Archive for May 2013

Bigfoot, Loch Ness monster, and Carbohydrate Deficiency

It is interesting to think about food in its three basic constituents: Fat, Protein, and Carbohydrates.

For each of these three constituents one can imagine a situation where there is excess or deficiency. In fact, over the centuries of recorded medical literature these states have been identified.  Well, five of the possible six states have been identified.

Fat:

Intake of excessive amounts of fat can lead to malabsorption.  Your intestines can’t absorb the fat quick enough.  This produces bloating and loose, frequent oily stools.

Deficiency of fat intake typically results when you have deficiency of particular essential fats. The omega 3 fats, long touted for their health benefits and found commonly in deep water fish, are types of fat that humans cannot manufacture. That is, if we don’t eat omega 3 fats we will not have them in our body to use.  A lack of omega 3 leads to increased inflammation, reduced arterial flexibility, and overall worse outcomes in cardiovascular disease.  In one recent study, over 90% of patients who were evaluated at an emergency room for cardiovascular disease had a very low omega 3 blood level.  Omega 6 is another type of essential fatty acid but is found in more types of food products such as plant oils.

Proteins:

Excessive protein intake has been known to cause many gastrointestinal symptoms as well as a general feeling of malaise.  The Inuit people have a native diet that is very high in fat.  When the young hunters try and take the easy way out and eat rabbits, the older, more wise hunters know this is not a good idea.  The young hunters develop a weakness and malaise given that rabbits are high in protein and very low in fat.  In fact, this has been called “Rabbit Malaise”.

Deficiency of general protein intake causes a condition called Kwashiorkor. This is the most common malnutrition syndrome seen as it is the prevalent disease of children starving in impoverished countries.  Additionally, of the twenty amino acids that make up all proteins twelve of them can be manufactured from other molecules by humans if they are needed.  Eight of the amino acids are unable to be manufactured.  That is, they must be eaten if we are to have them available in the body.  It is interesting to me that all animals have all eight of these essential amino acids available in their meat.  Whereas, there is only one plant on the entire planet that has all eight amino acids contained within it.  It is possible to eat a variety of plants and get all the essential amino acids however.

Carbohydrates:

Excessive carbohydrate intake can lead to sudden issues such as bloating and diarrhea.  Chronic excessive intake of carbohydrates can lead to hyperglycemia, impaired fasting glucose, insulin resistance, fatty liver disease, and ultimately diabetes.  We see this all the time in day-to-day life.

There has never been a disease discovered for failing to eat enough carbohydrates.  In fact, our body has a plan through our liver to manufacture all the glucose required every day.  So there is no such thing as a carbohydrate malnutrition.  It is impossible to eat so few carbohydrates as to cause disease for the ordinary person.

Why then do we base our food and nutrition guidelines on products made out of something that isn’t necessary in life?  Why is the bottom level of the food pyramid breads and pasta?

We teach patients to limit their carbohydrate intake to a level appropriate for their physiology.  By doing so, we have seen monumental reversal of disease, weight loss, reduction in medication use, and overall improved health and well-being.

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That Nagging Cough


​ It is doubtful that a day goes by in my office where no one coughs. It’s one of the most common symptoms we deal with day in and day out. Coughing is a protective reflex that helps to clear the lungs and upper airways. It is a symptom, and not a final diagnosis. There are dry coughs, wet coughs, deep coughs, light coughs, wheezing coughs, racking coughs, chronic coughs, and once in a while, whooping coughs, just to name some of the varieties. For many, it’s just a few days of a nuisance tickle. But for others, the cough just doesn’t seem to go away. Weeks or months go by, and still there is that nagging cough.
By definition, a chronic cough is typically defined as one that lasts for 8 weeks or more. What causes these persistent lingering coughs? In one study, almost half were found to have asthma and/or allergies as the cause. Often asthmatics, instead of, or in addition to, wheezing or getting short of breath, have a repetitive spasmy cough. For these folks, treating their asthma and allergies with appropriate inhalers, antihistamines, Singulair, or similar meds can bring their nagging cough under control. Likewise, allergy testing and immunotherapy can be highly effective in these situations.
Another 10% or more of persistent coughers have chronic postnasal drip (PND). This can be from chronic sinusitis or allergy as well. These folks tend to be constantly clearing their throats and “hawking up” mucous, especially first thing in the morning. Clearing these chronically inflamed or infected sinuses can be very challenging and often takes a great deal of persistence.
Chronic obstructive pulmonary disease (COPD) produces another 10% of the chronic coughers. This includes chronic bronchitis and emphysema and is most often brought about by smoking. One in twelve Americans has this disease and half don’t realize it. It can’t be cured, but can be managed. Still, the biggest help is putting down the cigarettes before the disease becomes advanced.
A trigger for yet another 10% of cough is gastroesophageal reflux disease (GERD). Here the acid from the stomach comes up the throat prompting a cough reflex. Treatment of the GERD with acid blockers and other measures will often yield substantial improvement in the cough.
Then there are medication side effects. The most common culprits are the ACE inhibitors, such as Lisinopril, a class of commonly-used blood pressure medications. They work well, but about 10% of folks on these meds develop a chronic cough or tickle in their throat that only goes away when the med is stopped.
Less common, but very important is whooping cough or pertussis. This has been called the 100 day cough, and this is no exaggeration. In infants and toddlers it can sometimes be fatal, and fully half of all infants who contract it are hospitalized. Unfortunately, by the time it has passed the “cold” stage of symptoms and shown itself for what it really is, antibiotics don’t change the course much (though they are vital to render the person non-infectious). Pertussis has been on the increase over the last couple of decades, partly due to laxity in immunization.
After certain more potent coughing illnesses there can be persistent airway inflammation that keeps the cough going after the other symptoms have passed. Air pollution or other irritant-exposure can also keep a chronic cough hanging on.
Besides these more common causes, there are rarer reasons for cough such as fungal infections, aspirated foreign bodies, cancers, cardiac asthma, habitual nervous coughs and so on.
So just saying we have a chronic cough is not enough. The real detective work comes in sifting out which of these many suspects is the actual culprit. Of course, sometimes two or more suspects are working together to allow an irritating cough to linger. At any rate, if you’ve got one of those long-running nagging coughs, get it checked out. You and everyone around you can benefit if the actual cause can be found and eliminated, or at least suppressed.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835

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