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Penance

By Dr. Jim Ferguson

I hope that Thomas Paine will not be offended as I paraphrase his immortal words, “These are the times that try men’s [waistbands].” The Thanksgiving cornucopia is past, but the Holiday Season has just begun and the pounds must be addressed if we are to button our slacks and zip our dress.

My patient came in and declared, “Doc, I’m on the ‘Paleo Diet’.” Fortunately, my Medical-ese saved me from appearing totally flummoxed. When you go to medical school you learn a new language, the language of science derived from Latin and Greek root words. In addition to text books I purchased Stedman’s Medical Dictionary which was about three inches thick. At first I looked up a lot of words as I studied, but as time went by fewer and fewer words stumped me. I actually looked up a word last summer and noticed the dust on the cover of my old dictionary. I said, “Paleo means old, so I guess you’re on a caveman’s diet.”

I was right. His “caveman” diet was based on what our hunter-gatherer ancestors were believed to have eaten. Their diet was meat, berries, nuts, whole grains and some plant vegetables. Our processed flour and sugar weren’t yet invented and salt was scarce. I can understand the logic of this diet, but there is little science to support it. Had I been argumentative I might have pointed out the life expectancy was twenty-five years at the end of the last ice age (about 12,000 years ago), and a man five foot tall was a giant.

There are many reasons humans now live longer and grow taller than in the past. These include clean water, antibiotics, vaccinations, but also safe and better food. In fact, the food and drug regulatory agency (FDA) began in 1906 after Upton Sinclair published his sensational novel The Jungle, depicting the deplorable conditions in Chicago’s meat industry.

It is true we have more processed food in our diet and often we leap to the conclusion that altering food from its natural state is bad. By definition a food that is frozen, refrigerated, dehydrated or prepared aseptically is processed. Pasteurized milk is therefore processed to kill bacterial contaminants. It is true that refined white flour, instead of whole grains, is often added to pasta and sodium is frequently used as a preservative and for flavor in canned goods. Obviously, Fruit Loops is not on the Paleo Diet.

Patients often ask me about diets, and I say it’s less about what you eat and more about how much you consume. All diets work if they provide fewer calories than required by the patient’s body, and result in weight loss and health benefits which justify the effort. Every year the US News and World Report reviews and ranks the numerous diets available. Also, Healthline.com offers a useful guide of the various options. The highest rated diet for cardiovascular health is the TLC (Therapeutic Lifestyle Changes Diet) developed by the NIH to lower the bad (LDL) cholesterol by restricting saturated fats. Also, the DASH diet receives high marks by lowering salt consumption and improving blood pressure control.

Every year the Weight Watchers program and Jenny Craig diet plans score very high marks through portion control, education and motivation. Diets like the Glycemic Index, South Beach and Nutri System focus on limiting sugar, and emphasize lean protein choices and lower caloric intake. Some believe that Americans can adopt the Mediterranean Diet of southern Italy, Greece and Crete and have the same improved outcomes. This diet emphasizing vegetables, fruit, olive oil, fish and poultry is sensible, especially if washed down with the advised red wine! However, the ancestry of southern Europe is different than the southern US. Perhaps it’s the moonshine instead of the wine.

Other diets include the high protein and low carb Atkins diet, the low fat and low carb Scarsdale, the low fat and vegetarian Dean Ornish, and many others including the goofy New Beverly Hills diet and the Grapefruit diet. My personal favorite for ridiculous is The Skinny Bitch Diet. The latter is essentially a vegan diet without dairy, caffeine, sugar or alcohol. I can see how this diet gets its name. The French have a philosophy that you are what you eat. All these diets say you are what you don’t eat.

I remain fascinated by medicine and the wonders of The Creation. Basic science research arguably seems foolish at times, but sometimes it connects the dots. How did our hunter gatherer ancestors survive before the earth warmed, allowing farming and animal husbandry to provide us a more reliable food supply? In the paleolithic era a kill of a large animal might provide food for a few days. A survival advantage would occur if those precious calories could be assimilated, stored and then carefully doled out during lean periods. The thrifty gene hypothesis holds that the insulin molecule evolved to give that survival edge.

A recent discovery adds to our knowledge of our ancestor’s gluttony-starvation cycle. The intestinal Paneth cell has been described as “the most beautiful cell of the human body” because of its appearance under the microscopic lens. However, research suggests that the Paneth cell’s beauty may also come from the explanation why cycles of fasting in our modern age seem to promote even more weight gain when dieting is discontinued. It appears that calorie restriction causes the Paneth cell to prime the intestinal cells for refeeding. When this occurs a burst of cellular growth results and the intestine is quickly transformed to greater absorptive efficiency.

As Spock would say, “Fascinating!”

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