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Keto Krazy?

Trinity physicians emphasize nutrition as one of the key pillars of good health. We’ve used low carb and ketogenic (or keto as it is known) plans to reverse chronic disease, promote extraordinary weight loss, and often reduce the need for daily dependence on insulin injections and high blood pressure medications.

If you’re ready to build a better foundation for good health then call the office to set up your appointment with our Medical Nutrition Management team of nurse practitioners and our registered dietician Carly Slagle, RD.


Medicine is Moving

           This has been a crazy, but mostly enjoyable week.  We moved our medical office about a half mile closer to the mountains on Rt. 321.  It’s exciting to see a band of workers busily laboring to turn a beautiful but empty shell of a building into a humming place ready to provide medical care.  When everything is first pulled out of a few dozen cabinets, drawers and cupboards, brought to the new place and strewn around, it looks like a bomb went off.  It seems impossible that that much stuff was stowed away in the old medical office.  It’s a bit overwhelming.  But slowly, with everyone doing their part, some semblance of order and organization is restored. Monday morning, we were (mostly) ready to roll.

It makes me think of how medicine as a whole is constantly moving, and the pace just seems to be constantly accelerating.  Some of the movement is exciting and helpful, while some of it is distracting, burdensome and counter-productive. The part that’s exciting is the explosion of medical knowledge: new treatments, better surgical approaches, more accurate understanding of the causes and prevention of disease.  Every time I start to get a migraine and reach for the medicine that stops it in its tracks and lets me keep working without the rather horrific pain I used to experience, I’m thankful for the advances of modern medicine, and that I didn’t live with migraines fifty or a hundred years ago.

At the same time, not every new discovery is better than what came before it.  New treatments sometimes come with new complications and almost always come at significant cost.  And realistically, trying to keep up with the steady doubling of medical knowledge is no easy task for any physician.  Happily, there are lots of online resources that can get you the information you need in a heartbeat.  Gone are the days of my bookshelves of medical texts that are already becoming outdated when they come to print, or the files of articles on recent studies that I used to keep.  Now a few clicks can get me where I need to go to find the latest studies and information on a given disease or treatment.

But as I make what I expect will be my final physical office move, I must confess to some major concerns about where medicine is moving.  Although much of this movement would apply to all branches of medicine, I’m mostly referring to primary care medicine – the front line, “blue collar” medicine done by family physicians, pediatricians, and general internists.  These are the first line of medical contact, often aided by physician assistants and nurse practitioners, who sort through someone’s symptoms and seek to arrive at a diagnosis and treatment plan.  It is estimated that 80% of the time a primary care doctor will completely handle whatever problem comes to them, and the other 20% or so, they will access an appropriate specialist.

So, what are the major threats to good, satisfying primary medical care?  Many answers could be given, but I see four major threats that end up producing the depersonalization of medical care.  By depersonalization in medical care, I mean that the idea of one human being trying to engage and help another achieve relief of symptoms and maximal health in the midst of a personal one-on-one human encounter, is being lost.  In its place is often a fast-paced, distracted, non-empathetic, and all-too-short visit.

While some efficiency is a good thing, medical care is best delivered when a personal human connection is made.  The iconic family doctor of Norman Rockwell paintings and stories of family physicians who personally knew their patients over decades seem quaint and unattainable in today’s medical and social climate.  That may be true, but if we recognize what is driving us toward an impersonal medical care we may be able to slow, or even reverse, the drift in that direction.  Next article I want to lay out the four factors that seem to be driving us toward an impersonal, unsatisfying medical care.  Maybe we can get medicine moving in a more positive direction, at least on a local level here in the Maryville area.

Andrew Smith, MD is board-certified in Family Medicine and practices at 2217 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835



cutlery-dining-dinner-109395.jpg            “Goldilocks was hungry.  She tasted the porridge from the first bowl. ‘This porridge is too hot!’ she exclaimed. So, she tasted the porridge from the second bowl. ‘This porridge is too cold,’ she said.  So, she tasted the last bowl of porridge. ‘Ahhh, this porridge is just right,’ she said happily and she ate it all up.”

The story of Goldilocks and the three bears fits the story of our relationship with the vital mineral, iron.  We don’t want to have too little, but we actually don’t want to have too much either; we want to have just the right amount.

Iron is an essential element for blood production. About 70 percent of our body’s iron is found in red blood cells as part of hemoglobin, which carries oxygen to the body, and in muscle cells, as myoglobin, which accepts, stores, transports and releases oxygen.  About 6 percent of body iron is part of certain proteins which are essential for respiration, energy metabolism, and nerve function. Iron also is needed for proper immune function.

Where do we get iron in our diet?  A wide variety of foods contain iron.  Red meat is a rich source of iron, and iron in animal products is absorbed better than iron from plant products.  Nevertheless, foods such as spinach, fortified breakfast cereals and even dark chocolate have substantial amounts of iron.  However, individuals vary a great deal in how well they absorb the food in their diet.

If iron consumption and absorption is chronically low, iron stores become depleted.  In the typical American diet, iron depletion from poor dietary intake alone is uncommon.  Most often, having low iron results from losing iron by blood loss.  In women who are still menstruating, blood loss from their monthly cycle is the most common cause of iron deficiency.  In non-menstruating women and in men, iron deficiency usually points to unrecognized persistent microscopic blood loss from the gastrointestinal (GI) tract.  Thus, a colonoscopy and upper endoscopy are usually carried out to search for a GI source of blood loss such as a colon polyp or cancer, or a bleeding ulcer.  There are numerous other causes of low iron, but the point is that, in addition to taking iron supplements, the reason for the iron deficiency must be thoroughly sought after.

What’s wrong with not having enough iron in our bodies? When iron is depleted over time, it begins to cause reduced red blood cell production and eventually results in a low red blood count, called iron deficiency anemia.  Other symptoms such as fatigue, shortness of breath with exertion, restless legs, paleness, headache, racing heart, and a desire to chew on ice (oddly enough) can accompany the low iron state.

So, should everyone take an iron supplement just to play it safe? No, indeed; in a healthy non-menstruating adult an iron supplement can cause iron overload, which has its own toxicity.  Likewise, children getting ahold of excessive amounts of iron-containing vitamins is a common cause of poisoning.

Besides taking too much iron in the form of supplements, there are also built-in genetic abnormalities which cause some adults to hold on to too much iron, even with a normal diet.  The best known of these hereditary conditions is called hemochromatosis.  It affects over 1 million Americans.  Iron overload from these causes can damage the liver, pancreas, joints and heart, and can even be fatal if left untreated.  Hemochromatosis is one of the few condiclose-up-idiomorphe-crystals-iron-56030tions that can benefit from an updated version of the old practice of blood-letting.

So, if you have symptoms that make you wonder if you have too little, or even too much, iron, get it checked out.  Iron is vital, but like Goldilocks, we want the amount to be just right.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


Spring Sneezing


We can treat spring allergies!

Springtime is in Bloom!
For many of us, those beautiful blooms mean suffering from seasonal allergies.  Are you taking multiple medications to gain relief?  Do you have side effects from allergy medications? Do you suffer several months of the year?   Have you tried allergy shots but were not able to come so often for your therapy?  Come on in to see if you’re a candidate for in-office testing and at HOME immunotherapy?