The Brain Controls Insulin Action

Insulin regulates blood glucose primarily by two mechanisms:

1. Suppressing glucose production by the liver
2. Enhancing glucose uptake by other tissues, particularly muscle and liver

Since the cells contained in liver, muscle and other tissues respond directly to insulin stimulation, most people don't think about the role of the brain in this process.  An interesting paper just published in Diabetes reminds us of the central role of the brain in glucose metabolism as well as body fat regulation (1).  Investigators showed that by inhibiting insulin signaling in the brains of mice, they could diminish insulin's ability to suppress liver glucose production by 20%, and its ability to promote glucose uptake by muscle tissue by 59%.  In other words, the majority of insulin's ability to cause muscle to take up glucose is mediated by its effect on the brain. 

Read more »

Carpal Tunnel Syndrome

Immediately Post-op Carpal Tunnel release
Carpal Tunnel Syndrome (CTS) is common and is the result of the median nerve becoming squeezed or "entrapped" as it passes through the wrist down into the palm of the hand.  Because this is a sensory nerve, the compression causes tingling, burning and itching numbness in the palm of the hand and fingers. A different nerve goes to the little finger and

Teens and Soda and Junk Science

The headlines of a number of newspapers say "Soda Boosts Violence Among Teenagers."  A new study out of Harvard's Public Health Division analyzed data from 1878 14 to 18 year olds and found those who drank over 5 cans of non-diet soda a week consumed more alcohol and smoked more cigarettes.  Additionally those teens were more likely to carry a knife and exhibit violence toward family and peers.

Harvard Food Law Society "Forum on Food Policy" TEDx Conference

Last Friday, it was my pleasure to attended and present at the Harvard Food Law Society's TEDx conference, Forum on Food Policy.  I had never been to Cambridge or Boston before, and I was struck by how European they feel compared to Seattle.  The conference was a great success, thanks to the dedicated efforts of the Food Law Society's presidents Nate Rosenberg, Krista DeBoer, and many other volunteers. 

Dr. Robert Lustig gave a keynote address on Thursday evening, which I unfortunately wasn't able to attend due to my flight schedule.  From what I heard, he focused on practical solutions for reducing national sugar consumption, such as instituting a sugar tax.  Dr. Lustig was a major presence at the conference, and perhaps partially due to his efforts, sugar was a central focus throughout the day.  Nearly everyone agrees that added sugar is harmful to the nation's health at current intakes, so the question kept coming up "how long is it going to take us to do something about it?"  As Dr. David Ludwig said, "...the obesity epidemic can be viewed as a disease of technology with a simple, but politically difficult solution".

Read more »

Robots Bring Care to Remote Places

Both in the United States and around the globe there is a mismatch between needed medical care and the doctors who can provide it.  Most physicians are located in urban areas where there are hospitals, teaching schools, lab and Xray and specialists to deal with most every medical condition.  Rural areas in the United States lack these resources and patients either do without,  or must travel far

Kid's Allergies and Asthma

There never seems to be enough time for parents to ask all of the questions they want of their kid's pediatrician.  And parents whose children have allergies or asthma have lots of questions and new concerns that pop up all of the time.  The American Academy of Pediatrics has published an updated guide called "Allergies and Asthma - What Every Parent Needs to Know."   This paperback should go a

Ovarian Cancer Screening of No Value

If you want to create an outcry of indignation,  just inform people that certain screening tests are of no value and do not increase time on this earth.  People love the idea that if they do all the right things and get all the medical tests at the right time, they can prevent disease ( ....uh...no, tests don't prevent anything) or catch cancer early and cure it.

The furor over the lack of

Losing Fat With Simple Food-- Two Reader Anecdotes

Each week, I'm receiving more e-mails and comments from people who are successfully losing fat by eating simple (low reward) food, similar to what I described here.  In some cases, people are breaking through fat loss plateaus that they had reached on conventional low-carbohydrate, low-fat or paleo diets.  This concept can be applied to any type of diet, and I believe it is an important characteristic of ancestral food patterns.

At the Ancestral Health Symposium, I met two Whole Health Source readers, Aravind Balasubramanian and Kamal Patel, who were interested in trying a simple diet to lose fat and improve their health.  In addition, they wanted to break free of certain other high-reward activities in their lives that they felt were not constructive.  They recently embarked on an 8-week low-reward diet and lifestyle to test the effectiveness of the concepts.  Both of them had previously achieved a stable (in Aravind's case, reduced) weight on a paleo-ish diet prior to this experiment, but they still carried more fat than they wanted to.  They offered to write about their experience for WHS, and I thought other readers might find it informative.  Their story is below, followed by a few of my comments.

Read more »

Male Circumcision

Male circumcision has been practiced for cultural and religious reasons since ancient times and it is estimated that about 1/4 of the world's men are circumcised.  It is a controversial topic and the debate about medical benefits of circumcision has not been fully resolved.   The Journal of the American Medical Association (JAMA) has recently published three randomized trials from Africa that

Doctors Charging Add On Fees

 My telecom bill is pretty high when you take the basic rate and then add on "additional bundled services ($4.99)", "Internet Services ($7.00)", "Additional Voice Service ($25.72)", Taxes, surcharges and fees ($10.47), "911 fee ($.24)" and "other charges and credits ($2.99).  One way doctors could deal with their declining incomes (down 7%-25% adjusted for inflation depending upon the specialty)

Calming

All is Well

Answer to Medical Challenge

The answer to the Medical Challenge this week is #3 - Graves' disease.

The skin changes seen on the lower legs are typical of Graves' dermopathy.  The skin has a leathery texture, thickening and fissuring.

Graves' disease, named after the Irish doctor Robert James Graves, who first described it in 1835 is caused by an overactive thyroid gland.  Thyroid auto-antibodies stimulate thyroid hormone

The Case for the Food Reward Hypothesis of Obesity, Part II

In this post, I'll explore whether or not the scientific evidence is consistent with the predictions of the food reward hypothesis, as outlined in the last post.

Before diving in, I'd like to address the critique that the food reward concept is a tautology or relies on circular reasoning (or is not testable/falsifiable).  This critique has no logical basis.  The reward and palatability value of a food is not defined by its effect on energy intake or body fatness.  In the research setting, food reward is measured by the ability of food or food-related stimuli to reinforce or motivate behavior (e.g., 1).  In humans, palatability is measured by having a person taste a food and rate its pleasantness in a standardized, quantifiable manner, or sometimes by looking at brain activity by fMRI or related techniques (2).  In rodents, it is measured by observing stereotyped facial responses to palatable and unpalatable foods, which are similar to those seen in human infants.  It is not a tautology or circular reasoning to say that the reinforcing value or pleasantness of food influences food intake and body fatness. These are quantifiable concepts and as I will explain, their relationship with food intake and body fatness can be, and already has been, tested in a controlled manner. 

1.   Increasing the reward/palatability value of the diet should cause fat gain in animals and humans

Read more »

Michael Jackson's Doctor

The 2nd degree manslaughter trial of Dr. Conrad Murray, the doctor who attended Michael Jackson at the time of his death June 25, 2009,  is now underway in LA.  The testimony that is taking place is certainly revealing of the last day of Mr. Jackson's life.  Michael Jackson died of an acute Propofol overdose and the toxicology report also revealed Valium, Lorezepam, Versed, Lidocaine  and

This Weeks Medical Challenge

Avert your eyes if you can't stand this weeks Medical Challenge  from the New England Journal of Medicine.  Click on the image for a better view.

This Patient is being treated for an endocrine disease.  What is it?
1.  Acromegaly ("giantism")
2.  Cushing's disease (excess cortisol)
3.  Graves' Disease (hyperthyroidism)
4.  Hashimoto's thyroiditis (a thyroid disorder)
5.  Type 1 diabetes

  The

scintillating scotoma

image from myaspiebrain
Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient's point of view.  After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing "words with friends" on my ipad and watching TV.  A scotoma is a partial loss of vision in a normal visual field.  Scintillate

Bedside Manners Worth $42 Million

A Chicago couple believes doctors should have good bedside manners and they have ponied up $42 million dollars to teach it.  Matthew and Carolyn Bucksbaum have donated to the Bucksbaum Institute for Clinical Excellence at the University of Chicago.  They made the donation for their own personal physician to lead it and say he's the kind of doctor students should emulate.  They were motivated to

The Case for the Food Reward Hypothesis of Obesity, Part I

Introduction

When you want to investigate something using the scientific method, first you create a model that you hope describes a natural phenomenon-- this is called a hypothesis.  Then you go about testing that model against reality, under controlled conditions, to see if it has any predictive power.  There is rarely a single experiment, or single study, that can demonstrate that a hypothesis is correct.  Most important hypotheses require many mutually buttressing lines of evidence from multiple research groups before they're widely accepted.  Although it's not necessary, understanding the mechanism by which an effect occurs, and having that mechanism be consistent with the hypothesis, adds substantially to the case.

With that in mind, this post will go into greater detail on the evidence supporting food reward and palatability as major factors in the regulation of food intake and body fatness.  There is a large amount of supportive evidence at this point, which is rapidly expanding due to the efforts of many brilliant researchers, however for the sake of clarity and brevity, so far I've only given a "tip of the iceberg" view of it.  But there are two types of people who want more detail: (1) the skeptics, and (2) scientifically inclined people who want mechanism.  This post is for them.  It will get technical at times, as there is no other way to convey the material effectively.

Read more »