All posts in Medical Diseases

“What if obesity is a coping mechanism for something far more sinister going on underneath the cell?”

Peter Attia, MD is a favorite blogger of mine who presented this talk at a recent TedMed conference.

For anyone interested in obesity treatment, diabetes, and healthy nutrition it is a must watch video.

Let me know what you think.

Peter Attia, MD at TedMed


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.


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.


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.


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.


Vaccine Question and Answer

I recently had the privilege of being asked to participate in a question and answer forum concerning vaccines.  A former patient of mine who has moved out-of-state is an avid blogger at  She covers all types of topics concerning family life, adoption both international and domestic, foster parenting, and in general raising your children in the fear and admonition of the Lord.  She is a wonderfully gracious person and blog host.

I’ve posted the links to her different posts below for those that are interested.  As she says better than most, this definitely is a sensitive topic.  Sometimes friendships can be strained when we so strongly disagree.  So comments for these posts are going to be limited to preserve the peace.  As a practice if you have questions about vaccines and our vaccination policy I’d encourage you to bring them up at your visit.  Trying to work through them in a blog comment section isn’t a good idea.  Remember these blogs are for informational and educational use.  We’re not making medical recommendations here except in the general sense.  Nothing specific is intended.  I hope it is informative for you and that you see why we ultimately have developed the vaccine policy that we have as a practice.

The first two posts are from Maralee with her own thoughts on vaccines.

Vaccines- My Introductory Thoughts

Vaccines- Who Do You Trust?

These next eight posts are where I answer reader submitted questions.

Vaccination Guest Post: Did I vaccinate my kids?

Vaccination Guest Post: Ethics and Parental Rights

Vaccination Guest Post: Is there value in delaying?

Vaccination Guest Post: Whopping cough outbreak and kids with special considerations

Vaccination Guest Post: Specific vaccines and their effectiveness

Vaccination Guest Post: The flu shot

Vaccination Guest Post: What’s in our vaccines and is it causing autism?

Vaccination Guest Post: Doctor compensation and adoption issues

This last post is Maralee’s summary thoughts.

Vaccinations summary- What you do for the least of these



Diabetes: Prevention and Treatment

“All I had was a bologna sandwich on white bread and a glass of sweet tea and my glucose is 250!” So went a call from “Sue”, a patient this week who already knew she had impaired glucose tolerance (IGT) or “pre-diabetes”. Now it’s beginning to look like she may actually have full-blown type 2 diabetes. Her only symptoms had been some vision changes – sometimes her vision seemed a bit blurry and other times fine. After seeing her ophthalmologist, she noticed that the change in her glasses hadn’t fixed the problem. Her fasting blood sugar had been 110 (normal is below 100 and diabetic is above 125). Likewise, her HbA1C (the blood test that reflects a person’s average blood sugar over the previous 3 months) had been 6.1 – not yet in the clearly diabetic range (6.5 and up), but already in the IGT range.

​Like so many entering into diabetes, Sue had only subtle symptoms and her initial blood work had been fairly unimpressive. Also like so many in the early stages of diabetes, she had little feel for the impact of foods and drinks (like white bread and sweet tea) on her blood sugar. We had actually just had an appointment that morning where we had begun to discuss foods to limit, including “sweets” and “whites” – breads, pastas, potatoes, rice. We had prescribed a glucose meter to check her blood sugar. At this stage it was more as a teaching tool to check her glucose at various times such as fasting in the morning, after a meal, when her vision was blurry, and so on.

So, what now for Sue? She has four choices. One would be to let this diagnosis scare her and just try to ignore it and stick her head in the sand (or sugar bowl). Unfortunately, diabetes is a diagnosis that has a nasty habit of refusing to be ignored. Over time, if ignored, it will bring nerve, eye, heart, kidney, circulation, and brain injury, or, in some cases, put a person into the hospital with a diabetic coma (from extremely high blood sugar). Yah, not a good choice to try to ignore it. I don’t have many patients going this route, but I do have just a few who check things so infrequently and haphazardly that they are close to this. I always hope they’ll change their ways before the bad stuff really starts happening.

The second choice would be to not change her lifestyle but treat with medicines and monitor her sugar along with other important risk factors like blood pressure and cholesterol. This is certainly a better choice, but a bit expensive. It’s a little like trying to put out a fire while sprinkling gas (in this case, flammable sugar) on it.

A third choice would be for her to “tweak” her lifestyle and take medicines to make up for any shortfalls in her efforts. We’re getting better now. If she can perhaps lose 10 or 15 pounds out of the 50 extra that she has on board, that will help substantially. In terms of exercise, a study where the “exercise group” did a 30 minute walk five days a week showed an eleven year delay in the onset of diabetes compared with the “no exercise group” – a rather huge impact. Likewise, cutting out sweets (or substituting Splenda) and limiting whites (and substituting whole-grain alternatives as much as possible) can have a major impact. Even if Sue isn’t perfect in these efforts, it will have a significant effect on her diabetes and allow her to reduce the number of meds needed to control her diabetes well.

The final choice is certainly what I love to see. This is where the person really changes their life. They begin to learn the ins and outs of a healthy diabetic diet. They exercise six days a week and slowly work their way down to their ideal weight and maintain it. These folks, the few, the proud, the diabetic marines, are able to essentially eliminate the risk factors normally associated with diabetes while minimizing the medicines that may be needed. And they feel great. We have a man whose HbA1C was 12 – terrible! He became a “change your life” kind of guy and now has his HbA1C down in the 6’s with no diabetes meds. At our office, we follow people in all four categories, but the more we can encourage into this last category, the better we like it. So if diabetes is raising its ugly sugar-coated head in your life, don’t stick your head in the sugar; change your life – the rewards are sweet.

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