Archive for the ‘BookNote’ Category

Back in the saddle – with a big book note

I’ve been scolded repeatedly over the last month or so about the unconscionable neglect of my blog. What can I tell you? Well, I’m back now!

Not that I’ve been waiting for an excuse to blog. There has been a lot to say, just hadn’t gotten around to saying it. However, the big impetus for me has been the release of the most anticipated book on nutrition in the last couple of years. I’ve posted regularly on the work of Gary Taubes, author of Good Calories, Bad Calories. At the risk of repeating myself, GC, BC was a turning point for me in that it opened my eyes to a completely new way of looking at diet and nutrition, and did so in a thorough and convincing way. While the book was not a diet book (no recopies there) I changed my diet to adhere to the general principles laid out in the book (eating meats and leafy vegetables until satisfied, eliminating sugars and starches, limiting fruit, etc.) and lost 20 pounds without any additional changes (i.e. no exercise).

While I still recommend GC, BC, it is admittedly a challenge to take on. It’s over 600 very densely-packed pages with lots of biology, biochemistry and medical terminology. Of all those to whom I’ve recommended the book, only a handful (3?) have reported they actually read it. Given it was so important and influential, Gary (we’re on a first-name basis, these days) got repeated requests for a ‘readers-digest’ version of GC, BC that more people would actually read.

In December, the much anticipated condensed release of the last ten years of Gary’s work was published:

Why We Get Fat: And What to Do About It (Borzoi Books)
The much-anticipated condensed version of the groundbreaking work begun almost ten years ago with his New York Times "Big Fat Lie" article and the epic "Good Calories, Bad Calories."

For all the times I’ve recommended GC, BC, replace that recommendation with Why We Get Fat. Not only is the book much more condensed and simplified, it also has the benefit of the previous three years since GC, BC was published. The message is essentially the same – just re-emphasized:

  • The principal driver of fat storage is chronic insulin elevation and chronic insulin elevation is driven by consumption easily-digestible carbohydrates
  • The presumption ‘calories-in, calories-out’ is the principle explanation of why we get fat is an over-simplification and says nothing about a causal relationship between what we eat and why we get fat

That’s enough for this post as I plan to have a series of posts on this book planned. It’s that important.

More very soon.

Sugar part trios – Beat Sugar Addiction

First of the passel of ‘sugar’ books I heartily recommend:

Beat Sugar Addiction Now!: The Cutting-Edge Program That Cures Your Type of Sugar Addiction and Puts You on the Road to Feeling Great – and Losing Weight!

Wish authors didn’t have to play the tabloid headline game with their book titles. Makes serious books look silly. This one is pretty serious.

While the author does focus primarily on the syndromes and conditions that emerge out of sugar addiction, there’s also a *lot* of really great education about what happens to your body hormonally and metabolically and when you consume sugar (of course, when I say ‘sugar’ I mean the whole gamut of sweeteners). He offers a useful breakdown of ‘types’ of sugar addiction that relate to specific responses (adrenal fatigue/distress, yeast overgrowth, etc.). He also approaches the issue from the specific medical conditions. This section I found especially useful and insightful. If any of these conditions means anything to you, you ought to consider reading this book:

  • Anxiety
  • Chronic Fatigue Syndrome/Fibromyalgia
  • Depression
  • Diabetes/Metabolic Syndrome
  • Heart Disease
  • Hypothyroidism
  • Irritable Bowel Syndrome/Spastic colon
  • Migraines and Tension Headaches
  • Obesity
  • Sinusitis

Another general area I appreciated was the way he encouraged the use of appropriate dietary supplements, acknowledging that when you’re trying to right a listing ship, you need to take more activist measures than ‘staying the course.’ Diet alone – especially given our modern patterns of food production/distribution/consumption – just won’t do it. One can imagine it might be a little too much for some, but I believe he erred in the right direction.

While I heartily recommend the book and I learned *a lot* reading it, as is my wont, there are a few things I’d change:

  • It’s great that he references the importance of vitamin D for overall health and specifically as it relates to the conditions that are associated with high sugar intake. His advice, though, is pretty lame. He basically says ‘don’t be afraid of the sun.’ Which is fine if you live in a non-industrialized location the tropics and you are regularly outside in the mid-day throughout the year. Most of the readers of his book would see no appreciable improvement in their vitamin D status by taking his advice. He’s clearly not up on the research in that area (see more).
  • Surprised that he is totally supportive of various sugar alcohols (erythritol especially) as sweetener alternatives. I’m willing to give him the benefit of the doubt on this one, but it surprised me nonetheless.
  • Gives processed fructose a free ride by not citing the highly toxic effects of processed fructose (see Dr. Lustig).
  • He cites a number of published studies and books, but did not take the trouble to include a bibliography or a list of references to the studies cited. In some cases, I was not able to find the studies he cited in either Pubmed or PLoS. I find that more than a little suspicious.

Even with these reservations, I strongly recommend the book. You will certainly learn something new.

UPDATE: Just happens my good buddy, Jimmy Moore, just recently interviewed the author and the audio may be obtained here.

Book Note: Anatomy of an Epidemic – worse still

It’s time to move on to another topic. Two books in a row about psychiatry and what has become of it due to the influence of pharmaceuticals is quite enough for me for a while. This book, though, is one that cannot be ignored:

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America [Hardcover]

It would be easy to lump this book together with Unhinged, Dr. Daniel Carlat’s book about this same issue from the perspective of a clinician. In fact, though, it addresses the issue from a different perspective.

Mr. Whitaker takes a wider, more epidemiological view and comes up with what can only be taken as a shocking conclusion: the central cause of the ballooning of psychiatric conditions over the last 50 years (anxiety disorders, bipolar, depression, ADHD) is the drugs themselves. That’s right, the drugs are causing the epidemic, not environmental toxins or video games or reality TV.

He comes to this conclusion by viewing the outcomes of patients who have been administered a host of psychiatric drugs over long periods of time. As it turns out, this distinction is key. Why? Because the clinical trials that are used to ensure that drugs are safe to be administered are typically (in the case of psychiatric drugs, always) trials of a short-term nature (six to eight weeks). What happens to people who are on these drugs for months? Years? Well, this book cites studies that have chosen to answer that very question and found that, in comparison to control groups who were not on the drugs long-term, those who stay on the drugs are worse off.

That said, I have to admit a fair amount of skepticism about all the clams in the book, so I would not take the entire message hook, line and sinker. But the core message: use of these drugs as long-term, chronic treatment actually makes things worse, is enough to get your head spinning.

As is my wont, here are a few links to audio interviews of the author also:

Need to Know on PBS
Medication Ethics Seminar
At Powell’s Books in Portland, OR
Video of Powell’s Books appearance

Gotta go now. I think I’m gonna be sick.

Book Note: Unhinged – Could it get any worse?

Recently completed a fascinating book by Dr. Daniel Carlat: Unhinged The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis. 

Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis

If you’ve seen my thoughts in a previous post about Dr. Barbara Angel’s book The Truth About the Drug Companies, much of what Dr. Carlat has to say will be familiar to you. What is noteworthy about this book, though, is that he recounts his experience as, essentially a Dr. Drug Rep for Wyeth (now part of Pfizer). In it you’ll find how the profession psychiatry has been utterly co-opted the pharmaceutical companies. Also for an eye-opening look at how some in the medical profession have sold out their patients, read Carlat’s article linked to above in the NYT Magazine.

Now with all this pharma-bashing, you’d think I’m just offering to rid the world of this scourge. Please understand that I am not. However, the practices that have been exposed time and time again have to stop. The first essential step in the process is for medical profession regains its professionalism in this regard (see Dr. Arnold Relman’s A Second Opinion). The other thing that has to happen is we as patients need to be better informed so we are able to look out for best interests. Be sure to ask the important questions about any drugs that are prescribed to you.

Oh, if you’re not so much into the reading thing, there’s an interview of Dr. Carlat from Fresh Air which was broadcast in July 2010.

Book Note: The Truth About the Drug Companies

Just completed a book I’ve been meaning to get to for some weeks

The Truth About the Drug Companies: How They Deceive Us and What to Do About It

While it’s gotten to be pretty easy to pick on the pharmaceutical industry of late, this laser-focused book does more than just lob a few broadsides. It pretty much eviscerates every one of the major arguments put forth by the pharmaceutical industry for their practices.

The author is Dr. Marcia Angell, who has had a front-row seat having worked on the staff of the New England Journal of Medicine for 20 years – winding up her career there as Editor In Chief in the late ‘90s. It’s hard to over emphasize the gravity of someone of Dr. Angell’s experience and stature writing a book like this that, as far as I can tell, doesn’t pull a single punch. I suppose it shouldn’t be an enormous surprise, She is married to Dr. Arnold Relman whose book A Second Opinion does much of the same for the entire practice of medicine in the US.

A Second Opinion: Rescuing America’s Health Care

Though this book is kinds long-in-the-tooth by medical policy issues standards (having been published in 2004) it’s not just a little depressing to note that the fundamentals haven’t changed (although, I should be fair and note that there have been some changes in the margins – will get to those in a bit)

So, what are the big takeaways, just in case you don’t read the book :). Well, here are a few:

  • By any objective measure, pharmaceutical companies pay *at least* twice as much for marketing and promotion of their products as they do for research and development of products. It might do well for you to really take that in. An industry that constantly bombards you with the holier-than-thou pronouncement of the centrality of their products to life itself, spends at least twice as much in marketing and promotions than it does for the actual science.
  • ‘Education’ to physicians and other care providers, is actually nothing more than a form of marketing. Everyone knows this but most choose to remain silent and play along
  • ‘Research’ (i.e. many of the clinical trials used to tout the capabilities of drugs) are nothing more than marketing in disguise. This is especially the case for the ‘Phase IV’ trials that take place after a drug has come to market. These trials are almost exclusively biased towards enabling the results to be used as marketing and promotions fodder – not for the purpose of actually determining the effectiveness of the drug or comparing its effectiveness with other treatments.
  • The price-fixing of the cost of drugs in the US (brought to you by millions of dollars in lobbing might heaped on your local legislators) is a putrid, steaming pile of excrement that is hard to believe those in charge sit in every day without expiring from the fumes.

Now, to be clear, I’m clearly not against pharmaceuticals, per se. We are able to live longer, healthier lives because of the breakthroughs in pharmaceuticals. There is a point at which one has to ask: are the benefits that are accruing to us now worth the cost?

Not only does Dr. Angell lay it on pharma, she also makes a few, common-sense suggestions for you, the consumer, to consider when encountering the medical care system:

When your doctor prescribes something, ask:

  • Where’s the evidence this works at all, or better than another, older, drug?
  • Are you getting your ‘evidence’ from the pharma rep, or was there an independently-funded, well-designed clinical trial that proved it was better?
  • Do you have any financial ties related to the prescription?

Other tidbits:

  • Ask your elected representatives if they receive contributions from the pharmaceutical industry.
  • Ignore direct-to-consumer ads for prescription drugs.

New Atkins – not your big-brother’s diet

You remember the craze, don’t you. Back in 2003 and 2004 it was all Atkins, all the time. TV shows, packaged products lining grocery store aisles. Phenomenal stories of quick weight loss.

Then, like every other fad, it seemed to fade away. Products disappeared from store shelves, negative stories started popping up in the press and grave warnings from people who supposedly know better than you.

So, why on earth would there be anything truly new about the Atkins diet that would be worth noting? Well, let’s find out.

New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great.

One more benefit from having attended last month’s ASBP conference in Seattle was the opportunity to meet two of the authors of this book. In speaking with Dr. Westman, I noted several of my colleagues at work had been probing to see how we could organize our efforts to increase the awareness of the benefits of carbohydrate restricted diets (and high-intensity strength training) towards the end of enabling weight loss and addressing metabolic syndrome and diabetes. Our benchmark for comparison was the very successful 20/20 Lifestyles program which was developed at the Pro Sports Club in Bellevue Washington. Without getting into tons of detail about the program, I can say that it has worked for a great many people. The challenge, though, is that it is extremely expensive and extremely time-consuming. However, it does tick all the ‘conventional wisdom’ dietary checkboxes (calorie restriction, reduced fat, etc.). We thought an Atkins-like alternative could be just as successful at a fraction of the cost and effort. Our first self-critical question was the risk. You’re always ‘safe’ if you stick with the conventional wisdom. If anything does go wrong (i.e. someone has a major adverse event while on the program) if you’re in with the crowd, you have cover. If you’re not, you’re liable to get picked off, if you know what I mean.

When I recounted this line of reasoning with Dr. Westman, he assured me that he had it covered. Specifically, a major reason why he and his collaborators wrote the book was to decisively report the overwhelming clinical evidence of the effectiveness of this approach and that he and his colleagues had been treating their patients very successfully in their clinical practice for years. Now that I’ve finally gotten through the book, I can report that he did not disappoint.

In some ways, it’s the standard fare: chapters about the principles around which the diet was based, chapters about how to actually implement the diet, meal plans, recipes. But there are two major things that make this book stand out in my mind.

Deconstructs all the potential straw-men

One of the oft-repeated characterization (caricature?) of the Atkins approach is that it’s all about eggs and sausage all the time. While this book is no exception in extolling the virtues of eggs and high-quality, full-fat protein, it explicitly calls out the value of what are referred to as ‘foundation’ vegetables. Simply described as the ‘non-starchy’ vegetables (leafy greens, cruciferous, etc.). These vegetables are part of the plan form day 1 (even in the ‘induction’ phase). They have even included options for vegetarians and vegans. That’s right: a vegetarian Atkins dietary plan – strange bedfellows, indeed.

Overwhelms you with clinical evidence

Just as the doctor stated, the big payoff for me in this book was chapters 13 and 14 which they clearly have targeted to skeptical clinicians. They reiterate all the relevant biochemistry, cite their many successful interventions and buttress their arguments by citing no fewer than 71 publications in peer-reviewed journals that support their approach. Seventy one.

In terms of down-to-earth, practical advice combined with scientific and clinical support for said advice, this book is now at the top of the heap (edging out ‘6-Week Cure’) of books I will recommend to those who want to alter their nutritional practices to benefit their overall health.

Healthier Without Wheat – Redux

In an earlier post, I mentioned having attended a talk given by Dr. Stephen Wangen, author of Healthier Without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance.

Healthier Without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance.

In that post, I said I’d follow up after having completed the book, so here’s the post I said I’d write.

The short summary is it should be an eye-opening book for anyone. Dr. Wangen has taken up this issue in a previous book entitled The Irritable Bowel Syndrome Solution as well in his clinical practice where he has become a ‘go-to’ person for those with wheat allergies, gluten intolerance and irritable bowel syndrome (IBS). Given I’ve been on the dietary fringe for some time, it’s easy for me to underestimate the extent to which this book pierces deeply entrenched notions about what’s ‘good’ and ‘healthy’ for you. Think about it, this book essentially makes the assertion that this staple of life (bread of life) should be treated more like a toxin and should only be consumed as a last resort, given its metabolic effects on the body.

As is often the case with books written by clinicians in active practice, it has more then its fair share of testimonials/case studies. While I understand this approach appeals to lots of people and makes the whole thing less dry for most, I skip over most of them. But they’re there for you if you want them.

Found his explanation of the origin of cereal grains and the differences and commonalities among them fascinating. He includes a ‘family tree’ of grains that include all the ones we find in common use today: wheat, oats, corn, rice, spelt, etc.

Having known very little about IBS, celiac disease and the like, it was enlightening to have him clearly delineate the differences among these conditions and state categorically that these ‘conditions’ only persist as long as you consume the offending item (wheat or gluten as the case may be).

The only major issue I had with the book is the repeated reference to an extremely wide range of symptoms that might lead you to consider whether you might have an allergy/intolerance. There were instances where, after I read the list, I wondered what adverse condition was left out. So that’s where I’d include a gain of salt. He also spent a lot of time describing the diagnostic methods he uses to make a determination as to what might be at the root of issues you’re seeing. Got a sense that these sections were more directed at his peers whose patients might pick up the book and ask their doctor’s about it. Wouldn’t want to leave out stuff that would clearly show you knew what you were doing since the book is likely to wind up in the hands of other physicians either directly or indirectly.

So, the bottom line is it is well worth the read if you or someone you care about has issues with wheat or gluten. It is also of interest to those who are not so wedded to our revered food staple (bread) that they might be considering giving it up to better their health.

21 Life Lessons from Jimmy Moore

About a month ago I had the privilege of meeting the internationally known low-carb blogger Jimmy “Livin’ la Vida Low-Carb” Moore. This opportunity to meet was afforded to me in connection with the American Society of Bariatric Physicians conference about which I wrote at the time.

Well he seemed like a fun and engaging enough fellow based on his blog, podcast and YouTube channel (busy guy!), but it’s nothing like meeting a person face to face. It’s hard to imagine anybody who wouldn’t like Jimmy. He’s fun, doesn’t take himself overly seriously and, at the same time, has a real thirst for knowledge which he shares with his readers. And, by the way, managed, through diet and perseverance, to rid himself of over 180 excess pounds by switching to a carbohydrate-restricted diet back in 2004.

So you can imagine my good fortune to be offered a signed copy of his most recent book 21 life Lessons from Livin’ la Vida Low-Carb.

21 Life Lessons From Livin’ La Vida Low-Carb: How The Healthy Low-Carb Lifestyle Changed Everything I Thought I Knew

The book book is organized around 21 lessons. Some about diet and nutrition (“Low-carb is much more than a diet” and “Low-carb is not even close to being a fad diet”). Others about life lessons (“If you put yourself out there on the internet, people will judge you” and “If you put yourself out there on the internet, people will love you”). Anyway, you get the drift. Weighing in (heh, he said ‘weighing in’) at 471 pages, he could have benefitted from the deft hand of a skillful editor, but the passion and the sincerity surely come through.

Throughout, Jimmy is his open, self-critical, yet always upbeat self. He’s been through a lot in life and you can’t help but admire his optimism. He’s become a friend now (thanks for the mention on your blog, by the way) and while I had admired him from afar and wished him health and success, having met him and gotten to know him, I can say that great things couldn’t happen to a nicer guy.

Keep it going, Jimmy!

Best Care Anywhere? The VA?

You better believe it.

The second edition of Best Care Anywhere: Why VA Health Care I Better Than Yours just hit the bookstore shelves and I just lapped it up. I was offered the first edition of this book back in 2007 when I was new to working in health care and so very uninformed about it. This book really swept away the cobwebs in my mind in that I had no concept that the incentives imbedded in our system of medical care delivery did not always encourage the best care. It, in fact, encourages more care which as we know from decades of work in comparing medical effectiveness (see Dartmouth Atlas of Health Care) actually suggests a negative correlation to outcomes.

In that way, this book very much undersells itself – it’s about way more than just the VHA. It does what it sets out to do by spelling out what researchers have found which is that in a broad range of metrics, the care provided our veterans in the Veterans Health Administration is the best care available in America  today. It’s also telling that this second edition is made available some 3+ years after the original and the data still hold true.

What is this data, you might ask:

  • New England Medical Journal noted that the VHA was “significantly better” in all measures connected with fee-for-service Medicare
  • Annals of Internal Medicine reported that the VHA was the best in all seven measures of quality in comparison to its private industry counterparts
  • RAND study concludes that the VHA outperforms all other sectors of American health care in 294 measures of quality
  • National Quality Research Center in Michigan found that the VHA had the highest patient satisfaction of any public or private sector health care system
  • Journal of the AMA wrote in 2005 that the VHA “quickly emerged as a bright start of patient safety”

That’s not even the whole list. And, by the way, they do it at a per-member cost that is a little over 8% less than private sector counterparts. More value at lest cost. I thought that was only supposed to be possible in the private sector.

Well, as it turns out, another thing the author succinctly points out is medical care does not behave like other markets. The author refers to this phenomenon as Roemer’s Law. Put succinctly: in typical markets, increased supply leads to lower prices, in medical care more supply just results in more utilization and higher costs. See, all this stuff in a very small package – and extremely quick read – and you have the makings of a classic. And it is.

Support Lierre Keith

Readers of this space will recall my recent recommendation of The Vegetarian Myth by Lierre Keith.

I’m writing about it again because I wanted to inform you that Lierre was a victim of a punk attack last week – apparently by those who were threatened by her message. Never mind Lierre lives with a severe spinal condition that renders her a physical threat to no one. Never mind that she was simply using well-put words to educate. While I cannot say I agree with all she says, I am extremely grateful for her contribution. However, some people who felt so threatened by the words sought to do her harm because of them.

My immediate, visceral reaction is one of utter disgust that someone would do this. My second thought (once my frontal lobes become engaged) is I can only imagine how utterly bereft one must feel in order for this act to make you feel better somehow. Must be quite an unbearable existence.

Have a nice grass-fed steak next time, instead of taking your frustrations out on those with whom you disagree.

For the rest of us, I encourage you to buy Lierre’s book. My post goes into all the reasons why it would be worth your while based on the books merits. All the more reason to support Lierre now to drive home the point that such acts only make the target of such cowardly acts stronger.

 The Vegetarian Myth: Food, Justice, and Sustainability

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