The right food for you

Scientists are continually learning more and more about the ways in which our gut bacteria (microbiome) affect our health. Now they are trying to individualize this information by pinpointing  the health effects of particular foods eaten by particular people, assuming bacteria are accomplices. Case in point: cardiologist Dr. Eric Topol participated in a two-week experiment in which a smartphone app tracked every morsel of food he ate, every beverage he drank, and every medication he took. He submitted a stool sample to get a reading of his gut microbiome and wore a sensor that monitored his blood-glucose level. All of this information was analyzed by artificial intelligence which produced an algorithm that showed the effects of the foods he ate.

Basically, he learned which foods (and the bacteria’s actions on those foods) created spikes in his blood-glucose levels. These spikes, which are thought to be an indicator of diabetes risk, are the first objective proof that people respond differently to eating the same food. In collecting billions of data points on thousands of people, researchers have found that more than a hundred factors are involved in glucose spikes (glycemic response). Surprisingly, they learned that food was not the key determinant. Instead, it was the gut bacteria. (It should be noted that a substantial portion of healthy people have high glucose levels after eating.)

Dr. Topol was surprised at the outcome of his test as shown by glucose spikes. He got an A for cheesecake, but C- in whole-wheat fig bars; an A+ for strawberries but a C in grapefruit; an A+ for mixed nuts, but C for veggie burgers; A+ for bratwurst, but C- for oatmeal.

Obviously, the takeaway from such studies is that there is no such thing as a universal diet—one that is right for everyone. Our bodies, and especially our microbiomes, are simply too complex. For one thing, we harbor 40 trillion bacteria and 1000 species in our guts—probably unique mixtures of these critters in every person. Dr Topol, for example, has way more Bacteriodes stercoris than the general population. In comparison, my most abundant bacteria are in the Prevotella bacteria family.

As to the right food for you: you’ll probably never know.

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

Health care delivered to your door

I guess it’s no surprise that entrepreneurs are taking advantage of people’s disgust with the current state of health care (7 in 10 people think health care has major problems at the least) by giving you easy access to doctors, wellness programs, and prescription drugs. It’s part of the on-demand economy, like Uber and Amazon.

Some companies, such as one called Heal, will send a doctor or nurse practitioner to your home to treat non-emergency problems such as a sprained ankle or strep throat. Another company, The I.V. Doc, offers intravenous treatments for conditions such as hangovers, food poisoning, and jet lag.  GymGuyz, is a “gym on wheels” that sends a trainer and fitness equipment to your home. Other companies will come to your home and inject you with Botox and Restylane, if that’s your thing.

Then there’s a company called PillPack, owned by Amazon. This online company sorts your medications by date and time and delivers them to you monthly in little packets marked with day and time. I guess that saves your from having to put your pills in those little boxes marked with days of the week.

Many health insurers are on board with some of these businesses, apparently because early detection and treatment could prevent a problem into morphing into something worse that require hospitalization. Moreover, the visits can help people stay on top of chronic conditions such as high blood pressure and diabetes. Some insurance companies are even forming managed care partnerships with these new health care providers.

None of this will do me much good. I don’t take prescription meds and I doubt that any health care person is going to make it to Boulder Creek, much less up our sketchy one-lane road.

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

Getting medical care in foreign countries

In a Facebook post, a trusted friend of mine shared the following story (not hers) from an American traveling in Taiwan:

“A few days ago my stomach began to hurt. Thinking it would pass, I went home to try and rest for the night. A bit later I vomited. I thought that was the end of it. But for the rest of the night, I kept vomiting almost every 30-40 minutes. Even after my stomach was completely empty, I kept vomiting. Soon it was nothing but stomach fluid and bile. I tried to drink water to stay hydrated, but I kept throwing it up, no matter how hard I tried to keep it down. By 3:00 am I had severe stomach cramps, my body kept trying to vomit even though there was nothing left. I was dizzy and light-headed. My symptoms showed no signs of abating.

At this point I had to seek medical treatment, I knew I had to go to the hospital. I wanted to avoid it. I had no idea how different Taiwanese hospitals would be, whether I would be able to find an English-speaking doctor, or what it would cost me (my US health insurance has lapsed and I don't qualify for Taiwanese National Health Insurance). My Taiwanese roommate called a taxi and took me to the ER at NTU Hospital.

I was immediately checked-in by an English-speaking nurse. Within 20 minutes I was given IV fluids and anti-emetics. They took blood tests and did an ultrasound to ensure it wasn't gall stones or appendicitis. From there I was given a diagnosis: a particularly severe case of ‘acute viral gastroenteritis’ (aka the stomach flu). After about three hours on an IV, I began to feel slightly better, my nausea disappeared and my stomach began to calm down. I was discharged with a prescription for anti-emetics and pain medication. Each day since I’ve gotten progressively better and am now pretty much back to normal.

The bill for the ER visit? US $80.00. Eighty. American. Dollars. Out of pocket. Full cost. No discounts. No insurance. At one of the best hospitals in Taiwan. And if I had NHI, it would have been a fraction of that."

Following this story, someone commented with her own story of out-of-US medical care: “I had surgery to put my elbow back together in a small town in France and was in the hospital five days. The cost to me was $4000 for everything. Of course, this would have been 'free' to locals. The cost to remove the wires from the repair 6 months later in Chicago was $18,000—an outpatient surgical procedure.”

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

Young blood

You may have seen news reports about people paying big bucks to get transfused with young blood. The idea was hatched in 2013 when a couple of Harvard scientists stitched two mice together, one older than the other. They found that stem cells in the older mouse began acting like those of the younger one, in which case injuries healed better.  Later studies found that older mice, who received blood from younger mice, developed stronger hearts, better cells, and shinier fur.

Unsurprisingly, some entrepreneurs jumped on the idea of profiting from these findings. A company called Ambrosia, for example, would transfuse you with two liters of young blood for $12,000, promising to make you feel younger and rid you of various diseases. The company completed a clinical trial last May in which 81 participants, who paid $8,00 to be included in the trial, were transfused with 1.5 liters of young people’s plasma. The participants’ blood was tested for various biomarkers—indicators of overall health. According to the CEO, they “saw some interesting things,” but the results have not yet been published, and on February 19^th, this year, the FDA shut them down. You’ve missed your chance.

At this point, there’s no scientific evidence that transfusing young blood into older people has any benefits. In fact, according to one specialist in the field, what Ambrosia was attempting is dangerous and “quite likely could inflict bodily harm.” Apparently, about half of people who receive blood transfusions for medical reasons have “very bad side effects.”

It’s true that younger blood is better than old blood. But that’s not what you’ll get if you need a transfusion. You’ll get a mixture of different ages. So don’t get your hopes up.

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

Maximizing profit in medicine

Anna Lembke, MD, chief of addiction medicine and professor at Stanford University School of Medicine, has this to say about her profession: “All of health care has become overwhelmed by a hucksteresque opportunism, in which making a buck is the driving force behind practicing medicine.” She talks about the “enormous pressures on doctors today to prescribe pills, perform procedures, and please patients…”

Most physicians today are in practices owned and operated by hospitals or “integrated health delivery systems.” I’m sure you’ve seen such “systems.” Here in Boulder Creek (population 5000) what used to be the Boulder Creek Medical Clinic is now under the aegis of Dignity Health Medical Group, as is our nearest hospital fifteen miles away. This arrangement has transformed medical treatment. Treatment options are often dictated by hospital administrators, the Joint Commission (an accreditation outfit) guidelines, and health insurance companies. Among other things, doctors are expected to “increase productivity”—that is, to meet their billing quota.

As Dr. Lembke says, “The pressure to see more patients per unit time and to bill more per patient pervades all of medicine, encouraging doctors to prescribe drugs.” She receives monthly billing statements informing her whether or not she is meeting her billing requirements. She tells the story of a family medicine doctor who “cherishes” the patients who only need a quick refill: “Those are my easiest patients. They are scheduled for ten minutes, but if I give them what they want, they’re out in five.”

I feel sorry for the doctors working under these circumstances. We, at least, have the choice to opt out.

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