Archive for October 2013

Gallbladder Blues

Gallbladder Blues

“Toe in, toe in!  Come on, retract, I can’t see what I’m doing!”
These were the commonly heard urgings by gallbladder surgeons when I was a med student nearly thirty years ago.  Gallbladders were removed through large incisions followed by long recovery periods.  We students would scrub in and stand for a few hours in the OR pulling on wound retractors to keep open the incisions so the surgeons could have good visibility.  Boredom or fatigue occasionally caused us to slacken at our duty and the surgeon would quickly chide us. Happily for med students, surgeons, and especially for patients, most gallbladders are now removed laparoscopically through small incisions with much more rapid recovery and far less suffering.
Some things haven’t changed though – when there’s pain in the upper abdomen, especially if it’s the right upper abdomen, the gallbladder is still one of the suspects considered.  This isn’t surprising since in the U.S. about 20 million people have gallstones, and each year about 700,000 patients have their gallbladders removed to relieve troublesome symptoms.  The gallbladder follows the appendix as the other sack-like organ next most frequently removed due to disease or malfunction.
So what does the gallbladder do when it’s working correctly?  The gallbladder is a 3 to 4 inch long pouch-like organ tucked up into a pocket of the liver in the right upper abdomen.  Bile and other digestive enzymes are secreted and stored by it.  When we eat a meal, especially a large fatty one, this little sack contracts, squirting its digestive enzymes through a little duct or tube into the intestine where the enzymes help digest the meal.
So far, so good.  But things can go wrong.  The gallbladder can develop gallstones of varying sizes.  Then when the gallbladder contracts one of these stones can become wedged in the duct leading to the intestine.  Depending on where the obstruction occurs, this can sometimes also block off the pancreas causing still more problems.  Either way, there is tremendous crampy pain, usually in the right upper abdomen or upper mid abdomen and sometimes radiating through to the back.
The pain typically starts shortly after a meal and may last for a couple of hours or more, until the stone passes into the intestine or falls back into the gallbladder after it finally stops contracting.  Occasionally the pain persists and a trip to the emergency department, sometimes followed by emergency gallbladder removal (cholecystectomy) is the only solution.  An ultrasound of the gallbladder and lab work are usually able to diagnose this problem.
Gallstones are not the only problem that can arise in the gallbladder.  A situation can arise in which it excretes less and less effectively even though it has no stones.  In this condition, the gallbladder may look OK on ultrasound and a special scan is needed to identify the problem. Or, even more dangerous, the gallbladder can become infected with bacteria, often due to one of these other malfunctions already mentioned.   This requires urgent treatment with antibiotics and eventual surgery.  And like most organs in the body, cancer can occasionally occur in the gallbladder.
Anyone can have problems with their gallbladder, but certain groups are more at risk.  The most common group would be Caucasian females around their forties who are overweight.  Also, during weight loss there is a temporary increase in gallbladder attacks as the person processes their own fat.
For these reasons and more, the gallbladder may sometimes have to be removed.  Often this affords a huge amount of relief for the person.  However, besides infrequent complications of residual stones, infection or problems with wound healing, about 10-15% of people have ongoing symptoms after the gallbladder is removed.  This has been given the long name post cholecystectomy syndrome (PCS).  This is not surprising since God puts things in place for a reason; when we have to remove them, sometimes there are issues to deal with.  The loss of the gallbladder can cause symptoms such as heartburn, indigestion, loose stools or cramping.  These can be managed but are certainly a nuisance.
So if you’re getting symptoms that make you wonder about this little 3 inch sack, see your doc and get it checked out.  It’s helpful when it’s healthy; but if it’s betraying you, it just might have to go.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835

More

Pumpkin Cheesecake

pumpkincheesecake

Pumpkin Cheesecake
 
Prep time: 20 mins Cook time: 1 hour Total time: 1 hour 20 mins. A creamy pumpkin cheesecake made with healthy real-food ingredients and minimal sweetener! Serves: 6-8. Recipe credit: http://wellnessmama.com/3351/pumpkin-cheesecake/ (I slightly modified a few things from the original version)
Ingredients
  • Crust:
  • •About 1 cup of almonds, pecans or hazelnuts, finely powdered in blender or food processor (I used 1 cup almond flour-approx.8 net carbs)
  • •2 Tablespoons of coconut oil or butter
  • •1 egg
  • •cinnamon to taste
  • •honey or stevia to taste (I used 1 tsp. honey, 1 tsp. Stevia, 1 tsp. Splenda)
  • Filling:
  • •12 ounces pumpkin puree (about 1.5 cups of homemade or about 1 can store bought)- Libby brand is approx. 8 net carbs for the whole can
  • •2 Tablespoons of coconut oil
  • •2 (8 ounce) packages of cream cheese at room temperature- approx. 4 net carbs
  • •3 eggs
  • •1 tsp pumpkin pie spices (to taste) or 1 tsp cinnamon and a sprinkle each of nutmeg and cloves
  • •1 tsp vanilla (optional)
  • •stevia or honey to taste (I used ½ Tbsp. Stevia, ½ Tbsp. Splenda, 1 Tbsp. honey)
  • •[Note: The above recipe can be doubled to fit in a 9x13 baking dish]
  • Total net carbs is approx. 30 net carbs for standard size pie with ingredients listed above.
Instructions
  1. Preheat oven to 375 degrees.
  2. Finely powder the almonds or pecans in food processor or blender.
  3. Mix with cinnamon, stevia, egg and coconut oil and use hands to press into bottom of pie pan.
  4. Put in heating oven for 10-15 minutes until crust is slightly toasted.
  5. In the meantime, mix the pumpkin puree, cream cheese, spices, coconut oil, eggs, vanilla, and sweetener (if using) with a mixer or immersion blender (or just throw in a blender).- I just used a handmixer since that is all I had-
  6. When crust has started to toast, remove from oven and pour filling into pan.
  7. Return to oven and cook for 35-45 minutes or until top doesn’t wiggle in center and starts to slightly crack on sides.
  8. Remove and let cool.
  9. Chill at least 2 hours or overnight before serving.
  10. **Approx. 30 net carbs. for a standard size pie dish**
Nutrition Information
Serving size: 6-8

More

Low fat, plant based nutrition study causes a lowering in HDL

Here’s a link to an interesting 30 day dietary intervention study out of Australia where over 5000 people were self selected to participate in a standard program which advocates a low fat, plant based diet.

Here’s the study’s description of the nutrition intervention:

The CHIP intervention, previously described, encouraged and supported participants to move towards a low-fat, plant-based diet ad libitum, with emphasis on the whole-food consumption of grains, legumes, fruits and vegetables. Specifically, the program recommended less than 20% of calories be derived from fat. In addition, participants were encouraged to consume 2-2.5 litres of water daily and limit their daily intake of added sugar, sodium and cholesterol to 40 g, 2,000 mg, and 50 mg respectively. Furthermore, the program encouraged participants to engage in 30 minutes of daily moderate-intensity physical activity and practice stress management techniques.

All the biometrics measured were lowered including HDL. HDL dropped 8.7% on average and was worse if the individual started out at a higher level. Of note the LDL and Triglycerides dropped some too. They changed more than the HDL typically so the ratios of LDL:HDL and Total Chol:HDL improved.

Interestingly, 323 participants resolved their diagnosis of Metabolic Syndrome because of their changes but 257 participants acquired the diagnosis of Metabolic Syndrome typically because of their lower HDL numbers.

The study didn’t disclose percentages of fat, protein, and carbohydrates that the participants were eating nor do we know if they measured them. So it leaves the question of what exactly caused the changes. A diet with a lower fat intake, in my experience, is replaced with higher carbohydrate intake with a relatively stable level of protein. Think about yogurt. All the yogurt is low fat but plain yogurt is not very palatable so they add fruit and flavorings (ie, carbohydrates). However this is my speculation only.

From experience, I see HDLs routinely rise as patient’s carbohydrate intake drops. We know that a low HDL is one of the most risky signs of cardiovascular disease, too.

Remember that humans can’t eat a zero protein or zero fat diet and live healthy nor long. They can, and many do, eat zero carb diets and remain very healthy. That puts carbohydrates in a different category as proteins and fats.

mbm

More

Fever Without Fear – HealthyChildren.org

So it’s 2A.M. and your son wakes you up crying.  As you touch him you notice he is burning up.  What should you do and (more importantly) why should you do it?

Here’s a good article written by American Academy of Pediatrics on dealing with fever.  Hopefully it will help answer some of your questions on fever and when to worry.

Fever Without Fear – HealthyChildren.org.

More