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Tuesday, November 19, 2013

Beating on wheat and raining on grains

Beating on wheat and raining on grains is very much in season. But I don’t think that’s what’s making us fat and stupid. I am pretty convinced it’s the paperclip. And, possibly, the Post-it note.

First, I have it on decisive authority that our paleolithic ancestors had no paperclips. And they had no Post-it notes. That probably clinches the argument right there, but there’s more.

The paperclip was reportedly invented in 1899. Since epidemic obesity, diabetes, and dementia have ensued, I think it’s rather clear that paperclips are to blame.

The Post-it note was invented, more accidentally than not, in 1974 or thereabouts. Just look at all the hell that has done broke loose since then! Not just all these epidemics of chronic disease, but climate change, overpopulation, desertification, and the wholesale death of bats and bees if not yet birds. Clearly, then, paperclips could only do so much damage on their own. Post-it notes put us over the edge.

Having established these indelible links among paperclips, Post-it notes, and all manner of calamitous mayhem, the prosecution is really tempted to rest on its laurels, but there’s still more. The innocent must be exonerated.

And to that end, there’s a defense of grains. Grains allegedly make us fat and stupid. But what about all those agonizingly skinny people in U.N. food relief lines living just about only on grains? What about the notorious “bread and water” diet for poor souls wasting away in dungeons and prisons? My understanding is that obesity is not the salient problem there.

OK, that’s feeble stuff, you’re right. But how about the fact that grains figure, often quite prominently, in the diets of all of the healthiest, leanest, longest-lived, most vital peoples on the planet? Look through the inventory of Blue Zones, and you find grains everywhere. The Okinawans ate them; the Seventh Day Adventists eat them; they figure in all of the best variations on the theme of the Mediterranean diet.

And they have fared pretty well in clinical trials, too. Grains were part of the dietary pattern shown to reverse coronary atherosclerosis. They were part of the diets, more than once, shown to prevent heart attacks 70 percent of the time in high-risk people. They were part of the diets shown to lower blood pressure, and prevent diabetes in almost two-thirds of high-risk individuals. There’s more, but that really ought to do it if you’re still reading.

As for the adverse effects of grain intake on brain function, I am aware of no reports indicating that Sir Isaac Newton avoided them. Or Goethe. Or Bach. Or Shakespeare. Or Einstein. And I’ve read of Julius Caesar dipping his grainy bread in olive oil, even as I do myself, meaning no disrespect to any Picts or Gauls listening in. I enjoy whole grain bread in olive oil, but harbor no malice toward Picts or Gauls. I draw the line!

None of this is an argument for refined starches, obviously. Just because whole grains have a pretty good track record doesn’t mean the same pedigree extends to what’s left behind when we’ve stripped off the hull and ripped out the germ. That would be like inferring that since Earth’s atmosphere is good to breathe, it would still be good to breathe if we sucked out all the oxygen. I wish you, the baby, and the bathwater good luck with that one.

Of course, it’s true that there were no “grains” per se in our native, paleolithic diet. That’s pretty damning.

But of course, there were no grain-fed cattle either. There was no bacon. There was no mustard. There was no ketchup either. There was no marinara sauce. Heck, there were no tomatoes. There were no beans, no lentils, no chickens as we know them now. No ground beef, and certainly no sausage. No deli meats. No hummus. There was mammoth, though.

The reality is that we can’t eat the foods our Stone Age ancestors ate, because their foods don’t exist now, and our foods didn’t exist then. The best we can do is approximate the native. And while the native did not include grains, it did reportedly achieve something like 100 grams of fiber daily from a wide variety of plant foods. There is little hope of getting to 100 grams of fiber daily even with whole grains filling in for the high-fiber plant foods our ancestors ate, and probably no hope of doing so without them. So those who consider eating grains a departure from the native should concede that not eating 100 grams of fiber per day is another.

Of course, if you do aim for 100 grams of fiber, permit me to recommend excellent reading materials in your bathroom; you’ll be spending a lot of time in there.

Still, the recent arguments against wheat and grains do seem really convincing. But then again, not all that long ago, arguments against dietary fat seemed really convincing. Then arguments against all carbohydrates, not just grains. Then arguments against all high-gycemic foods. And arguments against dairy. And arguments against eggs. And arguments against meat. And arguments against all animal products. And arguments against salt. And arguments against saturated fat. And arguments against tropical oils. And arguments against trans fat. And arguments against sugar in general, and fructose in particular. And arguments against gluten. And arguments against GMOs. And … well, you get the idea. All made persuasively, and with an application of religious zeal.

Of course, if any one of these arguments was truly valid about the one thing truly wrong with our diets, it would mean all the others are wrong. Of course we could account for that; eating the wrong foods has clearly made all the “other” guys dopey.

But maybe the only truly safe thing to do is assume they are all right. That’s what I’m going to do.

I’ve been sitting here on my fat tush long enough, and I’m off to start my next diet. I suppose I might attribute my excess poundage and listless mind to the hours in this chair in front of this screen, but there’s no popular book telling me to do that, so to hell with it. It’s the damn grains/sugar/carbs/wheat/GMOs/animal foods/etc.

My plan is to head on over to the fast food restaurant, and buy just about anything they sell. It doesn’t matter, because I intend to dump out the alleged food anyway; clearly nobody should be eating that crap. I intend to eat the Styrofoam.

Being a responsible, if dull and pudgy, parent, I will indulge my child in a Happy Meal. We will, of course, throw away that rubbish, too; my kid can eat the toy.

At least I would be setting out to the fast food restaurant now, if I could. I put my car keys on a paperclip, and for the life of me can’t remember where I left the damn thing. If only I had stuck a Post-it note reminder to the family mammoth, or the wall of my cave …

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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