Medical treatments for the poor (not)

Medical treatments for the poor (not)

I recently finished reading a book by a newly-minted doctor called No Apparent Distress: a Doctor’s Coming-of-Age on the Front Lines of American Medicine, by Rachel Pearson. As the blurb says, it’s “a brutally frank memoir about doctors and patients in a health care system that puts the poor at risk.” Pearson is a good writer.

While she was a medical student, the author volunteered at a free clinic in Galveston, Texas. One man, who lived at the Salvation Army shelter, came to the clinic with cancer of the esophagus. The local hospital had diagnosed the cancer but did not treat it because he was uninsured. He was 61, ineligible for Medicare, and, as an adult with no dependent children, he was also ineligible for Medicaid in Texas. At the clinic, all the staff could do was try to get him something for pain, which was extremely difficult because of the clinic’s non-opioid policy—even though opioids are the “standard of care” for cancer pain. They managed to get him a prescription for methadone, which his brother helped pay for. But not all pharmacies always carry methadone, and he’d have to ride his bike all over Galveston to find a pharmacy that had it on hand.

The clinic staff also tried to get him treatment by applying for indigent care, filling out endless paperwork and applying to hospitals all over Galveston County. The applications were denied over and over again. After eight months, the patient was finally accepted into the Galveston County indigent care system. But the county said he had to live within walking distance of the hospital that would be treating him. It was nowhere near the Salvation Army shelter. The patient’s brother came through again and bought him a trailer near the hospital. The patient was scheduled to begin chemotherapy. But the treatment never occurred. The county told the patient that he no longer qualified for indigent care because he owned a trailer. He was too wealthy.

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My opinions are supported

Here are a couple of research studies that support my opinions.

Fat versus carbs: A seven-year international study of 135,335 people, ages 35 to 70, showed that the people with the highest 20 percent in total fat intake—an average of 35.3 percent of calories from fat—had about 23 percent reduced risk of death compared with the lowest 20 percent, who consumed an average of only 10.6 percent of their calories from fat. The fats could be saturated, polyunsaturated and monounsaturated. What’s more, the higher fat diets were also associated with a lower risk of stroke. As to carbs, those who ate the highest 20 percent had a 28 percent increased risk of death, but not necessary from heart disease. This study was reported in the journal Lancet.

Over-treatment: A survey of 2,106 physicians, indicated that, on average, they believed that 20.6 percent of all medical care was unnecessary, including 22 percent of prescriptions, 24.9 percent of tests, and 11.1 percent of procedures. For example, they believe that a quarter of all spine surgeries may not be necessary as well as half of all stents placed in arteries. About 60 percent of doctors said patients demanded unnecessary treatment. They also said there are too many operations done for narrowed blood vessels in the legs. What the heck is that? I’ve never heard of such a thing. (I had painful varicose veins stripped from my leg when I was in my 20's and am glad I did. Pain went away. Plus the doc discovered I had an extra vein, which I guess can come in handy.)

Anyhow: eat fat! Avoid medical procedures (mostly)!

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Improve brain function (maybe) with low carb eating!

Most of the time your body burns glucose for energy. The glucose comes the carbohydrates you eat. If you don’t eat carbohydrates, your body burns fat for fuel—including stored fat. This process is called lipolysis. The byproducts of lipolysis are ketones—the fuel your body uses instead of glucose. In this situation, your body is in a state called ketosis. (Getting your body into this state is the basis of the Atkins diet.)

Recently, an article in The Scientist, had this headline:  “Studies: Ketogenic Mice Live Longer, Healthier Lives,” with the following subhead “High-fat, low-carbohydrate diets are shown to increase lifespan and preserve memory in two independent mouse experiments.” I knew that you could lose weight with a ketogenic diet, but live longer? Preserve memory?

Two independent studies on mice (published in Cell Metabolism) showed that the mice “avoided obesity and memory decline and displayed reductions in midlife mortality” and also showed “improvements in motor function, grip strength, and other indicator of muscle mass.” One of the researchers also noted that “The older mice on the ketogenic diet had a better memory than the younger mice. That’s really remarkable.”  While these are just mice we’re talking about, I wouldn’t be surprised if the same effect could occur in people, which the researchers will go on to study.

Eating a very low carbohydrate diet isn’t easy (fruits and vegetables are carbohydrates, not just bread, cakes, and pasta). I tried it for a while. You can get these special paper strips to test your urine to see whether your body has gone into a state of ketosis (burning fat for energy). Even though I was quite strict, mine never turned the color it was supposed to—although it did get part way there. But a friend of mine said it happened instantly for her. People are different!

Because I believe in low carb diets, that’s the way we try to eat around here. But my brain function hasn’t changed, nor has my weight. I'm not strict enough.

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Questioning inflammation’s role in cardiovascular health

In last week’s post, I wrote about studies that showed the role of inflammation in cardiovascular disease, particularly atherosclerosis (plaque in arteries; also called hardening of the arteries). But what about the Tsimane, a group of subsistence farmers and hunters living in Bolivian jungles? Scientists have been studying these people for 15 years. The Tsimane have frequent infections and show chronically elevated levels of inflammation. Nevertheless, they have very little atherosclerosis.

Their diet consists of 72 percent carbohydrates (corn, rice and plantains that they grow), 14 percent saturated and unsaturated fat, and 14 percent protein. Scientists recently gave 705 of these people cardiac scans to look for the presence of plaque buildup in their arteries. A score of 0 means no buildup; 0 to 99 indicates low levels; 400 or greater indicates high levels. Eighty-five percent scored 0, and only 3 percent exceeded 99. Even among those older than 75, only 8 percent exceeded 99. As a group, their scores were less than one-fifth the scores of people in the United States. Those who did develop some atherosclerosis developed it 25 years later than those in the US.

Their secret? You guessed it: they are constantly on the move, farming, hunting, and gathering. The men spend seven hours or so every day hunting, fishing and poling their canoes. The women gather nuts, farm rice, corn and plantains. Both men and women cover roughly eight miles a day! Goodness! That’s a lot of walking!

After my parents died of heart disease at ages 79 (father) and 85 (mother), I had one of those scans that were all the rage for a while (Oprah was promoting them). Mine was not whole body; just heart. My score was zero: no plaque whatsoever. That was 15 years ago when I was 66. Oddly, it didn’t make me feel immune. I still figure heart disease will do me in. I suppose I could walk eight miles a day. Not.

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Reduce inflammation for just $200,000 a year!

A new study has shown that a drug, originally used to treat juvenile rheumatoid arthritis and other rare disorders, reduces the risk of heart attacks and strokes in people with cardiovascular disease. The drug treatment does have a couple of drawbacks, such as the cost ($200,000 a year) and the risk of death. In fact, in the study, deaths from infection appeared to match any lives saved by the drug, so there was no difference in mortality. (The medicine suppresses part of the immune system, hence the deaths caused by infections.)

The drug, called Ilaris, reduces inflammation by inhibiting interleukin-1β, a substance that triggers inflammation in response to infection. The study report hints at the fact that lowering cholesterol may not be the answer to reducing heart attacks (half the people who have heart attacks have normal cholesterol). People with heart disease have high levels of inflammation, which is measured by the level of C-reactive protein in your blood. The importance of the study is that it’s the first real evidence that if you inhibit inflammation you reduce the risk of heart attacks.

Let me just say this: in my book, Fat: It’s Not What You Think, I say “Because atherosclerosis begins as a lesion and inflammation, the presence of C-reactive protein may be a more important indicator of heart disease than high cholesterol…C-reactive protein is released into the bloodstream in response to inflammation and plaque buildup in the coronary arteries.” I also quote a cardiologist who says, “Inflammation is emerging as the alpha and omega of heart disease.” My book was published in 2008. Just sayin’…

But how to reduce inflammation without paying $200,000 a year and suppressing your immune system? Some people swear by an anti-inflammatory diet, but research hasn’t proven the efficacy of that method. I don’t know the answer. Drugs such as Advil or Aspirin also don’t get the job done (they don’t work on interleukin-1β,) Maybe there’s nothing you can do. (On the other hand, my post next week questions the role of inflammation.)

If you haven’t read my first posts, you don’t know that I haven’t had a checkup or had my cholesterol checked in about 14 years. Not my thing. But it would be interesting to get checked for C-reactive protein. I’ve considered doing it just out of curiosity.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.