Not everything you put in your mouth is good for you.
There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner.
On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way.
The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist.
Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.
Leaky Gut: Facts and Fads
Leaky Gut: Facts and FadsThe latest fad of supplement makers is to talk about "gut health." The latest boogyman for the gut is the "leaky gut." The other name for leaky gut is intestinal permeability.
A Surgeon's ViewAs a surgeon, a "leaky gut" is a devastating surgical emergency. Surgeons emergently operate to remove the gut that no longer has a barrier function.
The dark gut is dead and needs to be surgically removed. This gut has no barrier function and will allow bacteria from the inside of the small bowel to easily enter the patient's bloodstream. Leading to septic shock and death.
The Non-Surgical Emergency or Chronic Leaky GutBut a leaky gut doesn't have to be so dramatic. Not leading to septic shock or needing to be removed. In this model, the intestinal barrier is "leaky," not to the point of causing sepsis. But the leaky gut enables small molecules to leak out of the gut into the bloodstream. Thus producing chronic inflammation.
Chronic inflammation may cause obesity. Emphasis on "may."
Emulsifiers and ObesityRodent studies have provided fascinating insights. Certain emulsifiers, when added to the diet of mice or rats, lead to obesity. In one experiment, rodents were fed identical amounts of kibble. But one group, emulsifiers, was added to their water. These emulsifiers, like polysorbate 80, not only produced obesity but also disrupted the microbiome of the gut (ref). But mice are not men.
When dietary emulsifiers are examined in humans, high levels cause disruption of the gut. However, there is little evidence that small amounts found in the food supply cause issues. (ref 4)
Non-Humans and Leaky GutWhile animal models are interesting, human studies provide useful information. That a rat or mouse has a leaky gut based on some intervention is not an equivalence in humans.
Functional Medicine and Leaky GutIf you searched "leaky gut," you will find a host of "functional medicine" doctors providing supplements, bone broth, probiotics, and other scams. On the shelves of drug stores and "health food stores," you will find abundant supplements to "support gut health."
Disease States and Leaky GutFunctional medicine physicians associate many disease states with leaky gut. The following have little or no good evidence to be caused by a leaky gut:
Alcoholic cirrhosisAsthmaAutismChronic fatigue syndromeDepressionEczemaEnvironmental enteropathyEosinophilic esophagitisFibromyalgiaKwashiorkorMetabolic syndromeMultiple sclerosisNon-alcoholic fatty liver disease (NAFLD)ObesityPancreatitisParkinson's diseasePsoriasisRheumatoid arthritis
Non-Controversial Causes of Leaky GutThere is no doubt celiac disease, Crohn's disease, radiation, and ulcers from non-steroidal anti-inflammatory drugs; certain bacteria can cause a change in intestinal permeability (another name for leaky gut). Celiac disease and Crohn's disease have been studied for years (ref 2, ref 3). While we know gluten exacerbates the auto-immune function of those with Celiac disease, we do not yet have a mechanism for Crohn's disease.
Gut Barrier Anatomy and FunctionThe small bowel's purpose is primarily for the absorption...
The Beer and Sausage Diet
The Beer and Sausage DietThere are a lot of crazy diets out there. All of them you can lose weight with. Weight loss has many advantages. But the beer and sausage diet was fun. Here is what we learned:
A calorie is just a calorieBeing in calorie deficit is difficultMeticulous journaling is importantYour lab values will improve with weight lossA beer is a good unit measureWeighing your food is important
Episode Sponsor: Modifyhealth.com
I'm The DoctorIf you hear Evo Terra on national television talking about the beer diet, you will hear my name. I'm the doctor.
Late one September, I get a call from my friend, Evo Terra. He said, "October is coming; I want to lose some weight and want to do a beer fast. "
So we devise a diet, not just beer - but let's add sausages. After all, what is beer without sausages?
Careful SupervisionThis was a medically supervised diet. It ran for the month of October every year for four years. Every week he would come into my clinic. Every week he would have blood draws.
cholesterol levels liver enzymesWeekly weightWe would check muscle mass vs. fat mass inflammatory markers
We were prepared to stop the experiment and return him to a normal diet. For Evo, a normal diet is maybe not your diet. Since Evo likes the food I make, I assume he has a great diet. For many years, one of my great joys in Phoenix was when Evo and his wife would come over for dinner Sunday nights. Damn, I miss those days.
There are advantages to beer and sausagesA beer is a single unit. There is little variation in terms of caloric intake.
Sausage can easily be weighed, and Evo was strict regarding the weight of his sausages.
We added vitamins and fiber to his regimen.
He had six beers a day, and a designated driver at all times.
Science WinsFor those who say grains are evil and you can never lose weight or you would have horrible inflammation, well, Evo didn't fit with that. Because no one does. The idea that grains are evil is a myth of the low-carb community.
Vegans didn't like the idea of Evo eating sausages: "Pure processed meat will lead to inflammation and all the evils associated with eating meat."
It didn't happen.
Calorie deficit led to weight loss, despite drinking beer and eating sausages.
His inflammatory markers didn't rise; they went down.
His cholesterol went down.
His liver enzymes decreased - not that they were high to begin with.
Every year he kept his weight off - we are now over ten years past the last experiment.
Conclusions:I don't recommend this as a weight loss method. I do recommend weight loss by the simple principles of calorie restriction, a well-rounded diet, and vigorous exercise. Which diet, you ask? Either the Mediterranean or the DASH diet.
Evo wrote a book, and you can buy it here.
Losing Weight with Apps
Losing Weight With AppsCan a phone app help you lose weight? How about with your cholesterol, blood pressure, or waist size?
Perhaps you've heard the latest Noom ads, where they boast forty publications showing that their app will help you lose weight.
Apple is coming out with more ways to have their new watch track your heart rate and steps, with apps even looking at your yoga workout and eventually telling your blood glucose.
Episode Sponsor: Modifyhealth.com
What the Studies ShowA recent meta-analysis of randomized controlled trials showed that the average weight loss in the first three months was slightly below five pounds (2.18 kg).
Unfortunately, the weight loss didn't last. Nine months later, they had regained a pound and a half for a total loss of 3.5 pounds (1.63 kg).
Blood Pressure, Cholesterol, and CaloriesThere was a slight improvement in blood pressure at three months. But cholesterol and total energy intake, as well as waist circumference and blood glucose, remained the same.
The Proliferation of AppsThere are over 500,000 applications on Android and Apple phones to track various health data points. In addition, there are other devices just measuring fitness. The theory of measuring fitness behaviors with calorie tracking to provide feedback to improve health is appealing.
Many Apps With Poor QualityMany apps had a lack of behavioral coaching and poor quality of scientific information. Tracking over a three-day period found that the accuracy of energy intake among apps was only fair in terms of total calories and amounts of macro- and micronutrients.
What About NoomNoom is one of the more popular paid apps. They boast over 40 peer-reviewed articles. A quick glance at the articles showed some surprising flaws:
One article compared Noom in pancreatic cancer patients to a control group who received no coaching.
Another article used Noom data for their references.
Article after article that Noom sites are little more than using Noom's data without dropout rates.
References:Chen J, Cade JE, Allman-Farinelli M. The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment. JMIR Mhealth Uhealth. 2015 Dec 16;3(4):e104. doi: 10.2196/mhealth.4334. PMID: 26678569; PMCID: PMC4704947.
Chew HSJ, Koh WL, Ng JSHY, Tan KK. Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes. J Med Internet Res. 2022 Sep 21;24(9):e40141. doi: 10.2196/40141. PMID: 36129739; PMCID: PMC9536524.
Keum J, Chung M, Kim Y, Ko H, Sung M, Jo J, Park J, Bang S, Park S, Song S, Lee H
Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial JMIR Mhealth Uhealth 2021;9(8):e21088 URL: https://mhealth.jmir.org/2021/8/e21088 DOI: 10.2196/21088
Pohl, M. "325,000 mobile health apps available in 2017—Android now the leading mHealth platform. Research 2 Guidance." (2017).
Decreasing Cholesterol drugs and diet
Decreasing cholesterol: drugs and dietThere is a persistent belief that lifestyle can take care of all cholesterol problems. Lifestyle can make things worse, but once things are worse, it cannot make things better.
Once you have disease, or cholesterol is higher, you need treatment often beyond lifestyle management.
This distresses many people, who wish to have control over their fate.
High cholesterol is one of the main causes of heart attacks, strokes, and peripheral vascular disease. You can lower cholesterol through diet and exercise by as much as 15 percent. Lifestyle changes are the first choice to decrease cholesterol. Modern drugs, however, will lower cholesterol levels far more than diet or exercise.
The progressive changes of a vesselThe normal artery, as shown below, is a free-flowing blood vessel. When a person is in their late teens, there is already fatty formation on the inside of the vessel wall.
As more fat is deposited in the vessel wall, blood flow decreases, leading to ischemia in the end organ.
Angina, or heart pain, occurs when there is insufficient blood flow to the heart secondary to an artery narrowed by plaque.Factors contributing to atherosclerotic plaque formationDamage to the blood vessel begins the process of
SmokingHypertensionHigh blood sugarsDiets rich in saturated fats and refined grains
However, the lower the level of LDL, the less risk those factors become, as you shall see.
Anatomy of the Blood VesselIf you examine the autopsy specimen of the coronary artery above, the blood flows through that lumen. The inner wall, the wall the blood comes into contact with, is called the endothelium. There are three layers to the wall of an artery:
Tunica intimaTunica MediaTunica Adventicia
Atherosclerosis begins when the cholesterol transport protein enters the wall of the tunica media, whose first layer is the endothelium.
Discovery of LDLIn 1954, Dr. John Gofman reported the discovery of LDL and HDL. These were the particles found when he separated plasma cholesterol-carrying lipoproteins with an ultracentrifuge. Gofman was the first to note that heart attack patients had high LDL levels. The correlation of high LDL and heart attacks has been called “one of the most profound epidemiologic correlations in all of medicine.”
High LDL levels have been shown to correlate with atherosclerosis in all species studied.
High LDL and AtherosclerosisThe higher the LDL level, the faster atherosclerosis develops. Factors that increase atherosclerosis are those which injure blood vessels: smoking, hypertension, hyperglycemia, and genetic factors that predispose endothelium to early injury.
High LDL levels can lead to heart attacks in children as young as 6 years old. This rare form of homozygous familial hypercholesterolemia inspired Brown and Goldstein to elucidate the genetic defect in the receptor for LDL.
Discovery of the LDL receptor defecta href="https://pubmed.ncbi.nlm.nih.gov/3513311/" rel="noopener noreferrer"...
Alcohol and the Mediterranean Diet
Alcohol and the Mediterranean DietAlcohol consumption is controversial. No one disputes that excess alcohol consumption leads to dire consequences. But what about moderate alcohol consumption? Can we define moderate alcohol consumption? Is there a safe and therapeutic level of alcohol consumption?
Alcohol is a component of the Mediterranean Diet. However, the consumption is limited to 10 ounces of red wine for men, which translates to 14 grams of alcohol. Half that amount for women. In a number of articles, this amount of alcohol is beneficial.
Bias from AuthorsConfirmation bias is ingrained in all humans. Treatment programs for alcohol addiction teach that there is no safe level of alcohol consumption. Fundamentalist Christians, Muslims, and other organized religions have taboos regarding alcohol consumption. Finally, consumers of alcohol will be biased against abstinence.
Components of WineIn their article, Wine, Polypenols and Mediterranean Diet, the authors note that one can get polyphenols from other sources in the diet, and thus the alcohol may be unnecessary. They conclude that moderate consumption is likely an important component of a mechanistic as well as social norm.
Dose Dependent Effects of Polyphenols on the BodyDecreased risk of cardiovascular diseaseDose-dependent reduction of LDL-CIncrease HDL-C and decrease triglycerides in patients with diabetesReduction of Blood PressureIncrease production of nitric oxide (NO), which increases blood flow and reduces blood pressureImprove LDL/HDL ratioResveratrol inhibition of pro-inflammatory agentslower risk of type 2 diabetesResveratrol improves glucose homeostasisModulate gut microbiotaImprovement in blood vessel wall function (endothelial function)Reduction of drugs in diabetic patients
Mechanistic vs HolisticThe issue with the Mediterranean Diet is always those who approach from a mechanistic view versus those who approach nutrition and lifestyle from a holistic view. The original data from the Mediterranean Diet came from the Seven Countries Study. This was a holistic examination, not only of their diet but also their lifestyle.
Alcohol Toxicity is in the DoseA bit of wine is good, a lot of wine is not.
If you look at every improvement in human physiology with alcohol listed above, the opposite effect happens when the dose is beyond about 50 grams of alcohol.
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Mediterranean Diet After Weight Loss Surgery
Mediterranean Diet after weight loss surgerySuccess after weight loss surgery doesn't end with an operation. It just gets started.
The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention. The Mediterranean Diet is the best post-operative diet one can have.
Weight Loss and the Mediterranean DietThe Med Diet is favorable for health. Multiple studies have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery.
Preoperative Med DietWe began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale. Contrary to weight loss plans, our emphasis was learning the Med Diet.
Weight Loss Surgery Protocol Liquid PhaseThe immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins. Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet.
Early Solid Food PhaseLegumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos. Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish.
We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce.
Later Solid Food PhaseAs the stomach continued to heal, we stressed the increase in food with multiple fiber types. We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats.
Follow upCooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook. Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not.
Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were validated using dietary logs during follow-up with patients.
Getting in that quantity of foodStomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult.
All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point.
The increase of vegetables in the diet is one way to reduce inflammation.
Food increases over timeFood volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The...
Knowledge is power
Dr Simpson pulls no punches when giving you the facts but delivered in a way that is interesting with heaping scoops of wit and humor.
Great stuff here! Or not stuffed
Great podcast Terry appreciate your myth busts always learning
Love this food podcast!
If you're an avid fan of all things food, biology and science - this is a GREAT podcast. Not only is the host a Doctor - but if you look deeper - he's a bariatric surgeon - which really helps with his view on how food works within our bodies - not just tastebuds! I especially LOVE the food myths he continually busts! A true and verified show - with not just some "host" but a man who's gone to the University of Chicago, and backs all his facts with anotated notes - love it.