Tuesday, March 27, 2012

What is Diabetes?

Diabetes(diabetes mellitus) is a metabolic disease where there are high levels of sugar (glucose) in a person's blood. Type 1 diabetes is caused by the pancreas not producing enough insulin and Type 2 diabetes occurs when the cells do not respond to insulin to metabolize sugar. Type 2 diabetes is more common, is often genetic,  and there is an epidemic if this type of diabetes occurring


In upcoming posts, I plan to pursue two main themes.  The first is a more comprehensive exploration of what determines eating behavior in humans, the neurobiology behind it, and the real world implications of this research.  The reward and palatability value of food are major factors, but there are others, and I've spent enough time focusing on them for the time being.  Also, the discussions revolving around food reward seem to be devolving into something that resembles team sports, and I've had my fill.

The second topic I'm going to touch on is human evolutionary history, including amazing recent insights from the field of human genetics.  These findings have implications for the nutrition and health of modern humans. 

I look forward to exploring these topics, and others, with all of you in the coming months.

Monday, March 26, 2012

Recent Media Appearances

Men's Health interviewed and quoted me in an article titled "Reprogram Your Metabolism", written by Lou Schuler.  Part of the article was related to the food reward concept.  I'm glad to see the idea gradually reaching the mainstream. 

Boing Boing recently covered an article by Dr. Hisham Ziauddeen and colleagues in Nature Reviews Neuroscience that questioned the idea that common obesity represents food addiction-- an idea that I often encounter in my reading.  Maggie Koerth-Baker asked me if I wanted to respond.  I sent her a response explaining that I agree with the authors' conclusions and I also doubt obesity is food addiction per se, as I have explained in the past, although a subset of obese people can be addicted to food.  I explained that the conclusions of the paper are consistent with the idea that food reward influences fat mass.  You can find my explanation here.

Sunday, March 25, 2012

This is what gastroenteritis looks like

Good news:  It only lasts a day

Spots on the Scrotum

The answer to yesterday's Image Challenge was #2 - Fordyce's angiokeratomas.

Like many unusual medical names, the condition was first described by John Addison Fordyce in 1896.
These tiny blood vessels (capillaries) are under the superficial dermis and can be found on both men and women in the scrotum and vulva area.  They are painless and appear in the 2nd and third decade and may continue

Thursday, March 22, 2012

Food Reward: Approaching a Scientific Consensus

Review papers provide a bird's-eye view of a field from the perspective of experts.  Recent review papers show that many obesity researchers are converging on a model for the development of obesity that includes excessive food reward*, in addition to other factors such as physical inactivity, behavioral traits, and alterations in the function of the hypothalamus (a key brain region for the regulation of body fatness).  Take for example the four new review papers I posted recently by obesity and reward researchers:
Read more »

Image Challenge


 What is the diagnosis?

 You be the doctor.  This 32 year old man wonders about the raised spots on his testicles.  They are non-tender and non itchy.  (click on the image for a close-up view)

1. Beta-galactosidase deficiency
2. Fordyce's angiokeratomas
3. Radiation dermatitis
4. Scabes
5. Varicocele

The answer will be posted tomorrow so be sure to check back.  Make your guess in the

Wednesday, March 21, 2012

Goal Play Leadership Lessons

My blog friend,  Paul Levy,  former CEO at Beth Israel Deaconess Medical Center in Boston,  was the first hospital CEO to create a blog ("Running a Hospital")  that became famous for it's honesty and look into a hospital's inner workings.  He is now embarking on the next chapter of his life with the publication of his new book," Goal Play - Leadership Lessons from the Soccer Field."   Who knew

Monday, March 19, 2012

Speaking at AHS12

I'll be giving a 40 minute presentation at the Ancestral Health Symposium this summer titled "Digestive Health, Inflammation and the Metabolic Syndrome".  Here's the abstract:
The “metabolic syndrome” is a cluster of health problems including abdominal obesity, insulin resistance, low-grade inflammation, high blood pressure and blood lipid abnormalities that currently affects one third of American adults.  It is the quintessential modern metabolic disorder and a major risk factor for diabetes, heart disease and certain cancers.  This talk will explore emerging links between diet, gut flora, digestive health and the development of the metabolic syndrome.  The audience will learn about factors that may help maintain digestive and metabolic health for themselves and the next generation.
Excessive fat mass is an important contributor to the metabolic syndrome, but at the same level of body fatness, some people are metabolically normal while others are extremely impaired.  Even among obese people, most of whom have the metabolic syndrome, about 20 percent are metabolically normal, with normal fasting insulin and insulin sensitivity, normal blood pressure, normal circulating inflammatory markers, and normal blood lipids.

What determines this?  Emerging research suggests that one factor is digestive health, including the bacterial ecosystem inside each person's digestive tract, and the integrity of the gut barrier.  I'll review some of this research in my talk, and leave the audience with actionable information for maintaining gastrointestinal and metabolic health.  Most of this information will not have been covered on this blog.

The Ancestral Health Symposium will be from August 9-12 at Harvard Law School in Boston, presented in conjunction with the Harvard Food Law society.  Tickets are currently available-- get them before they sell out!  Last year, they went fast.

See you there!

Sunday, March 18, 2012

How Doctors Get Paid

Medical economics is more confusing than "advanced derivatives" and the entire banking industry collapse.  Have you ever wondered how doctors get paid?  I will try to give a brief tutorial.  Consider it "Doctor Reimbursement 101".

First of all, all payments made by Medicare or Insurance companies are based on a weird rating called the Relative Value Scale.  A group of mainly specialty

Saturday, March 17, 2012

Qnexa, the Latest Obesity Drug

There are very few obesity drugs currently approved for use in the US-- not because effective drugs don't exist, but because the FDA has judged that the side effects of existing drugs are unacceptable. 

Although ultimately I believe the most satisfying resolution to the obesity epidemic will not come from drugs, drugs offer us a window into the biological processes that underlie obesity and fat loss.  Along those lines, here's a quote from a review paper on obesity drugs that I think is particularly enlightening (1):
Read more »

Friday, March 9, 2012


I just had a featured article published on Boing Boing, "Seduced by Food: Obesity and the Human Brain".  Boing Boing is the most popular blog on the Internet, with over 5 million unique visitors per month, and it's also one of my favorite haunts, so it was really exciting for me to be invited to submit an article.  For comparison, Whole Health Source had about 72,000 unique visitors last month (200,000+ hits).

The article is a concise review of the food reward concept, and how it relates to the current obesity epidemic.  Concise compared to all the writing I've done on this blog, anyway.  I put a lot of work into making the article cohesive and understandable for a somewhat general audience, and I think it's much more effective at explaining the concept than the scattered blog posts I've published here.  I hope it will clear up some of the confusion about food reward.  I don't know what's up with the image they decided to use at the top. 

Many thanks to Mark Frauenfelder, Maggie Koerth-Baker, and Rob Beschizza for the opportunity to publish on Boing Boing, as well as their comments on the draft versions!

For those who have arrived at Whole Health Source for the first time via Boing Boing, welcome!   Have a look around.  The "labels" menu on the sidebar is a good place to start-- you can browse by topic.

Tuesday, March 6, 2012

Electronic Health Records Don't Cut Costs

A new study was published in the Journal Health Affairs that reports computerized patient records are unlikely to cut health care costs and might encourage doctors to order more expensive tests.

Save your research dollars, Health Affairs...I could have told you that!

The electronic health record gives doctors information about the patient instantly and helps coordinate care between

Saturday, March 3, 2012

Spam Comments on EverythingHealth

Dear Readers,
I am seeing more and more comments on EverythingHealth that are not real but are simply there to drive readers to commercial webpages, advertisers or porn. 

All bloggers love comments and the dialog that goes with social media.  That is why we blog and I never delete controversial comments or criticisms.  Most commenters are respectful and very thoughtful and I learn a lot from


I've decided, on the sage advice of a WHS reader, to join the world of Twitter.  I'll be using it to announce new posts, as well as communicating papers that I find interesting, but either don't have time to blog about or think are too technical for a general audience.  My tag is "whsource".  Head on over to Twitter if you want to follow my tweets.

Thursday, March 1, 2012

Embezzlement in Doctors Offices

I just read an article that talked about more medical practices being victims of embezzlement.  In a 2009 survey of members of the Medical Group Management Association (MGMA), 83% of 945 respondents said they had been the victim of employee theft.  I guess this means I can come out of the closet now.  I have always been ashamed that my practice of 5 Internal Medicine doctors was embezzeled by