the cynical, grasping, manipulative mentality of the pharmaceutical industry, I just had to share it.

Fellow bloggers regularly expose the same issues, but somehow, hearing such a long and detailed exposé from an institution like the BBC, with candid testimonies from former employees, really brought it home. You can read the accompanying news story on the BBC website, or listen to the whole, one-hour program if you have time:

News Story Summarising the Program
Direct Link to Podcast

... Read more

The Wheat Experiment - Blood Test Update

A week ago I received the results of my latest blood test. I had been eating wheat-based products for two weeks prior to the test, to test the theory that my supposedly abnormal readings were only considered abnormal compared to a population that eats a different diet.

In Doctors and Nutrition Part 2 - My Wheat Experiment, I explained why I thought this might make a difference based on a chapter in Dr Eades' The Protein Power Life Plan. In fact I contacted Dr Eades via his blog and he kindly gave his opinion, which you can also see in the post. Since then I have started reading Dangerous Grains, where there is even more compelling detail about the impact grains can have on the immune systems of those sensitive to its proteins.

Here's what I was eating for the first 14 days in January:

With lunch - a large tablespoon of wheatgerm.
With dinner - a slice of bread.
On the final evening before the test - a gigantic naan bread.

If my hypothesis was correct, my reversion to a diet that included wheat should have produced a significant change in the readings.

Wheezing Throng

My test was just over a week ago on Thursday. Having offered up several vials of blood and waited for over an hour amongst the jaundiced, wheezing throng of the oncolgoy waiting room, I was called to see my specialist. I mean no offence to sick people, by the way - but it's only natural to feel a little out of place when, like me, you consider yourself a well person being treated like a sick one.

My specialist's opening gambit was how pleased he was to see an increase in the neutrophil count. As a result of this, he said, we could wait 4 months until the next test (this time it had been 2.) I left the consulting room a few minutes later, happily clutching my freshly printed results.

Irony

I am sure the irony of our mutual pleasure is not lost on you - he thinks it's good news because my counts are closer t0 'normal' which means I am healthier, whereas I think it's good news because my raised counts indicate I have forced my immune system to respond to a substance that is doing me harm, thus proving his perspective is flawed.

Since then I have dug out my test results from the last 3 years and plotted them on the graphs you see below and at the bottom, When I first looked at these, I was disappointed. My initial pleasure at learning there had been an increase in neutrophils was tempered by the context of that increase. The count may have gone up by 10% in 2 months, but that's not a lot when you consider they had fallen by over 30% in the preceding 6 months. It could simply be natural variation.

Drunken Rampages

Then I looked again at the white cell and neutrophil charts again and thought about what I had been doing over that period - at which point it hit me: I went Paleo in November 2007. So I added a marker on the chart to show where this happened. Notice, by the way, that the white cell and neutrophil counts pretty much follow each other, which I am told is not unusual because neutrophils are basically a type of white cell.

As I said in the other post, I was never a big bread eater: but I did eat it on occasion, and since it is in my nature to binge, I suspect that on those occasions I consumed a lot. I must confess to hazy recollections of drunken rampages through London cake shops in 2006 and 2007. Only when I went Paleo did this stop abruptly - until the first two weeks of January this year.

Now the readings make more sense: you could argue that the two successive declines in 2008 were a result of my entirely bread-free diet taking effect. The small reversal in direction seen in the latest results for neutrophils and white cells could be a result of the two weeks of wheat consumption.

PNH

As a footnote, the specialist also told me he had sent away my most recent sample for some additional tests - one to look at the nutrient profile and another to look at something called PNH.

The nutrient profile test was no doubt his response to our conversation at the previous appointment when I did some gentle probing to assess his receptiveness to the outlandish idea that diet may somehow affect the way our bodies function and therefore be impacting my results. We'll see what comes back from that, but if it's anything like the conversations I have had with other specialists and doctors, he will simply tell me my vitamin profiles look fine, so diet is not the issue.

PNH I don't know much about, but I gather it can potentially confirm the diagnosis of aplastic anemia, something which, as I've said before, I consider to be a euphemism for low blood counts we can't explain. Perhaps there is a subset of people with unexplained low blood counts who genuinely have a problem - and perhaps this PNH test would be positive for such people. When I get the results from this I will dig a little more to understand its significance.

Also of interest might be the sudden jump in platelets (see chart at the bottom) - I have no idea what connection, if any, there might be there, but in any case I will ping Dr E and (if he has time) get his view on the readings.

Piano

So what will I do in April? I will probably remain 100% strict with my diet until then to see whether my readings come back down. If they do, no doubt my specialist will be less happy and I will be summoned for another test 2 months later, leading up to which I will guzzle even more wheat than last time to see if I can play my readings like a piano.

Clearly there is little scientific substance to my experiments - my conclusions are surely a result of rampant confirmation bias and have little or no statistical value; but in the context of a medical profession with an almost willful lack of interest in how diet affects disease, I can't see I have much to lose...



See Also:
High Carb Feasts Could Help You Sleep
Doctors and Nutrition Part 1: My Yellow Skin Mystery
Doctors and Nutrition Part 2 - My Wheat Experiment
Doctors and their Good Intentions: the Blood Test Fiasco Continues
[Blood Test Update in Post on Weight Loss]
High Carb Feasts and Sleep - a Failed Attempt... Read more

The 5 Least Likely New Year Resolutions for 2009

Linda Van Horn, Chair of the USDA-appointed 2010 Dietary Guidelines Advisory Committee In 2009 I am going to turn the USDA food pyramid on its head by persuading my committee to stop recommending people's diet include so much brown, starchy carbohydrate. I can see the evidence is starting to point towards a sea change in nutritional best practice and rather than wait for the bureaucratic oil-tanker to turn around I intend to set the cat amongst the pigeons by arguing vehemently against the compromising of my committee's objectivity by the agricultural department and industry lobbies.

Andrew Wadge Chief Scientist at the UK Food Standards Agency In 2009 I am going to stop publishing the eatwell plate on our website and ask my people to review the evidence for its composition. I have realised that the recommendation for bread, rice and pasta as a huge proportion of the ideal diet is based not on evidence but history - we've always eaten food in those proportions therefore it must be the right diet. I know I will probably lose my job because there will be outrage and confusion, but I am going to do it anyway because I know the long term health benefits to emerge from the mayhem will in the long term make it worthwhile.

Jeffrey Kindler, CEO of Pfizer In 2009 I am going to re-think Pfizer's business model. We will no longer base our strategy on the bottom line, which I recognise is driving practices not always in the best interest of public health. Instead, we will focus on what is genuinely in the best long term interest of the consumer, namely prevention through improved nutrition. I realise this has very little commercial potential compared to the market for drugs to treat the symptoms, but believe that by reinventing ourselves as a new, more ethical breed of drug company we will make the world a better place and set a precedent other companies may follow.

Robert Mugabe, president of Zimbabwe In 2009 am going to take early retirement and begin a career writing children's books.

Osama bin Laden, leader of Al Qaeda In 2009 I am going to turn myself in. I am sick of living in caves and my friend Ahmed told me they have running water and cable at Guantanamo.

... Read more

Doctors and Nutrition Part 2: My Wheat Experiment

In part one, My Yellow Skin Mystery, I described how a succession of doctors lacked the nutritional knowledge to spot that carotenoderma was probably at the cause of my yellow skin. This harmless condition is caused by consuming a lot of fruit and vegetables of a certain kind, information I had clearly volunteered during my consultations.

Since changing to a paleo/primal/hunter gatherer diet (and therefore ditching the juicing,) my skin has returned to its former glory - but the low blood counts identified by the doctors when trying to explain the skin colour, remain. The low counts turned out to have nothing to do with the skin colour, yet were a concern to the doctors, who referred me to various haematology doctors.

Here is where we pick up the story. Every 6 months or so, I am obliged to visit the oncology department at my local hospital, yield half a dozen vials of blood, wait while these are analysed, then have an amiable, but ultimately unrewarding conversation with a well-meaning haematologist.

Blood Counts we can't Explain

The condition with which I have been diagnosed is aplastic anemia. You can be diagnosed with this on the basis of your blood counts alone, regardless of whether there are any further symptoms. When I looked into the possible causes I discovered a whole variety, to the extent that one gets the impression aplastic anemia is a euphemism for low blood counts we can't explain.

Since climbing aboard the specialist merry-go-round I have spoken to at least three different consultants, had countless blood tests and, in one memorable episode, been subjected to a bone marrow biopsy. This was necessary to establish whether my low blood counts stemmed from something more sinister in my bones (such as the big C), which as it turned out, it did not.

Laurel and Hardy

In case you are ever in a position where a bone marrow biopsy is necessary, be aware that the clinician-to-patient lexicon is never further from reality than when you have the experience described to you. You know how doctors often talk about a little scratch when they mean the sensation of a needle being pushed into your skin? In this case I was told that it might be a little uncomfortable - which I soon learned translates into you will endure 20 minutes of teeth-clenching pain while the Laurel and Hardy of the haematology world good-humouredly blunder their way through the process of trying to drive a frighteningly large needle into your hip bone.

I am quite sure that in the context of the pain endured daily by many, less fortunate people, this was a walk in the park - but I still chuckle now when I think about the well-intentioned fraud practised by my consultant on that occasion. The icing on the cake was when, on my next visit, I explained how extraordinarily unpleasant the whole ordeal had, in reality, been. Well, it is one of the most painful procedures we do, was her response. As I recall, I was practically stuck mute by the chutzpah of this descriptive u-turn, and therefore unable to make my feelings known.

Protein Power

I am just coming to the end of The Protein Power Life Plan by Drs Michael and Mary Eades. It's a great book, and I will review it in due course. In the chapter The Leak Gut: Diet and the Autoimmune Response, the doctors discuss the theory that proteins called lectins found in grains are able to force their way through the protective barrier of the gut wall, whereupon they are attacked by the cells of our immune system, which see them as foreign. The likeness these lectins bear to other cells in our body lead our immune system, which of course is a fast learner, to turn on itself, causing, over the long term, autoimmune diseases like arthritis.

Bread-Guzzling Population

When I read this I had something of an epiphany. Even though I have only been on a hunter gatherer diet for a little over 12 months, I have not been eating bread in significant amounts for several years. Never really like it. More of a porridge/oatmeal guy.

If the normal ranges against which my blood counts are being evaluated are based on the bread-guzzling general population, then my counts might appear relatively low because in the general population, immune systems are more active.

On my most recent visit to the hospital, I raised the question of diet with my current specialist. Experience has taught me that the direct approach does not tend to work - unless the specialist already has an inkling about a theory, coming right out with it will elicit an expression of benevolent disinterest. So I told him about my diet, being careful to make clear my avoidance of bread, pasta, rice and beans. Ironically, it was the absence of dairy in which he showed any kind of interest and there was certainly no hint that he might be aware of the lectin connection.

So I thought: what if guzzled wheat-based food for 2 weeks prior to my next blood test. Since my counts have been consistently at the same level for a few years, might this be a perfect opportunity to prove or disprove my theory?

Asking Dr Eades

Lacking confidence in my own knowledge and knowing that my theory was probably grossly simplistic, I put it to Dr Michael Eades via a comment on his blog. He kindly responded:

I really don’t know. You may be one of those people who are walking proof of the idea of biologic variability. Most people have blood counts within a certain range (considered normal). You may be one who has low-counts that, while abnormal for others, may be fine for you. Especially since the bone marrow (Ouch! indeed) and the other battery of tests was negative. And you may well be correct about the grains. Since ‘normal’ people consume a ton of grains, and since the ‘normal’ ranges were set by looking at zillions of blood counts from ‘normal’ people, it may be that those on no-grain diets have different counts.

I don’t want to recommend that you load up on bread before your next test because it’s against my religion, but I would be really interested in learning the results of your tests if you do. I’m not sure because I don’t eat much bread and we don’t keep it around the house so I don’t have a loaf to look at, but I think most bread is fortified with folic acid, which could affect blood counts. You could always bake your own to avoid this variable.

So there you have it - my potential wheat experiment. The question is, do I care enough about proving my theory to subject my body to two weeks of gut-bloating wheat guzzling? I had an opportunity to do it last month, but did not dare. I know this may sound strange to someone who has not experienced eating the hunter gatherer diet. Perhaps I will do it early next year.

Doctors and Nutrition

So, once again, I am staggered by the conspicuous absence of knowledge about nutrition in the medical profession. You would expect, given there are strong links between aplastic anemia and autoimmune disease, that a haematology specialist would be aware of the dietary lectins theory - which is, incidentally, widely documented beyond the Eades book.

I know I am on shaky ground here - I have little or no medical knowledge of my own and yes, the specialist might have read Eades' book from cover to cover and dismissed the theory out of hand. Thus, by not mentioning it, maybe he was merely giving me the benefit of his own, expert assessment. But I doubt it. Given that he spent 25 minutes talking about various - by his own admission - tenuous reasons why not eating dairy could be the cause, it would have been odd not to mention other theories.

There's only one way to find out: watch this space next year for an update on the wheat experiment...

See Also:
Doctors and Nutrition Part 1: My Yellow Skin Mystery
My Wheat Experiment Blood Test Update
Doctors and their Good Intentions: the Blood Test Fiasco Continues
[Blood Test Update in Post on Weight Loss]... Read more

New Evidence: High-Carb, Grain-Based Diets could be Secret to Longevity

Guest Post by A. Hack

A study published this week in the Journal of Nutritive Science suggests that high-carb diets rich in grains may be the secret to a long life.

Professors Heimlich Manoeuvre and Claus Van Munchausen from the Institute of Nutritionally Nutritious Nutrition followed around 300 cases over 12 months to test their hypothesis that greater consumption of grain-based carbohydrates leads to increased longevity. The study found a strong relationship between age at death and the consumption of grain-based carbohydrates.

To avoid confounding factors that might contradict their hypothesis, the professors excluded people who ate a low carbohydrate diet (fewer than 80% as a proportion of calories.)

"This study is all about understanding the effects of carbohydrate on age" said Professor Munchausen,"so by choosing a sample that includes only people who eat plenty of carbohydrate we ensure a meaningful set of results."

In addition, the professors sampled only people who were eating fewer than 500 calories per day and engaged in vigorous exercise for 2 hours or more per day.

"With so many people exercising and dieting these days it was important to study the effects of carbohydrate in a context that reflects society's current trends," said Professor Munchausen.

One controversial aspect to the study is the high number of deaths in the sample, primarily from malnutrition, dehydration and exhaustion. Critics have accused the authors of 'ambulance-chasing' and 'prowling eating disorder web sites like vultures' - but the professors remain defiant.

"These people fail to understand the difficulty in designing a study of this nature," said Professor Munchausen, "and in any case the subjects were quite willing participants once we had offered them money."

Further criticism has come from those claiming conflicts of interest lie at the heart of this study. Asked about his membership of the American Grain Association and European Grain Farmers Committee, Professor Manoeuvre was dismissive.

"I am perfectly capable of separating my commercial and academic roles," he said, from his 15-bedroom, 10 million-dollar, sea-front property. "These accusations are motivated by jealousy and a desire to see others fail."

Meanwhile, Professor Van Munchausen, whose wife chairs the Bread Users and Manufacturers Society, insisted there was no way his research could have been influenced by external factors. "I do not get involved with BUMS," he was keen to stress. "I leave that up to my wife."

In spite of question marks over the methodology, many are proclaiming the death of low-carb diets and sales of bread have increased by 10% overnight.... Read more

Doctors and Nutrition Part 1: My Yellow Skin Mystery

A few years back, Mrs M's mother decided that I looked yellow. At the time I was eating what I considered to be the ultimate in healthy diets and was as fit as I'd ever been, so you can imagine the scepticism with which I greeted this suggestion. I mentioned it to a few friends but was surprised to receive responses along the lines of Yeah, I suppose you do.

Made quite indignant by this apparent conspiracy, I wanted to know why no one had mentioned it before. I examined photos and disputed opinion, but eventually could see that the only way to put this one to bed would be to get medical opinion. I would go to the doctor, who would proclaim me to be entirely well.

At the doctor's I answered all the questions I had expected, was prodded in the traditional places and yielded fluids of various kinds. Since I knew I had no other symptoms, it was no surprise that this initial examination yielded nothing.

Low Fat Diet

Keen to impress with my diet and lifestyle but acknowledging I may not have it entirely right, I did some quizzing of my own. Could eating a very low fat diet cause it? What about my punishing running and weights regime? I described my diet in detail - the steamed white fish, the six pieces of fruit per day, the daily litre of freshly juiced fruit and vegetables, the eggs, muesli and the oatmeal.

This was when it started to dawn on me that doctors (I saw a number during this period) might not exactly be experts in the field of nutrition. When I explored with them the more nuanced aspects of my diet, a faint glaze would develop in their eyes, their polished bedside manner unable totally to conceal the lack of interest; and when I solicited opinion, there were so many hedges and caveats that I frequently departed with more questions than answers.

Tests

Yet one useful thing doctors can do is run tests - which is exactly what they did; and the good news was that they were now able rule out all kinds of obvious problems. No, it was not jaundice. My liver was fine. My vitamin profile was excellent. I had slightly elevated levels of creatinine, which might have been due to the exercise, but a subsequent retest proved this not to be a problem. Kidney function was also normal.

However, there was something that was not right. My blood counts. The red and whites were at the very low end of normal. So I wanted to know - could this make me yellow? No, not really, was the answer.

This is where the whole business changed. I was referred to a haematology specialist, who asked me many more probing questions and prodded in new places. She was no more interested in my diet, of course, and frankly even less interested in the yellowness. She was, however, very interested in my blood counts, and a regular schedule of tests quickly took shape. Soon, the yellowness had become a historical footnote and the blood test roller coaster was under way. With the blood I parted with over the following two years you could have fed an army of vampires.

Mystery Solved

For now I want to wind the clock forward. Two years later, roughly six months ago, there was an equally abrupt pronouncement about my skin colour, this time from Mrs M herself. You aren't yellow anymore, she had decided. Once again I canvassed wider opinion and this was confirmed. It was official - I was no longer yellow. Yet my blood counts remained the same.

By now my Googling skills and nutritional knowledge were more advanced, so I set about looking into it. Before long I had identified a harmless condition called carotenoderma, the primary symptom of which is yellow skin and the cause of which can be "...excessive dietary intake of carotenoids..."

Wikipedia lists many fruits and vegetables with which the condition has been associated and it looks startlingly like the diet I was eating at the peak of my yellowness. The 8 apples, 5 large carrots, 100g of spinach and whole cucumber that went into my juicer each day might alone be responsible, but on top of that were the fruit and vegetables I was eating in whole form.

Nutritional Wisdom

For me that was all the evidence I needed - because it had been almost exactly 6 months ago I had decided to ditch the juicing altogether on the basis that it was not in keeping with my Paleo lifestyle (I'm fairly sure hunter gatherers did not have access to Champion juicers.) So I had figured out in 10 minutes on the Internet what the collective nutritional wisdom of 3 doctors and a specialist had failed to diagnose in 2 years of consultations.

The low blood counts question does remain a mystery of its own and we will explore the possible dietary explanations for that in part 2.

See Also:
Doctors and Nutrition Part 2: My Wheat Experiment
My Wheat Experiment Blood Test Update
Doctors and their Good Intentions: the Blood Test Fiasco Continues
[Blood Test Update in Post on Weight Loss]... Read more

Five Great Quotes about Doctors and Medicine

Quotes:
Health and Nutrition
Longevity
Doctors and Medicine

"The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease"
~Thomas Edison






"The longer I live the less confidence I have in drugs and the greater is my confidence in the regulation and administration of diet and regimen."
~John Redman Coxe, 1800






"It's bizarre that the produce manager is more important to my children's health than the pediatrician. "
~Meryl Streep







"Sometimes I get the feeling the aspirin companies are sponsoring my headaches. "
~V.L. Allineare


"Half the modern drugs could well be thrown out the window, except that the birds might eat them."
~Martin H. Fischer

Quotes:
Health and Nutrition
Longevity
Doctors and Medicine
... Read more

The Professor Diet Part Three: No Shortcuts any Time Soon!

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!

In my post, The Professor Diet Part 2: Healthy Junk Food I asked whether in the future we would be able to eat one food and have it taste like another. For example, we might eat what looks like a slice of chocolate cake from the Nintendo range of foods but is actually a healthy meal. By wearing the Wii ‘sense’ headset at the same time, we would fool our brains into thinking the healthy meal tasted like chocolate cake.

Something I failed to consider in that discussion was that when we eat food, the body does more than tell us how it tastes. Ironically, this point is clear from the article on obesity and artificial sweeteners I cited in my original The Professor Diet: Eat as Much Junk as you Like post. The article suggests that the taste of sweetness causes ‘digestive reflexes [to] gear up for that intake.’

So although I do still think this is an area that will be explored by science soon, it will not necessarily herald the new age in which the meddling of scientists with our food and taste does not have unintended consequences. Perhaps eventually they will become such skilled manipulators of the brain and food that we will be able to enjoy virtual junk food without any adverse affects on our bodies – but I cannot see that being anytime soon. For that to happen they would need to understand nutrition first, and as Natural Messiah points out here, there is some way to go on that score.

Thanks to Jimmy Moore from Livin’ La Vida Low-Carb for reminding me that what we taste affects our bodies too!

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!... Read more

The Professor Diet Part Two: Healthy Junk Food

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!

Imagine this: you eat a piece of chocolate cake. It looks like chocolate cake, tastes like chocolate cake and has the texture of chocolate cake. Yet when you have finished eating it, you are not left with that wired, sugar-loaded feeling, and more to the point, do not experience the sugar low 30 minutes later.

The reason these expected feelings did not transpire is that it was not chocolate cake – at least not as we currently understand it. For reasons I will come onto, what you have just eaten was nutritionally equivalent to a steak of grass-fed beef, servings of carrot, broccoli and zucchini, and a handful of wild-growing berries and nuts.

What led me to consider this scenario was this article about research being conducted into the mechanisms governing our sense of taste. Whilst I have no specific knowledge in the area, it seems likely that there are billions of research dollars being pumped into this sort of thing, given the potential for commercial applications.

In The Professor Diet Part 1, I decry the fact that we are taught by the news flowing out of research labs to look to science for answers to problems that a healthy diet would solve. Yet when I follow this research to its logical conclusion – the scenario I describe above – I find myself wondering whether things are as clear-cut.

What I mean is this: if at some point, scientists are genuinely able to create the cake described above, and if it genuinely has precisely the same impact on our bodies as the steak, vegetables, berries and nuts, would any of us still want to eat healthy food? Would the doctrine of self-discipline that is so important to me and many others lose all its meaning? If we could choose what we thought we were eating but ensure that what our bodies were getting was, let’s say, a hunter gatherer diet, then getting the right nutrition would be too easy.

“Can I get a slice of chocolate cake?”

“Sure - Paleo, Zone, Atkins or regular, sir?”

How might the scientists achieve this? What follows is educated speculation. I stress again that I have no specific knowledge in the area – if any of you have such expertise, please comment. Also, for the purposes simplifying the discussion I talk about food as if it were made up of a homogenous mass of the same molecule.

One possibility, and the one we are most familiar with today, is trying to find molecules that taste like one thing but are in fact another – just as we have done with artificial sweeteners. Yet the problems with this approach became evident soon after well-intentioned but deeply misguided regulatory bodies allowed them to be included in our foods.

Until now we have been less interested in what a molecule does once it has passed the taste test. Imposter molecules like Aspartame have successfully made things taste sweet, but then had other, undesirable effects. Finding a molecule that tastes like one thing but digests like another strikes me as an approach doomed to failure. After all, our bodies are used to dealing with molecules that occur naturally in food – so unless the molecule that is digesting really is the naturally occurring one, we are back in the Aspartame situation where there are potential side effects.

Yet maybe there is a way in which the molecule of real food could be cloaked by another molecule, only to be released by the digestion process. The cloaking molecule has one taste, but when digestion begins it releases the molecule of genuine food. Of course for this to work, the cloaking molecule would have to be a harmless by-product. Not only that, but by changing the digestion process it’s highly likely that however harmless the by-product of de-cloaking, something will be different. You can’t fool millions of years of evolution that easily.

If there is a way this can be achieved, I think it is by going straight to the brain. We are already close to commercially available game controllers that use brain signals (Brain control headset for gamers); and Sony clearly thinks there might be a future in sending signals the other way so that our senses can be controlled externally (Sony patent takes first step towards real-life Matrix.) This is another area into which billions of research dollars must be being poured. Might the two areas of well-funded research meet?

If we can fool the brain into thinking the food has the right taste and texture then all we have to do now is make it look like the food we like – much easier. In 10 years, when the Wii comes with a standard headset for controlling games with your mind and receiving feedback from the game, could there be a ‘Wii Taste’ game which has an accompanying range of Nintendo foods?

So back to my original question – if this happens in our lifetime, what does it mean for us? Should we be glad that we can now eat junk but still have a healthy diet? Personally I get a lot of pleasure out of exercising the kind of self-control that is necessary to eat a completely healthy diet – would there be a hole in my life? Perhaps I would find other outlets for this need.

And what about our palettes? These would still face ruination with the constant barrage of junk taste, regardless of the nutritional value behind it. Yet would this matter if we are free to eat junk all the time anyway? We might no longer need a sensitive palette.

I would be interested in your thoughts on this.

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!... Read more

The Professor Diet - Eat as much Junk as you like

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!

Whenever I hear about some new drug or technique to tackle obesity or protect us from diet-related disease I always think of the professor from Futurama. For non-Futurama fans: the professor typically begins “Good news everybody!” before announcing some incredibly sophisticated, yet crazily inappropriate invention which has either fundamentally missed some basic point or is ludicrously over-engineered.

In a recent post, You’re on that Funny Diet, Right?, I mentioned society’s apparent belief that we are entitled to derive pleasure from everything we do and how because of this, many people don’t get the idea of permanently giving up foods they like.

Meanwhile, scientists work hard to find professor-like solutions to what they see as the problem. “Good news everybody! Using my digesta-block-a-tron I can stop fat from being metabolised. I just install this dial in your chest and you can choose how much fat from a meal gets digested!”

The basic point apparently being missed – the elephant in the room, if you like – is that if we all stopped eating junk, we would start enjoying the basic food we currently think we are not able to enjoy and the medical problems we are spending billions trying to resolve would begin to diminish in the population.Don’t get me wrong, I accept the near-impossibility of this - I still daydream about cakes thanks to my latent sugar addiction. We have been led by the nose into a mire of confused cravings and unclear directives from organisations with misguided and dubious agendas.

Yet it's by no means clear the scientists' intentions are quite so innocent. A cynic would say that their ‘solutions’ are not driven by the desire to uphold our right to enjoy our food, but by the desire for money - for them, their employers, or both. A cynic would say they are not missing the point at all – they simply don’t care.

The rest of us are missing the point precisely because of the scientists and what they tell us:

Well hey, the scientists have found the problem - we just to turn off those genes! (The obesity gene) ...or maybe we all just need to take some drugs to prevent us getting heart disease! (Statins for kids!) ...and it's not that we shouldn't eat so much sweet food - we were just sweetening it the wrong way! (except that oops, this may not work after all: Artificial sweeteners and obesity) ...and it's not that we should eat less starchy food - we just have to remember to block its digestion! (Blocking starch digestion)

The list is potentially long, so I will stop here. Feel free to add your own.

As the diagram shows, this is a vicious cycle. How to we get out of it? This is a question for a future post.

The Series:
The Professor Diet - Eat as much Junk as you like
The Professor Diet Part Two: Healthy Junk Food
The Professor Diet Part Three: No Shortcuts any Time Soon!
... Read more

Are we Underrating the Anecdotal?

There is an ancient British superstition which says if a child rides on a bear's back it will be protected from whooping-cough. Perhaps it’s just as well we destroyed the bears and their habitat centuries ago or we’d have a serious health and safety issue on our hands.

Such absurd beliefs can arise because of how we are programmed. There is a survival advantage to making associations between things that turn out to be true (such as poisonous berries and death) but no particular disadvantage to making associations that turn out to be false. This is how superstition develops. If I rub olive oil into a wound and it doesn’t get infected, why not do it every time I get a wound – just in case that’s what provided the protection. If you are interested in a full explanation, see this article in Scientific American.

Evolution has taught us to hedge our bets. So when someone tells their doctor about something they are convinced is curing their condition, the doctor is right to be cautious.

On the other hand, you sometimes read about a study finding evidence to support a piece of received wisdom and can almost hear the cries of “Well I could have told them that!” being uttered in kitchens up and down the country. I guess if you have an infinite number of monkeys randomly making superstitious connections, eventually they will come up with some genuine cures.

As someone with a science degree, I do have a reasonable grasp of the meaning and importance of controlled experimentation and empirical measurement – but as someone with a keen interest in nutrition who has experimented extensively with my own diet I am aware that anecdotal evidence often contradicts the advice given by the establishment; when that happens, it’s hard not to question whether sufficient value is attached to the potential value of that evidence.

Some years back a friend of mine was diagnosed with ulcerative colitis. It came as no surprise, since it ran in his family. Purely by chance, he was introduced to a ‘juicing’ diet by someone. This involved living, more or less, on the juice of various fruits and vegetables.

My friend decided to do some research. Naturally, he did not rent a medical facility and conduct controlled clinical trials with a recruited sample of colitis sufferers. Instead he read the testimonies of fellow sufferers who had tried juicing.

There are concerns around adopting radical diets like this which a doctor would quite rightly raise. Nevertheless, my friend went ahead with it for several months, over the course of which his symptoms started to disappear. I know, I know – what else was he doing during this period? It’s likely that his whole outlook on life had changed. Maybe as well as adopting the diet he had stopped sleeping for 3 hours a night and pouring half a litre of scotch on his cornflakes.

Nevertheless, whilst the symptoms were gradually disappearing for whatever reason, his specialist was suggesting fairly powerful drugs that would help slow down, but not cure the illness and telling my friend to prepare for the possibility of a life with a colostomy bag; he was not very interested in my friend’s supposed miracle cure.

Disillusioned by the advice he was getting from his specialist, but excited by his apparent reprieve from a life with a colostomy bag, my friend spoke to someone he knew in the medical profession, who laughed and said “Don’t expect them to be interested in anything that’s not in the textbooks.”

I understand why medical professionals would feel like this. If they took the time to fully explore every patient-reported treatment, they would barely have time to see a fraction of the patients they are expected to handle. Moreover, both practically and ethically, doctors can only recommend treatment for which there is clinical evidence and can only sanction lifestyle choices the establishment generally accepts to be safe. My friend’s specialist would have been irresponsible to say “Wow, sounds like that worked for a bunch of people and it sort of makes sense – so I would stick with the juicing instead of taking these clinically proven drugs.”

Don’t get me wrong, clinical researchers have looked into (and no doubt continue to look into) the connection between diet and ulcerative colitis and it would be a mistake for me to try to establish just how much was known when my friend was advised; but for me this story is important because it illustrates how a collection of anecdotes can be a powerful indicator that clinical research is required.

It’s possible my friend’s story was one of many that percolated into the medical research community and contributed to the anecdotal ‘noise’ driving clinical research on the condition – but given the reaction of his specialist, I doubt it; and this is what concerns me. The percolation process feels inherently inefficient. Do all the anecdotes get through? Many anecdotes may not even get as far as a specialist if patients have the impression there is no interest.

When my friend was researching his condition, the internet was embryonic and certainly lacked the kind of community-based interaction that now abounds. 15 years later there are millions of voices talking about the things that matter to them most – and health comes pretty high up the list. The internet is a huge database of case studies – the question is whether we are taking full advantage of it. The market research industry (obvious candidates to leverage this medium) is only just beginning to tap into the potential of social media as a research tool. It seems a safe bet that the medical profession is no further forward. The difference is, the stakes are so much higher for the latter. If market researchers don’t have a big push on harnessing social media, Acme sells fewer widgets. If the medical profession don’t, progress in researching important health issues is slower, so more people suffer.

But as well as being under-used in aggregate, are individual anecdotes sometimes given less importance than they deserve?

There was recent controversy over Dr John Biffa’s criticism of a diabetes organisation. He implied they are wilfully giving bad dietary advice to diabetics and subsequently received a grilling here and elsewhere. It was a pity that Biffa so poorly dealt with an issue that has been widely debated on the web – are low carbohydrate diets a better way to treat diabetes than the low fat diet recommended by most diabetes organisations?

If you trawl the web for testimonies on the subject, it is possible to find many from people who say they have self-treated type 2 diabetes with a low carbohydrate diet - and people appear to have been talking about it for a long time. Indeed I was unable to find any testimonies from people for whom such a diet had failed. I came away with the impression that this is the best diet for diabetics.

Of course this means nothing – it’s circumstantial, anecdotal and subject to recall bias and the placebo effect (not to mention my own ability with Google.) Plus, there are also testimonies from diabetics whose lives have been improved by the recommended low fat diet. Nevertheless, it seems that one organisation is indeed changing their advice and it would be fair to say that there is now a fair bit of research taking place in the area.

My question is this: can’t a single anecdote be considered powerful in its own right if it contradicts advice positioned as being for everyone in a certain group? For example, if an organisation is recommending a diet for people with a certain condition, yet one person is shown to improve significantly on another diet, doesn’t that prove the advice is flawed? Surely the advice should either be re-positioned or withdrawn, pending further research? If we believe it does then Biffa’s insinuations of chicanery sullied a valid criticism about the quality of advice to diabetics by this organisation.

To return to the question about anecdotes driving research, I would like to offer a final thought. Trials to evaluate the effects of diet are often expensive and difficult to run, and for potential funders like pharmaceutical firms there is rarely a pot of gold at the end of the rainbow; but this is all the more reason why we should make sure the research that is done is the right research. Instead of ignoring people who publish internet testimonials about themselves and others on the basis that it’s ‘purely anecdotal’, why not find a way to proactively engage with them? This would create a double benefit.

First, there would be the potential for more case studies to drive research in the right direction. The internet is teeming with people documenting their own experiences and supposed cures. Just because they are talking about it on the web instead of in a consulting room, does it make their story any less valid as a case study?

Second, by engaging with people who are potentially disillusioned with the medical establishment, a better understanding between all concerned could be fostered – it is a PR opportunity not to be missed. After all, in this case it may turn out they had a point.... Read more

Why (Refined) Sugar is Bad: Some References

In my post We're all Junkies I ask the reader to go to Google and find the evidence for why sugar is bad.

I did some digging myself this morning, and found a couple of sites which appear to be reliable sources.

On Sugar Addiction: Society for Neuroscience [link removed] - this seems to be an organisation with a good reputation. Update, 3rd Oct 2010: this link was removed because it no longer works - however, this article summarises the content of the paper that was published in 2003.

On the damage sugar does: Mercola.com - whilst Dr Mercola is selling products, the references he gives in this article are from respected medical journals. Note that one or two of the articles he cites refer to the consumption of high concentrations of simple sugars, not specifically refined sugar.

See Also:
We’re all Junkies
Cigarettes, Sugar and our Innate Short-Termism
The Worst Sugar Pushers of all - Health Food Stores
... Read more