Category: health care

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Seth Roberts2 Comments

 

Assorted Links

Seth Roberts5 Comments

Thanks to Alex Blackwood and Bryan Castañeda.

How Patrick Vlaskovits Discovered His Migraines Were Due to Wheat

Seth Roberts8 Comments

My personal science taught me that (a) there are useful things health experts don’t know (b) that the rest of us can discover. I am curious how these discoveries are made. When Patrick Vlaskovits commented

I suffered migraines my whole life until my 30s. I am prescribed meds to help me manage the pain. These meds are better than nothing. Then I quit eating grain-based products, no migraines ever.

I asked him how he discovered the connection. He replied:

This was in years pre-Paleo — I played with Atkins and one day my wife said to me: “You haven’t had a migraine for at least a month now.” And it hit me, holy shit, I hadn’t.

Until then, my whole life even as a small child, I would get insane mind-melting-migraines seemingly at random —- and when they hit, my face would twitch and aside from the pain, I would experience hyper-light-and-sound-sensitivity. My response would be to sit the shower in the dark for hours on end and then crawl into bed to fall asleep and hopefully wake up sans headache. This was from grade-school through post-grad-school.

What no one had seen until then was the lag time between my digesting some wheat product and onset of migraine — usually about a day. Nowadays, I tend to eat wheat-free (and disallow it from my toddler’s diet) but I will indulge in a NYC pizza or something similar if traveling — I reckon that about 10% of those cheat instances I am hit with an earthshattering migraine.

BTW I mentioned this a few years ago to Ryan Holiday, and he mentioned it to his girlfriend — a few weeks ago I saw both of them in NYC, and she has a virtually identical story. Crazy.

He added later:

[After avoiding wheat] my nighttime tooth grinding also stopped as did my insomnia [“being tired but unable to fall asleep, would go to bed at 11pm, my mind would race for hours on end in a state of neither sleep nor being awake, I would finally fall asleep around 5 am, and have to get up at 730 am to go work, and be exhausted all day —- this went on for years”] — generally, I feel 1000x better not eating wheat –

I have been tested with a skin-prick test and was told that that my results came back normal, not sensitive to anything.

I am unsure of what it is in wheat that I react to – an obvious culprit could be gluten in modern wheat, could also be mycotoxins (per Dave Asprey’s thinking), could perhaps be pesticide residue; I simply don’t know. — however, at the end of the day, it doesn’t matter. A simple risk less change resulted in orders of magnitude change for the better.

Last thing, another family friend has a 10 year old who has migraines, I recounted my story to them and early evidence looks like health improvement via avoidance of wheat.

How well-known is this connection? A few articles mention it: this one, for example. Here is a whole paper — in 1979 — about how food causes migraines:

The commonest foods causing [migraines] were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), chocolate and milk (37%) each), beef (35%), and corn, cane sugar, and yeast (33% each).

Thirty years later, this extremely useful information has yet to reach most migraine doctors, apparently. An even older article (1976) said:

The 10 chief offenders among food allergens are cow’s milk, chocolate and cola (the kola nut family), corn, eggs, the pea family (chiefly peanut, which is not a nut), citrus fruits, tomato, wheat and other small grains, cinnamon and artificial food colors. Food allergy results in a remarkable variety of clinical syndromes.

The Mayo Clinic website says that migraines are sometimes caused by food but fails to say that if you suffer from migraines you should try an elimination diet to look for possible causes.

The Cost of Hope by Amanda Bennett

Seth Roberts7 Comments

I came away from The Cost of Hope by Amanda Bennett (copy sent me by publisher) full of admiration for two people the book barely mentions: Bennett’s parents. How did they raise her to be such a competent and resourceful person? The book isn’t about her. It is mainly about her husband’s fatal illness and their marriage. She never brags, but glimpses of staggering competence slip through. In 2006,

I am the only editor of a major newspaper in the United States [the Philadelphia Inquirer] to run the Danish cartoon of Mohammed wearing a bomb on his head instead of a turban–the cartoon that causes riots in Europe. By the following Monday, protesters are in front of our building carrying signs with my face and the face of Hitler. Joe Natoli, my publisher, and I plunge into the crowd, shaking hands, talking to families, listening to their stories. The crowd turns friendly. I emerge with several copies of the Koran.

She tells this story because her husband is proud of her, which means a lot to her:

The pride I see on Terence’s face . . . keeps me going, even when I am scared.

However, she was courageous before she met him. In 1983, she took a job in Beijing as a correspondent for the Wall Street Journal, which is where she met her husband. Their first encounters, she says, were a series of fights.

Most of the book is about what happened when her husband came down with a rare form of kidney cancer — especially how much the treatments cost. For $600,000 — paid mostly by insurance — they bought a few more years of life together. It was worth it, says Bennett, adding but did it have to cost so much? Her best insight comes when she notices the wildly different prices paid for exactly the same treatment (CAT scans) — exactly the same treatment, same machine, same operator. The “retail” rate is, let’s say, $20,000. One insurer pays $5,000, another pays $1,000. She wonders why. Her moment of insight comes when she is back in Beijing at a fakes market with her 10-year-old daughter. At such markets, tourists are told prices wildly above what the seller will accept. In one case a fake Chanel purse is offered for 2000 yuan ($300). A woman who pays 200 yuan walks away happy. “I got it for 200!” she tells her friends. Bennett’s (adopted Chinese) daughter pays 20 yuan. (Apparently Bennett has her parents’s parenting skills.) Wildly inflated retail prices for health care — so much more than what sellers will accept that they are almost meaningless — exist to take advantage of poor negotiators, Bennett realizes.

The Cost of Hope was a pleasure to read and, as I’ve said, Bennett is an astonishing person, but it omits an important point. Bennett, like most people who write about the high cost of American health care, fails to point out its central tenet: First, let them get sick. Bennett’s husband died young (early 60s). He was significantly overweight, how much we aren’t told. Apparently he had diabetes — again, few details are given. Obesity and diabetes are preventable. One of the first treatments her husband receives for his cancer is IL-2, meant to boost the immune system. What about boosting his immune system before he got sick? For example, by improving his sleep. This neglected approach might have prevented or delayed her husband’s cancer and extended his life much more cheaply and painlessly than what happened. The biggest flaw of her book is her failure to ask — literally ask, such as ask the head of the National Institutes of Health — why prevention, especially cheap prevention, is ignored.

Whose Side is the FDA On?

Seth Roberts7 Comments

The FDA is supposed to protect Americans against unsafe drugs — drugs with bad side effects, for example. According to this interview with Ronald Kavanaugh, a former FDA employee who worked there 10 years, that is not what actually happens. Here are excerpts from the interview:

I think most people would be shocked at how malleable safety data is. Human studies are usually too short and the number of subjects in them too small to adequately characterize [= detect] the most dangerous risks.

Human clinical pharmacology trials are typically done in Europe, yet clinical pharmacology reviewers at FDA have been barred from analyzing this information prior to studies being conducted in the US.

If reviewers say things that companies don’t like, they will complain about the reviewer or they will call upper management and have the reviewer removed or overruled.

When you do raise potential safety issues, the refrain that I heard repeatedly from upper management was‚”where are the dead bodies in the street?” Which I took to mean that we only do something if the press is making an issue of it.

FDA’s response to most expected risks is to deny them and wait until there is irrefutable evidence postmarketing, and then simply add a watered down warning in the labeling.

Which is why bad side effects are sometimes discovered after FDA approval.

Thanks to Anne Weiss.

Mark Bittman Glimpses a Big Truth: Avoidance of the Obvious by Doctors

Seth Roberts11 Comments

Mark Bittman writes about food for the New York Times. If he covered health instead of food, would he have dared to write this?

When I was growing up, drinking milk at every meal, I had a chronic upset stomach. . . . In adolescence, this became chronic heartburn, trendily known as GERD or acid reflux, and that led to . . . an adult dependence on Prevacid, a proton-pump inhibitor. Which, my gastroenterologist assured me, is benign. (Wrong.)

Fortunately my long-term general practitioner, Sidney M. Baker, author of “Detoxification and Healing,” insisted that I make every attempt to break the Prevacid addiction. Thus followed a seven-year period of trials of various “cures,” including licorice pills, lemon juice, antibiotics, famotidine (Pepcid) and almost anything else that might give my poor, sore esophagus some relief. At some point, Dr. Baker suggested that despite my omnivorous diet I consider a “vacation” from various foods.

So, three months ago, I decided to give up dairy products as a test. Twenty-four hours later, my heartburn was gone. Never, it seems, to return.

His gastroenterologist (and probably several other doctors) failed to tell him that his digestive problem might be due to eating the wrong foods. It is as if an astronomer fails to understand — or at least tell his students — that the earth is round.

It is equally interesting that someone smart enough to write for the New York Times fails to figure this out for himself. How strange that a food writer would not connect food and health — someone else had to draw his attention to the possibility. Although Bittman praises Dr. Baker, you are not going to figure out what foods are bad by adding things, such as licorice pills, to your diet. Dr. Baker failed to understand this obvious point, which Bittman still fails to see, apparently. Bittman should be utterly astonished by this mountain of avoiding the obvious, including his own.

In a later column he feels “frustration” and begins to notice how big the problem — self-serving avoidance of the obvious by doctors and the rest of mainstream health care — is:

Experiences like mine with dairy . . are more common than unusual [huh?], at least according to the roughly 1,300 comments and e-mails we received since then. In them, people outlined their experiences with dairy and health problems as varied as heartburn, migraines, irritable bowel syndrome, colitis, eczema, acne, hives, asthma (“When I gave up dairy, my asthma went away completely”), gall bladder issues, body aches, ear infections, colic, “seasonal allergies,” rhinitis, chronic sinus infections and more. (One writer mentioned an absence of canker sores after cutting dairy; I realized I hadn’t had a canker sore — which I’ve gotten an average of once a month my whole life — in four months. Something else to think about.)

Although lactose intolerance and its generalized digestive tract problems are well documented, and milk allergies are thought to affect perhaps 1 percent of the American population, the links between milk (or dairy) and such a broad range of ailments has [have] not been well studied, at least by the medical establishment.

Yet [wrong word] if you speak with people who’ve had these kinds of reactive problems, it would appear that the medical establishment is among the last places you’d want to turn for advice. Nearly everyone who complained of heartburn, for example, later resolved by eliminating dairy, had a story of a doctor (usually a gastroenterologist) prescribing a proton pump inhibitor, or P.P.I., a drug (among the most prescribed in the United States) that blocks the production of acid in the stomach.

Finally he turns to emotion:

There is anger as well as surprise, because you’d think that with a grapevine’s worth of anecdotal stories and at least some studies linking dairy to physical problems, few people began this kind of self-testing at the suggestion of their doctor — unless, that is, their doctor was in the “alternative” camp. [he is so angry he gets confused?]

So I got mail saying things like, “When I think back to all the things I’ve missed because I had a migraine, it makes me a little angry that the solution for me was so simple.” When a lifetime of suffering, medical visits and prescription drugs can be resolved with a not especially challenging dietary change — one that, when it works, has rewards well worth the sacrifice — a certain amount of retroactive frustration seems justifiable.

The big trip begins with the small step. Maybe Bittman will begin to wonder at the dystopic miracle of a healthcare system in which respected gastroenterologists fail to grasp that digestive problems are often caused by food. No one else in prestige media has managed to notice this, as far as I can tell.

Thanks to Lisa Wiland.

DIY Medicine: Sinus Infections Caused by Wheat Gluten

Seth Roberts9 Comments

Five years ago programmer and author David Kadavy suffered from constant sinus infections. The doctors he had seen about it hadn’t helped: “They tended to test me for environmental allergies, stick a camera up my nose, and ultimately prescribe some bullshit allergy medication that didn’t work.” What did work:

One day I was reading an old book on holistic medicine. Of course, the first thing I wanted to know was how could I prevent being constantly congested. The book said that foods such as wheat, meat, and dairy often contributed to excess mucous production – and thus, sinusitis. I was miserable, and clearly willing to try anything, so I cut out all three of those things the very next day.

Within two days, the difference was incredible. My head had cleared up, I had boundless energy, and other problems – such as a patch of eczema that I had on my eyelid for years – all cleared up. . . . Through a bit of experimentation I was able to place the blame for my sinus woes (and that eczema thing) on wheat. . . . Not only did the experience have me looking at food differently, it also had me looking at medicine differently. How could I see so many GPs, allergy specialists, ENT [ear nose and throat] specialists, and dermatologists without a single one of them saying “you know, you should look at your diet?”

Yes, how could that be? And, to paraphrase Alex Tabarrok, what else are they missing?

Thanks to Melissa McEwen.

No Mention of Fermented Foods in Article about Importance of Bacteria

Seth Roberts4 Comments

A new article in the New York Times by Carl Zimmer is about the importance of the bacteria inside of us. Several studies are described. Then it comes to the practical use of the knowledge. Here’s what we can do to improve our inner bacterial ecology:

To ward off dangerous skin pathogens like Staphylococcus aureus, for instance, Dr. Segre envisions applying a cream infused with nutrients [Treatment 1] for harmless skin bacteria to feed on. . . . Adding the bacteria directly may also help. Unfortunately, the science of so-called probiotics [Treatment 2] lags far behind their growth in sales. In 2011, people bought $28 billion of probiotic foods and supplements. . . A growing number of doctors are treating C. difficile with fecal transplants [Treatment 3]: Stool from a healthy donor is delivered like a suppository to an infected patient. The idea is that the good bacteria in the stool establish themselves in the gut and begin to compete with C. difficile. This year, researchers at the University of Alberta reviewed 124 fecal transplants and concluded that the procedure is safe and effective.

No mention of fermented foods. The obvious difference between fermented foods and Treatments 1-3, besides pleasure (fermented foods more pleasurable), is that Treatments 1-3 can be sold for high prices. Fermented foods cannot. (Except wine.) The omission is curious. Just because the people that Zimmer interviews have tunnel vision doesn’t mean that Zimmer must.

 

 

More Examples of Mainstream Health Care Ignoring the Immune System

Seth Roberts19 Comments

In a recent post I made an obvious point. If our immune systems were stronger, we would need antibiotics less often and antibiotic resistance would become less of a problem. I hadn’t heard this point made (for example, this WHO report fails to say it). This was one example, I said, of how mainstream health care ignores the immune system. Perfectly obvious things, such as this idea about antibiotic resistance, fail to be noticed. I gave five more examples. Since then I have come across even more examples:

1. Hospitals do little to help patients sleep and often interrupt sleep, Nancy Lebovitz pointed out (better sleep –> better immune function). This article describes the problem. One way to improve hospital sleep — beyond don’t wake patients up — would be to provide exposure to strong sunlight-like light in the morning and prevent exposure to sunlight-like light after dark. I found that an hour of sunlight or similar light from fluorescent lamps in the morning improved my sleep. Most fluorescent light resembles sunlight (both have strong bluish components), incandescent light (reddish) does not. Until they install dual lighting systems (bluish light during the day, reddish light at night), hospitals can provide blue-blocker glasses to wear after dark.

2. The book Immortal Bird (sent me by the publisher) tells how Damon Weber, born with a defective heart, had a heart transplant when he was a teenager. After the transplant, problems arose. The doctors involved (at NewYork-Presbyterian ­Hospital/Columbia University Medical Center) took the problems to be signs of transplant rejection. In fact they were due to infection. Drugs given to deal with the mistakenly-assumed rejection suppressed Damon’s immune system. They reduced his ability to fight off the infection and he died. The author of the book, Damon’s father, sued the doctors and hospital for malpractice. The doctors did not exactly “ignore” the immune system, but they apparently failed to fully grasp the danger of immune suppression, even though the infection that killed Damon is common in transplant cases. (Although Columbia Presbyterian charged half a million dollars for the transplant, “three years into the lawsuit the [hospital’s] medical director claimed Damon’s post-op records couldn’t be located.”)

3. I asked a UCSF medical student what she’d been taught about the immune system. “We cover it!” she said. In a section called “Infectious Disease, Immunology, and Inflammation”. What makes the immune system work better or worse? I asked. “If you’re stressed out, it doesn’t work well,” she said. If you’re malnourished, like in Bangladesh. You need “nutrients and vitamins”. (A booklet I got telling me to take less antibiotics told me to “eat healthy”.) She also said the students get entire lectures on how to treat diseases so rare they might never be encountered. There is a whole section on genetics. Sure, they cover it. So superficially that they don’t remember the most basic idea: Better sleep –> better immune function. I said our health care system is built around first, let them get sick. That’s right, she said. Ignoring the immune system is an excellent way to allow people to get sick.

4. Melissa McEwen pointed out that proton pump inhibitors, such as Nexium, reduce the body’s ability to fight infection. They are prescribed for acid reflux and reduce how much acid the stomach makes. Because stomach acid kills bacteria, there should have been far more concern about their safety. “Proton pump inhibitors (PPIs) are among the most widely prescribed medications worldwide [billions of prescriptions]. . . . The collective body of information overwhelmingly suggests an increased risk of infectious complications,” says this article. Because the drugs are so common, the damage is great and, because of more infection, not restricted to those who take them. It could have been avoided by research into treatments that do not harm the immune system.

How Common Are Medical Errors? A Horror Story

Seth Roberts6 Comments

In this post a contract artist who calls himself Wolverine gives a long list of life-threatening medical errors that happened to him. I hope that he will eventually add dates so that the rate of error becomes clearer [more: all the errors happened within a 14-month period] but even without them the stories suggest that life-threatening errors are common. (As does the effectiveness of surgical checklists.) Medicine is a job where if you make a mistake only the customer suffers not you. Surely this is why the error rate is so high. Wolverine was operated on by a surgeon who, because of a fatal error, had lost his license to practice in California. He changed states, was hired again, and made the same error on Wolverine.

I learned about this from Tucker Goodrich, who has been corresponding with the author and told me something remarkable:

He’s eating a paleo with raw milk diet. The other transplant patients he knows are all eating the modern American diet and dying of infections; he’s been infection-free for two years.