All posts in Medical Diseases

When do I need my flu shot?

In a weekly email I receive from the state health department it shows the state and national trends for the spread of influenza.

I’ve included it below. You can see that Tennessee as a whole (and I’d include Knoxville in particular) starts to see influenza infections in early December.

I recommend patients receive their vaccinations by the end of October. This gives the body time to make enough antibodies for adequate protection.



The luxury of obesity

Ever thought about the fact that some people always assume that other people who are overweight are worse off than someone who isn’t? Have you ever thought that yourself?

I hear from patients all day long about how they feel okay about their health even when they have an awful diet and no exercise habit. Most of the time they feel this way because they aren’t overweight or at least aren’t as overweight as someone else in their life.

Society judges health based primarily on weight. It’s just not that simple.

I’ve come to believe that obesity is a luxury. It’s one extra (and very powerful) mechanism the body has to protect us from the outcomes of a less than perfect nutrition plan. Sometimes those choices are voluntary and sometimes they aren’t.

Think about it this way. A simple 7 inch banana has enough sugar (ie, glucose) stored within it in various carbohydrate forms to raise my fasting blood sugar from 85 mg/dL all they way up to 351 mg/dL. If my body didn’t protect me, then a simple banana would make me instantly diabetic.

Thankfully my body is better at protecting me than sometimes I am at choosing my food. All that sugar is moved from my blood stream into my cells. My brain uses some to do math and write a sentence. My heart and lungs use some to beat and breathe. My muscles use some to walk down the sidewalk or ride a bike. In the end, almost after all other cells have used as much of that sugar as they can, the body must still get rid of the rest of it. If it doesn’t, bad things like blindness, Alzheimer’s, and kidney failure can occur. So where does that sugar go?

That’s were adipose (the five dollar word for fat or storage cells) comes into play. Adipose takes up the extra sugar and stores it. As that happens these cells grow larger. So they really are a protective mechanism for keeping too much damaging sugar out of the blood stream. But not everyone has adipose cells that are good at taking up the extra sugar. Some people lack virtually any ability to grow their adipose cells in response to a bad diet. Nearly 20% of diabetics have a normal weight.

So why is obesity a luxury? When you need protection from less than ideal food choices it’s nice to have that extra place to store your bad decisions. The alternative is to let loose all those extra sugars into the blood stream and allow them to cause havoc on your system.

We tend to consider cars with more airbags and safety features as better vehicles. We should be thankful we get our own safety features for our bodies. Better yet though, let’s not live a life dependent on our safety features protecting us from the consequences of our choices. Let’s eat and exercise in such a way as to not stress, strain, and overwhelm our body’s plan to be healthy and strong.


Original Research: Low-carb versus Low-fat diets

Another bit of original research has recently been published in the Annals of Internal Medicine comparing a low carbohydrate diet and a low fat diet.  It evaluated the effects on weight loss and other cardiovascular markers in patients who are at risk for cardiovascular disease but had no known disease yet.

Nutritional studies are often very difficult to do because when you intervene in someone’s diet it is impossible to only change one thing.  A lower carbohydrate diet by necessity is going to be higher in either fat or protein (or both) than before.

Here’s a summary the editors published about the article.  I’ve italicized some key aspects to the study.

What is the problem and what is known about it so far?

Obesity is a common problem that increases the risk for cardiovascular disease. Diets may emphasize reducing one’s intake of fat or carbohydrate. It is unclear whether one approach is better than the other, and they have not been compared in studies that included a substantial number of black people.

Why did the researchers do this particular study?


To compare weight loss from low-carbohydrate and low-fat diets.

How was the study done?


The researchers enrolled obese people who did not report a history of cardiovascular disease and randomly assigned them to a low-fat or low-carbohydrate diet. During the 1-year study, participants also attended individual and group dietary counseling sessions. Data on participants’ weight, waist size, blood test results, and physical activity were collected at regular intervals during the study. About half of the participants were black.

What did the researchers find?


At 3, 6, and 12 months, participants on the low-carbohydrate diet had lost more weight than those on the low-fat diet. At 12 months, those in the low-carbohydrate group had lost an average of 7.7 pounds more than those in the low-fat group. Although participants in the low-fat group had a greater reduction in their waist size at 3 and 6 months, there was no difference at 12 months. Overall, blood levels of certain fats that are predictors of risk for cardiovascular disease also decreased more in the low-carbohydrate group. Physical activity was similar in the groups throughout the study, suggesting that the greater weight loss among participants in the low-carbohydrate group was not because they exercised more. When the researchers evaluated the black and white participants separately, the results were similar.

What were the limitations of the study?


The study lasted 12 months, and whether the participants will maintain the weight loss is not known (people often lose weight initially on a diet but gain it back later). In addition, because the study lasted only 12 months, it is not known whether the reductions in blood markers of risk for cardiovascular disease will be accompanied by reductions in the development of coronary artery disease, heart attacks, strokes, and other cardiovascular problems. Finally, this study involved regular meetings with dietary counselors, and whether results would be similar for people on a similar diet without such counseling is uncertain.

What are the implications of the study?


A low-carbohydrate diet may be an option for people seeking to lose weight or reduce risk factors for cardiovascular disease.


The low carbohydrate diet produced a more pronounced weight loss over 12 months which couldn’t be attributed to a difference in exercise levels.  Also one of the successes of this study was the use of dietary counselors to help the participants follow the dietary recommendations of their group.  We have found that to be a key element to success too.  For the last five years we have developed a thriving program of nutritional counseling with nurse practitioners and physician’s assistants that has resulted in several thousands of pounds of documented weight loss, a normalization of most of our participants’ biochemical cardiovascular risk markers, a reduction in medication burden, and a reversal of the disease state in many.

We encourage all our patients who desire to lower their risk for heart disease or improve their weight to a healthy level come meet with our nutritional counselors.  Their visits are billable to all insurance programs and typically patients only have  copay as their out of pocket expense.

I encourage you to call the office at 539-0270 to set up an appointment today.


Information on Ebola

Here are two links to some high quality resource material on Ebola and it’s associated Marburg virus.

It’s a good reminder that we live in a world full of microbes who desire to use us as their food source and means of propagation.  Without all our defensive mechanism, both those inherent to our physical bodies such as intact skin and a powerful immune system and those as attributes to a conscious mind such as knowledge of hand hygiene and proper sanitation measures, we would not stand a chance against this continual onslaught of invaders.  However, for the majority of humans we survive and thrive in the most hostile of microbial environments for decades on end.  We are the dominate species on the planet for many reasons but chief among them is that we have been fearfully and wonderfully made.

Ebola epidemiology and clinical symptoms

Ebola diagnosis and treatment