The "Wonders" of Modern Medicine

Doctors are excellent salespeople. I know, because I am one. When I see a patient, I have a lot of selling to do. First, I have to sell myself to the patient, in the sense that I have to get them to trust me. Without the patient's trust, they are very unlikely to do anything I say. Next, I need to sell my chosen course of therapy to the patient. It is well known that the placebo effect constitutes about 30% of any treatment. The practical meaning of this is that if the patient does not believe the medicine I am giving them will work, it is highly unlikely to do so. Finally, if I am to admit the patient to the hospital, I have to "sell" the admission to the physician who will be taking care of them on the floor. If I do a poor job of this, and the admitting doctor doesn't believe there is enough cause to justify the admission, they will not admit the patient, and the patient's life could potentially be jeopardized.

The profession of medicine has sold our usefulness to the general public. We have done so out of necessity. Most of us, while getting into medicine in order to help people, also need to make a living. I am one of the lucky few who are employed by a hospital, and am paid hourly for my work. In private practice, a doctor's earnings come solely from the number of patients they see, and what exams, studies, and procedures they can bill for.

With this comes a sort of hypocrisy. Doctors have to make themselves indispensable to patients, in order to get them to come to the office. Also, they have to have reasons for patients to keep coming in. Hence the yearly physical your doctor insists that you get, and for the older population, the monthly or weekly visits for blood pressure checks and the like.

The problem is, somewhere along the line, we as a profession oversold ourselves. We made the general public believe that if they had ANY symptom, no matter how mild, they needed to have it checked out by a doctor. As a consequence, during the months of October thru February, my ER is flooded with people who have nothing more than an upper respiratory infection (the common cold). They come to the ED with runny nose, cough, aches, chills, and fever.

The fact of the matter is, no matter what I do, they will be better somewhere between 3 and 7 days, depending on their individual immune system. Barring very high risk groups (infants under 3 months, and people over 90, as well as cancer patients on chemo), these symptoms don't require any tests, treatment, or the monitoring of a medical professional. 99% + of people with URI symptoms don't need to come to the ED. They don't even need to see their family doctor. They just need to drink a cup of tea and rest for a few days, and they will be just fine.

That brings up the natural question of why do these people come see me? People in general are not stupid. They won't do something unless they think they will get something out of it. The only possible answer is that they believe I have something to offer them. Aside from some medicines I can give for symptom relief (many of which can be purchased over the counter), I don't.

What is interesting is when you generalize this principle to all of medicine. In reality, very few things we do in medicine make much difference. There are obviously some exceptions:

• Surgery for emergent conditions such as appendicitis, bowel obstruction, and the like
• Vaccines (no, they don't cause autism, and yes, the absolutely work. When is the last time you saw someone with smallpox)
• Antibiotics for truly life threatening infections (pneumonia, skin infections, sepsis (blood infection), diverticulitis (an intestinal infection), and others)
• Heart catheterization for people having an acute heart attack
• Aspirin for heart attack (although this is a bit of a cheat, given that the ancient Egyptians used willow bark for pain relief and multiple other purposes over 300 years ago. Aspirin is made from willow bark).

This isn't a comprehensive list, but the treatments above are the best of the best.

Other than that, much of what we do, even in the very ill patient, is merely optimizing conditions and waiting for the body to either heal itself, or succumb to disease. Here is a list of medical treatments that have marginal if any benefit:

• Surgery and chemotherapy for most type of cancers (increase survival across the board by 1-2%)
• Heart catheterization for chronic chest pain (no evidence of increased lifespan)
• Coronary bypass surgery (no evidence of either long term symptom reduction or increased lifespan)
• Statins for heart disease prevention (they make your lab numbers look better, but they don't prolong life or prevent heart attacks)
• Opiate pain medicines for chronic pain (they just lead to a cycle of addiction. Your body increases its opiate receptors ironically making ALL pain worse)
• TPA "clotbuster" for acute stroke (the jury is still out on this one, although more studies than not have shown no benefit)
• Insulin and oral medicines for Type II diabetes. (Type I, or childhood diabetes, absolutely benefits from tight glucose control with insulin, but that is a totally different disease process)

So, you might be asking, what is the point of all this? Well, in the midst of all of our advances in technology and multitudes of new drugs hitting pharmacy shelves daily, we have forgotten the forest for the trees. Doctors on average have about 3 hours of nutrition education during school. During the average patient visit (about 10 minutes, just so a doctor can make a little bit of profit with a completely full schedule), virtually no time is devoted to educating patients on the benefits of the correct diet and exercise in preventing disease.

Doctors want to help people. If we had the time and knowledge, we'd talk much more about eating right and exercise than drugs and procedures. Big pharmacy doesn't really care about helping you. Unfortunately, there is no money in healthy people. They don't take very many medicines. If, on the other hand, you have several chronic diseases for which you need to take medicine daily for life, jackpot!

So, if you want to achieve better health, the answer is not in a pill. Now, don't get me wrong. Life threatening emergencies like heart attacks, strokes, and such are still dangerous, and emergent treatment is often quite helpful, so definitely don't avoid medical care if you think you have something serious. Just keep in mind the things that clearly don't work.

Now, compare the list of things that don't work to a vegan diet and exercise. Below are the benefits of a vegan diet:

• 50% lower risk of heart disease as compared to meat eaters
• 50-66% lower cholesterol
• Less than half the likelihood of high blood pressure
• 40-60% lower rate of stroke
• 40% lower rate of depression
• 66% lower rate of obesity
• Lifespan between 4 and 8 years longer than people who eat animal products
• 70% lower risk of cancer (especially the big 3- colon, breast, and prostate)

Hippocrates, the father of modern medicine said over 2500 years ago "let food be thy medicine." I find it ironic that more than two millennia later, despite all of our formidable technology and giant grab bag of drugs, his advice is still the most sound and effective.

Omnivore Rage

Omnivore Rage

Weight: 275

Exercise: Ran 2 mi yesterday, 3 mi today.

Having been a vegan for about 4 years (with a 1 year lapse in between), I am well used to all the usual questions that omnivores ask: 

"Where do you get your protein?"

"Doesn't eating only plants get boring?"

"How can you be a runner and not eat meat?"

"How can you possibly live without milk and cheese? I could never do that."

"What are you eating?!?"

"Quinoa? Never heard of it. Sounds gross."

The list goes on and on. Not that I'm complaining. The massive amounts of energy I get from eating vegan more than make up for it. I knew from the moment 4 years ago that I decided to stop eating meat, eggs, and dairy that I would be viewed as odd by most mainstream people. (Any of you who know me personally, already know that I am a bit odd, and totally comfortable with it). Thus, I thought I was very well prepared for anything that could be thrown my way about the subject of veganism and fitness.

The other day, I was totally caught by surprise. I was speaking with a very good friend of mine (who shall remain nameless), and happened to mention the fact that I was vegan again. As most people do, he peppered me with several questions about a vegan diet, and why I choose it. I apparently mistook his questions for genuine interest and politely suggested that he check out the facts, and perhaps consider adopting a vegan diet himself. I was totally unprepared for what happened next.

This friend of mine, normally a quite rational person, became angry. He raised his voice and said that he "would never do that." Further, he asserted that "people have to eat meat," and that anyone who doesn't is not only "dumb" but also a "scrawny weakling."

Ignoring the obvious insults, I asked him why we have to eat meat. He said "what else are you going to eat at Thanksgiving, Easter, or Christmas?" and also that he was a "meat and potatoes" kind of guy, because that's what he had always eaten.

His response to my questions got me thinking. I am definitely not a militant vegan who insists that no one eat animals, ever. I also don't go around throwing buckets of red paint on people who wear fur coats. I don't picket fast food restaurants. I merely advocate eating a plant based diet because it is the surest way to promote health, avoid or cure disease, and maintain vitality as long as possible. My third DevolveHealth eating rule says:

"Eat a wide variety of fruits, vegetables, grains, nuts, and legumes and VERY LITTLE if any meat, dairy, and eggs."

This is based on the simple logic (which has been backed up by a lot of research) that our primal ancestors would have eaten mostly plants (vegetables and legumes), fruit (which was only available certain times of the year), and seeds and nuts (also available only seasonally), and very little meat. It's not that they would try and avoid meat, but meat (also known as an animal) is pretty hard to come by. It turns out most animals, prior to domestication, didn't want to just lie down and be eaten. They were either much faster than we are, or had adequate weapons or size to fight us off. 

It was only after the development of weapons and then the domestication of animals that mankind had ready access to meat. It was only in the past 50 years or so that mankind (at least people living in industrialized countries) had access to as much meat as they wanted on the cheap, due to factory farming practices and cheap government subsidized corn.

As my friend was unintentionally pointing out, what we eat is a very emotional and cultural matter. Some of my own best childhood memories are of Sunday afternoons spent eating homemade spaghetti and London Broil with my mother's spaghetti sauce (if I ever gave that recipe away, she would drive up from Florida to kill me). 

The problem is, culture has changed with time, as have our waistlines and rates of disease. The typical diet about a hundred years ago (garnered from various sources) consisted of a small portion of meat, about 2-3 oz, fresh vegetables and grains, and seasonal fruits. Meat and grain made up about 20-30% of the food eaten, whereas the other 70-80% consisted of vegetables and fruits when available. There was no corner grocery store, and people had to live off of what they could farm, hunt, and fish. Thus, the diet would vary based upon what time of year it was, and how lucky or unlucky the family hunter/trapper was.

Compare to today. The average diet today consists of 50-60% refined grains or oils. These come in the form of processed sweets, pre-packaged foods, sodas, bread, and the like. 30-35% of our diet comes from meat, mostly in the form of chicken, pork, or beef, all of which has been factory farmed and is full of toxins, artificial hormones, and antibiotics used to keep the animals alive long enough to reach slaughter weight. That only leaves a measly 5-10% for fruits and vegetables. The most commonly eaten vegetable? The potato. There is nothing wrong with potatoes. They have many vitamins and minerals, and are quite healthy, when combined with other vegetables. The downside is that they are rather starchy, with a high glycemic index. Combine that with an overload of sugars, raising our post meal blood glucose, and the high protein and saturated fat load of the meat, and you have a perfect recipe for insulin resistance (read: diabetes). 

Sadly, my friend was misled. I can't really blame him though. So was I for many years, and I am a doctor, for God's sake. Since just after World War II, we have been very gradually conditioned to accept processed foods as staples, and encouraged to eat ever more meat and dairy. There are two main groups who are conditioning us this way. Offender #1 is the USDA. The US Department of Agriculture is a farm advocacy group. They are also the people who write our nutritional guidelines, and determine the "% daily value" which goes on the side or back of every food package sold in the US. Their primary interest is to make sure that the people they represent (namely the dairy farmers, meat farmers, and vegetable farmers, 99% of whom grow only corn and soybeans) make as much profit as possible. Is it at all surprising that the nutrition pyramid for at least 30 years has recommended grains, meats, and dairy products as the 3 most consumed nutrients?

Offender #2 is the National Dairy Farmers' Association. As the name implies, they work for dairy farmers. What they also do on the side is provide educational materials to schools on nutrition. I'm sure I don't even have to tell you what they are telling our children to eat. "Milk. It does a body good." speaks for itself. For more on just how bad milk is for you, read my previous post on milk. 

We all eat what we eat for a variety of reasons. Two of the most important are taste and history. We like food that tastes good, and we like to eat what we ate when we were children, because of the memories the food evokes. The same is true of holidays. We don't eat a turkey at Thanksgiving because it is an intrinsic part of the holiday (there is absolutely no evidence that turkey was eaten at the first Thanksgiving. It was probably added sometime in the 1800's). We eat it because it reminds us of our childhood, and happy times with family. In a way, it brings us closer to our distant and deceased family members, if only in our minds. Sadly, those "traditional" meals have been perverted over the years, by ever increasing levels of processing, and the agendas of groups who have placed profits over our health.

Now that makes me mad!

What are You Eating?

What are You Eating?

Weight: 276.6
Running: Getting better. 2-3 miles per day

As a consequence of my job as an emergency physician, I eat lunch and dinner (and even breakfast, depending on which shift I am working) at my desk. Since I get the opportunity to work on the sickest of patients, who are often unstable and can deteriorate quickly, I have to be close to the action at all times. This means eating at my desk most days. Years ago, I never realized the consequence of eating in public. Since I have been a vegan and back, and vegan again, I have become acutely attuned to an interesting phenomenon: people are always quite interested to what other people eat. While sitting at my desk checking labs, looking at past medical histories, and making medical decisions, many techs, nurses, and other physicians pass me without a second glance. Add an open food container sitting innocently next to me, and suddenly every single person who passes me asks the same question: "what are you eating?"

The interesting thing about the question is how it changes when I am sticking to a vegan diet. It isn't the words. They remain the same. It is the tone that changes. When I have a "balanced" plate in front of me, with meat, veggies, and grains, I get the normal "what are you eating?" No tone, no curiosity, no agenda. Similar to when someone asks "how are you today?" They don't really want to know. All they want to hear is "good," or something similar. It is mainly a rhetorical question.

Oddly, when I have a vegan entree in front of me which is non-traditional, the tone of the encounter changes. Take as an example two days ago. I had for lunch red kidney beans, quinoa, and avocado. Besides being delicious, this dish is full of protein, fiber, good fats, vitamins, and minerals. In short, it is the perfect lunch. Despite its obvious health value, when people looked at my food, they took on an incredulous tone when asking about it. Based on the tone, you would think that I was eating fried tarantula or something equally crazy.

Thinking about the responses of these well meaning people merely confirmed how screwed up our American diet actually is. The reason for the unusual responses is that quinoa and beans is unexpected. It was out of the range of what people who eat the standard american diet expect. These days, we consider a plate of 10 oz meat, a small spoonful of veggies, and a cup of potatoes normal. The diet we were designed to eat was quite different than that.

Our ancestors, before agriculture, were only able to eat what they could find or kill with their bare hands. If you think logically about what their diet might be composed of, we can make some conclusions about what we should be eating. Our ancestors would eat mostly vegetables, as those are plentiful and available year round. Next most likely would be fruit. Fruit is seasonal, but stays still and is easy to collect. Finally, and in the most limited of quantities, would be animal products. Although there are a great many animals in nature, they are rather fast and hard to catch. The ones who aren't fast outweigh us by hundreds of pounds, and have teeth, claws, and tusks to kill us.

Thus, since we are essentially unchanged from our primeval ancestors from a genetic standpoint, the proper diet for modern man should be as follows: 70% vegetables, grains, and legumes. 25% fruit. 5% (or less) meat, eggs, or dairy. Completely off the menu are processed sugars, oils, and flours, as those don't exist in nature in any form. Our bodies are simply not made to process them, and they are the cause of many chronic diseases that we suffer from.

A couple of years ago, when I wasn't quite as mature, I was quite annoyed by the "what are you eating" question. I have since revised my view of the situation. The best way to lead is by example, so when I am eating an extremely healthy meal, and someone asks with suspicion what I am eating, I choose to use it as a teaching moment. Hopefully, if I expose enough people to exciting new vegetables, grains, and fruits, and teach them to avoid animal products such as dairy, meat, and eggs, I can improve not only my health, but also the health of those around me. Not only is that my duty as a physician, but also my goal as a health educator.

The next time someone asks you "what are you eating," consider what you are eating, and if that food is the right kind of food to fuel your body. If so, please share your knowledge with others. For more info on what to eat, please visit www.devolvehealth.com, and learn to eat like our ancestors, and like our bodies were designed to eat.

Quinoa and Red Beans With Avocado
1 cup quinoa, rinsed
1 can red beans
1 avocado
1/4 tsp salt

Cook quinoa according to package directions. Drain red beans. Once quinoa is finished, mix both together. Peel and pit avocado, and dice. Mix in with quinoa and beans. Add salt and mix well. Serves one. Goes well with salad or other green veggies.

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Relapse

Relapse

Hi all. I know it has been a LONG time since I have written. An awful lot has happened to me in the past year and a half or so.

Those of you who have followed my blog the previous couple of years know that through a rigorous vegan diet and daily exercise, I had gone from a horribly obese 350 lbs to a svelte 200. I had reclaimed my health, lost my hypertension and borderline diabetes, and discovered more energy then I knew was possible. My depression, which had plagued me for years, had even gone away. Without a doubt, I knew my avoidance of processed foods and animal foods, as well as daily exercise had been responsible for my weight loss. Overall, I had never felt better in my life. I felt as if I was invincible.

Life, however, is never without its share of tragedy. Just when I thought I had reached my highest point, the universe decided to take me down a peg or two. First, my wife demanded a marital separataion. Not terribly long after, I found out she was having an affair. Finally, three days before our 11th anniversary, she filed for divorce. The marriage I had hoped to save for the months of our separation was over.

I was completely devastated. I went from living in a nice house to a one bedroom apartment. I only got to see my kids 8-10 days a month. The illusion I had of a "good life" was completely shattered. Financially, I was shackled by huge child support and alimony payments, which amounted to approximately 60% of my monthly salary. I was forced to work extra shifts every month in order to make ends meet.

As I have mentioned many times in the past, I am an emotional eater. When I get upset or anxious, I tend to resort to food as my comfort drug. As unhappy as I became, I simply quit. I stopped eating my unprocessed plant-based diet. I stopped exercising. Instead, I took to sitting and watching television to take my mind off of my circumstances. And I ate. A lot. I ate fried chicken, mashed potatoes, macaroni and cheese, pizza, and all of the "comfort foods" that I used to rely on. 

It is surprising how simple it is to slip back into old patterns. I vowed that I would never eat animal products again, but under pressure, that vow was easily broken. Not surprisingly, given the research I have shown in previous blog posts (feel free to read them all), bringing back the animal foods meant the return of the weight, and the return of my chronic diseases. Depression, obesity, and high blood pressure quickly returned. I ballooned from 200 pounds to 280. I was afraid to write blog posts advocating health, because I felt like a hypocrite, and I was ashamed to tell my story, as it had taken a huge turn for the worse. 

Not too long ago, however, I realized something. This part of my story is worth telling. Relapse is part of the process of change. The question to ask is not "will I mess up," but "when will I mess up?" Clearly, resorting to those comfort foods was a huge mistake, and It cost me dearly. 

Thankfully, I regained control of my life. I deepened my connection with God, filling a lot of the void in my life. As much as I hate dating, I also met a wonderful woman who is as fully committed to me as I am to her, and we were wed in January. 

The waters having calmed a little in my personal life, I took a look at my health. At first, I thought going vegan again would be too hard, given that I had strayed from it for so long, so I tried to eat Paleo. That just didn't work for me. One good thing I discovered trying that eating plan was how bad gluten is for us. I will elaborate on that in a future post. 

Finally, since no other eating plan has ever worked for me, I decided to return to a vegan diet. Specifically, I decided to follow my own eating advice, the DevolveHealth Eating Rules:

1. Eat foods as they occur in nature

2. Eat a wide variety of fruits, vegetables, legumes, and nuts, and very little if any meat, eggs, or dairy

3. Choose foods for nutrition, not flavor

Within a week of committing to eat plants again, my energy returned, and I began to feel better. I have lost about 10 lbs so far, and will not stop until I reach my goal weight of 185.

As with many things in life, buried in tragedy is hope, and opportunity. I had thought my rough patch was just a punishment, but now I realize that I can make some good from it. The last time I reached out to you readers about nutrition and exercise, I did it as someone "on the other side" if you will. I had already achieved my goal. The mountain always looks smaller when you are at the top. This time, I will take you along with me on the journey, and we can help each other climb.

I encourage each of you to set a goal to reach with me, be it a weight goal or a fitness goal. On my end, I promise to post frequently on my progress and the lessons I learn. I hope you will commit to following me to fitness and a better life. Feel free to post your story, or your commitment in the comments. Mine is far from the only story worth telling.

Either way, this should be an adventure!

Jacob Ott, MD