Sunday, October 18, 2015

Diesel Exhaust Causes Disease

The Combustion Process

Gasoline and diesel fuels are mixtures of hydrocarbons (made of hydrogen, oxygen and carbon atoms.) Hydrocarbons are burned by combining with oxygen. Nitrogen and sulphur atoms are also present and combine with oxygen when burned to produce gases. Attempts to reduce exhaust emissions from gasoline and diesel engines have been compromised by limitations of testing, inherent flaws in the design and inadequate maintenance of emission control devices.

Diesel engines a pose different emission control problems than gasoline engines. Diesels require more sophisticated and expensive components than the catalytic converters fitted to gasoline engines. Diesel emissions contain nitrogen oxide gases and carbon particles, the smallest of which contribute to lung and heart disease. Increases in airborne fine particulate matter increases the risk for myocardial infarctions, strokes and heart failure. Particle deposition in the lungs activates the sympathetic nervous system and triggers the release of systemic pro-inflammatory responses.

Brook and Rajagopalanb stated: "Higher circulating levels of inflammatory cytokines cause vascular endothelial dysfunction and activation of vasoconstrictive pathways while blunting vasodilator capacity. At the molecular level, the generation of oxidative stress with the consequent up-regulation of redox sensitive pathways appears to be a common mechanism of these pro-hypertensive responses. Due to the ubiquitous, continuous and often involuntary nature of exposure, airborne fine particles may be an important and under-appreciated worldwide environmental risk factor for increased arterial BP.

In Sept. 2015 a scandal erupted when Volkswagen, the world's largest car manufacturer, was caught cheating on emission tests of their diesel engines. In testing lab conditions, VW could show conformity with emission standards fro nitrogen oxides. Subsequent independent testing of VW diesel vehicles in road tests revealed high levels of nitrogen oxides emitted in real operating conditions. Errors in media reports proliferated with talk of defeat devices and software that would fool emission tests.

Relevant engineering data was not readily available but likely the cause of the problem was the Nitrogen Oxide converter (aka NOx storage catalytic converter ) that required injections of unburned fuel to keep the converter clean and functional. The exhaust output was supposed be free of nitrogen oxides. The computer that controlled fuel injection was programmed to inject more fuel than was needed for combustion for about 2 seconds per minute. The fuel reaching the converter would burn increasing the temperature in the converter. Burning the diesel fuel in the converter would likely increase the emission of other air pollutants. The software functioned optimally for emissions testing and was turned off when the engine was in service. The NO converter was a poor design that would increase fuel consumption and decrease engine performance if the converter was operated for full emissions control.

Jack Baruth advocated the end of diesel cars and pickup trucks. He stated: "Western democracies encouraged diesel even though they were perfectly aware of the health hazards posed by diesel particulate exhaust. Those risks are far better documented than even the most "settled" climate science, and they are very real. Eurocrats chose diesel in order to be seen to be doing something about global warming, and the manufacturers had to abide by their choice. The result? Paris has had to ban cars for hours or even days at a time because of smog. According to The Guardian, "diesel-related health problems cost (the British National Health Service) more than 10 times as much as comparable problems caused by petrol fumes. Last year the UN's World Health Organization declared that diesel exhaust caused cancer and was comparable in its effects to secondary cigarette smoking. And that was when people thought that these diesels were meeting pollution standards! Now, of course, we know that many of them were not, and that even the diesel cars that weren't designed to cheat the tests are not performing in the real world the way they do in the test labs. In other words, diesel-powered automobiles are killing people, and in not inconsiderable numbers. The jury is in and the evidence is clear." (Jack Baruth. Road & Track. Oct 2015)

A review in the Science journal, Nature, questioned the relationships between auto manufacturers and regulatory bodies: "Among the questions raised by the scandal that allowed the German car maker Volkswagen to sell 11 million vehicles containing software that cheats emissions tests, many will ask why the regulators failed to notice and halt the practice. The answer is not complicated. Regulated industries exert massive, discreet pressure on regulators such as the US Environmental Protection Agency (EPA), to stop them doing their jobs properly."

To put the VW scam in perspective,  the big problems were corporate cheating and deliberate violation of public trust. It appears that this deception will cost VW several billion euros and is an embarrassment for all of Germany. Regulatory agencies have been alerted to their limitations and will be changing testing procedures for all new engines that include monitoring emissions during real driving tests in real driving conditions.

See Air and Breathing by Stephen Gislason MD

Sunday, August 23, 2015

Blood Circulation to the Brain

The brain is a unique organ in the body. The blood circulation in the brain is more complex, more regulated, and less understood than the circulation in any other tissue. The large arteries carrying blood to the brain are the internal carotids and the vertebral arteries. The condition of these arteries determines how much blood flow is available to the brain. The smaller cerebral (pial) arteries respond to changing demands from blood supply from cerebral tissues. This auto regulation tries to maintain stable cerebral blood flow even with unstable cerebral perfusion pressure. Brain circulation responds in complex ways to a large number of stimuli. Failure of autoregulation may be one of the most common sources of brain dysfunction especially in people with high blood pressure on medications.

Brain activity regulates brain circulation by controlling cardiac output and blood pressure. Emotions, especially anger, are strong events that act on the cardiovascular system; heart rate increases and blood pressure rises, often dramatically. Cognitive tasks increase blood flow and metabolic rate in the regions of the brain that process the task. Changes in localized blood flow are the basis of functional imaging studies that reveal the modules in the brain that are active during task processing.

Blood-brain barrier

Cerebral microvessels have a unique feature, the blood-brain barrier, which protects sensitive brain cells from disturbing elements circulating in the blood. Endothelial cells line blood vessel. Their behavior regulates permeability. In the brain, tight intercellular junctions limit endothelial permeability. A variety of chemical signals to and from endothelia cells control blood vessel transactions with glial cells and neurons. Cerebral vessels have nerves supplies -sympathetic, parasympathetic, and sensory nerve fibers. Gaseous transmitters such as nitric oxide (NO) dilate small blood vessels and participate in the regulation of blood flow.

Syncope (fainting) is an expression of reduced cerebral blood flow. Prolonged standing, emotional arousal, blood pressure drugs, cardiac arrhythmias, and autonomic nervous system failure are common causes of syncope. Blood tends to pool in the legs with prolonged standing. Muscle activity is required to pump venous blood uphill back to the heart. With reduced venous return, cardiac output drops and humans faint. A common symptom, the feeling of lightheadedness is an expression of reduced blood flow to the brain. Since cerebral arterial disease increases with age, decreasing symptoms of limited blood flow become more common such as lightheadedness, fainting, personality changes and deteriorating cognitive ability.

Some of the disturbances will be regional with selectively compromised functions. Other disturbances will be global. The use of medications to reduce blood pressure may have adverse effects because lowering blood pressure can decrease cerebral perfusion in patients with chronic vascular brain pathology; they may develop focal hypoxia and even ischemia in poorly perfused regions of their brain.

Stroke is the leading cause of disability in the U.S. and Canada

Stroke is the leading cause of permanent disability in the U.S. and Canada, second leading cause of dementia and the third leading cause of adult death. Stroke is the third leading cause of death and a major source of disability in the US where 700,000 people have a stroke and 158,000 die from stroke. From 1993 to 2003, the stroke death rate fell 18.5%, but the actual number of stroke deaths declined only 0.7%, according to 2006 statistics.

The main event of a heart attack is the occlusion by a sudden blood clot of one or more blood vessels supplying the heart muscle. A similar occlusion of blood vessels supplying the brain will result in the death of brain tissue or cerebral infarction. Another cause of stroke is hemorrhage from a ruptured blood vessel. Yet another stroke mechanism is the occlusion of a brain artery by a clot that traveled to the brain from another body location, usually the heart; embolism is most likely to occur in people with atrial fibrillation and mechanical heart valves.

Neurologists say doctors and the public should give stroke victims the same urgent treatment given to heart attack victims. The clot-dissolving drug TPA (tissue plasminogen activator), when used in the first three hours after a stroke, can restore blood flow in the brains of some patients. Some hospitals have better tools for dealing with strokes, but require the stroke patient to seek treatment quickly. The message in the media is to act fast on the warning signs of a stroke - stokes are now described as "brain attacks" to encourage the same sense of urgency attributed to heart attacks. Symptoms include weakness or numbness, especially on one side of the body; blurred vision, usually in one eye; slurred speech; dizziness; and explosive headache.

The hope for dramatic rescue of stroke victims with TPA is somewhat tarnished by the impractical requirement of getting the right treatment right away. One major problem is that some strokes are caused by bleeding into the brain and TPA would make this worse. Before getting TPA, patients must be checked to ensure they are not bleeding in the brain. If you were planning to have a stroke, you have to set up an ideal circumstance in order to be rescued. You would have to recognize that you were having a stroke almost immediately; you would have to get to a well-equipped hospital promptly; the emergency room would have to be set up to make the diagnosis promptly, get a high quality CAT scan done and interpreted by an expert and then you would have to satisfy several criteria for treatment - the first is that the CAT scan shows that there is no bleeding associated with the stroke symptoms.

Preventing Strokes

We share the conviction with a growing number of experts in the field that simple, safe home remedies especially diet revision and exercise can substantially reduce this destructive disease and save untold suffering and billions of health-care dollars. Smoking must stop. Diabetes, high blood pressure, and high blood cholesterol must be controlled to prevent stroke and, again, diet revision with weight loss and increased daily exercise can work wonders. Drugs are only required if risk factors are not controlled by changes in diet and lifestyle.

Well-known risk factors are

  • high blood pressure
  • smoking
  • high alcohol intake
  • diabetes
  • excess body fat
  • physical inactivity.

Stroke Prevention

  • Diet Revision -- Alpha Nutrition Program
  • Exercise and Weight Loss
  • Reduce blood pressure
See The Human Brain is Health and Disease by Stephen Gislason MD

Wednesday, July 15, 2015

Self-Care

Dr Gislason wrote: "Selfcare only works if you have adequate knowledge and effective problem solving strategies. In the best case, you would know enough about your body functions to interpret symptoms as they arise and you would take corrective action. You would develop a good sense of what problems you can manage yourself and you would know when to seek help. You would use all the preventive strategies available to you and would use screening tests to detect early stages of disease. I have written several books on specific diseases with the idea of presenting adequate knowledge and suggesting problem solving strategies."

The Alpha Nutrition Program is a rational plan that requires new learning, discipline and self-control.  A basic intention is to do a better job of self-regulating. Self-regulation implies control over behavior. I learned by watching a few thousand people attempt to do this program that people with some measure of self-control were uncommon. I learned that self-discipline was in short supply and that rational plans tended to fail without a lot of support. Since eating is a social activity, changes in eating habits require a social method. 

Some exceptional people live well-organized lives with traditional lifestyle eating habits and operate from an internal locus of control that gives them an enviable ability to self-manage. If you have a well-developed center, you have an easier time developing new patterns, once you accept that it is necessary and desirable to change. You can plan an orderly transition from old to new. People with a strong internal locus of control are more skilled at collecting and evaluating information. They accept professional advice as information, not as parental authority. They tend to feel more confident making their own decisions."

Interface with MDs

For many years, we have proposed a collaborative relationship between patient and physician. The growth of medical information in the internet gives every intelligent person access to current information and to a variety of options. Often a patient with a specific disease is better informed than the physician. Carolyn Clancy, director of the US Agency for Healthcare Research and Quality stated: Patients are becoming more involved in decisions about their care. Even though this is a major change to how we (MDs) practice medicine, it will, over time, create a genuine partnership between doctors and patients. We recognize the importance of clear, ongoing communication, including questioning why a particular treatment decision was made. We need to engage our patients in the same way. My agency has developed a new public awareness campaign with the Ad Council to encourage patients to take a more active role in their healthcare.

A Free Copy of the book Self Care for the 21st Century is available as a PDF file for download.

Tuesday, July 14, 2015

Narcotic Drugs Addiction and Death


Narcotic drugs have always been associated with addiction; however, narcotic drugs remain the best agents to relieve pain. Pain management is the reason people are most likely to seek medical attention. Physicians try to balance their desire to elevate suffering against concerns that the patient in pain just wants a drug prescription. Physicians remain constrained by problems of drug dependence and addiction and are reluctant to prescribe narcotics or prescribe weak, inferior narcotics such as codeine and demerol. 
Weintstein et al polled 386 physicians in Texas and found that a significant number of physicians had prejudice against the use of opioid analgesics, displayed lack of knowledge about pain and its treatment, and had negative views about patients with chronic pain. They suggested that new educational strategies are needed to improve pain treatment in medical practice.  
 The narcotics that are considered to have the greatest addiction potential include codeine 60 mg, oxycodone, methadone, hydromorphone, demerol (meperidine), fentanyl, and morphine. The World Health Organization (WHO) suggested a progressive treatment of pain. For mild pain: aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs and adjuvants. For moderate pain: mild opioids. For severe pain: traditional opioids. Physician concerns are justified. Narcotic-dependent people routinely solicit prescriptions from a number of physicians and become good at feigning painful conditions. Every primary care physician will have patients who tend to demand prescriptions for pain relievers and other psychotropic drugs and will become chronic users, unless the physician steadfastly resists their demands and limits prescriptions to short term use. 

Prescribed narcotics are always available for sale on the street. Most originate with doctors who are lenient prescribers. Drug traffickers have lists of lenient Doctors who write narcotic prescriptions on demand for a fee.  Prescribed narcotics are always available for sale on the street. For example, about two million Americans have admitted taking OxyContin (oxycodone) illegitimately. The US Drug Enforcement Administration reported that it is one of the most abused prescription drugs. Another narcotic, hydrocodone also has a high potential for abuse. Hydrocodone, as a narcotic cough medicine, is one of the favorite drugs sought by recreational users when they visit emergency departments. Both drugs act on the opioid mu receptor which blocks the transmission of pain in the spinal cord.
In the USA OxyContin is a $1.5 billion per year product. A report in the New York times from rural Kentucky ( July 2004) provides a perspective on narcotic drug use: “Ever since prescription painkillers like OxyContin became the drugs of choice among dealers and addicts in Appalachia, the days of small-town pharmacists' dispensing medicines from behind an ordinary counter have become a quaint memory. Now many pharmacies have turned into virtual fortresses. Some have bars over the windows. The most sought-after drugs are stored in vaults. The pharmacists often work behind safety glass, and some have even armed themselves. Surveillance cameras and alarm systems monitor every spot. Dan Smoot, chief detective for Operation Unite, an anti-drug task force said that prescription drugs remained the top problem for police agencies in the mountains. Mr. Smoot recently led the largest drug raid in Kentucky history, arresting over 200 people on charges of buying or selling prescription drugs on the black market.” 

The muscle relaxer, carisoprodol (Soma) is another favorite street drug which contains a metabolite of meprobamate, an old tranquilizer. Taken with alcohol, Soma produces stupor or "Soma coma." Tramadol (Ultram) is a pain medication that can produce a mild euphoric state. Dextromethorphan is a cough suppressant found in many cough syrups, which produces a euphoric state when taken in large quantities and can produce visual hallucinations.    People who take opioid analgesics for many days will develop physical dependence and will suffer withdrawal effects if the drug is discontinued suddenly. Symptoms of withdrawal include drug cravings, muscle cramps, joint pains, anxiety, nausea and vomiting. Withdrawal is most intense following IV heroin use and is relatively milder after taking oral medications.

Fentanyl has become the most potent narcotic with the greatest danger in the form of sudden death. Gatehouse and Nancy reported on the tragic rise in Fentanyl deaths in Canada. They described:" Over the past few months, fentanyl has been making headlines across North America, as police discover more and more of it on the streets, and overdose deaths surge. Authorities in Alberta linked the drug to 120 fatalities in 2014, and 50 more in just the first two months of this year. In British Columbia, it killed almost 80 people in 2014, and was responsible for a quarter of all drug deaths, up from just five per cent in 2012. In Ontario, where 625 people died of opioid overdoses in 2013, fentanyl was involved in 133 of those cases and, each year, it now kills twice as many people as heroin. First developed by pharmaceutical trailblazer Paul Janssen in 1959, it was originally used as an anaesthetic under the brand name Sublimaze. The slow-release transdermal patches for chronic pain relief were introduced in the mid-1990s. Its dangers have also long been recognized. There have been a number of scholarly studies about all the doctors and nurses, especially anaesthesiologists, who have become addicted to it, and notable victims such as Jay Bennett, the late guitarist for Wilco, who died of an accidental fentanyl overdose in 2009 after being prescribed the patch for an old hip injury. And the drug’s illicit analogues—there are at least a dozen variations—have been killing people on the streets since the late 1970s, most infamously under the name “China White.”
The deeper story of the drug and its abuse is even more worrying. Police and health workers now face an unprecedented situation, with a burgeoning street trade in both the legitimate prescription patches and illicitly manufactured fentanyl—often sold in pill form and made to look like OxyContin, a far less powerful narcotic. The drug, also available in liquid and powder form, is increasingly being used to cut cocaine and heroin, dramatically boosting their potency, often with fatal consequences. Indeed, fentanyl seems to turning up almost everywhere you look. And it’s killing both inexperienced newbies and hardened addicts. The illicit fentanyl that’s currently flooding Canadian markets in pill form has more benign nicknames: greenies, green beans and green monsters (all references to its emerald hue). But that doesn’t make it any less deadly. Stamped as OxyContin, the fentanyl has been retailing for as little as $10 a pill—an indication of how cheap it is to manufacture, and how easy it is to obtain the raw material.
The big B.C. investigation in March turned up two industrial pill presses that were used to make the 29,000 tablets. Two of the 14 people arrested in associated raids in Alberta and Saskatchewan are “full-patch” members of the Hells Angels. A third man is the president of an affiliated motorcycle gang, the Fallen Saints.
Then there’s the other problem: the growing abuse of the legitimate pharmaceutical version of the drug. Prescriptions for high-dose painkillers have skyrocketed over the last 15 years. A study by a group of Ontario researchers, published last fall in Canadian Family Physician,  determined that Canadians are now the world’s biggest per capita consumers of legal opioids, with more than 30 million high-dose tablets and patches distributed every year. Such widespread availability of opioids inevitably leads to widespread abuse. A recent meta-analysis by an American Scientist, published in the journal Pain, found that the average rate of misuse of prescribed painkillers is around 25 per cent  and that one in 10 medical users ends up addicted. In recent years, it was OxyContin that was driving that trend, because it could easily be crushed and snorted. But, once governments forced the manufacturer to introduce a tamper-resistant formulation, called OxyNeo, to the Canadian market in early 2012, the preferred high quickly became fentanyl.
Dr. Karen Woodall, a toxicologist with the Ontario Centre of Forensic Sciences in Toronto, regularly testifies as an expert in fentanyl cases. She first noticed the drug in 2005 in the autopsy files that cross her desk. She later traced deaths as far back as 2002, mostly via people overdosing after chewing cut-up bits of patches—a particularly dangerous practice, since there’s no way to predict the quantity of the drug in each piece. “The big problem with fentanyl is that a lot of people who aren’t tolerant to the drug are taking it. And if you’re not tolerant, it’s a lot more likely to cause serious toxicity and even death,” she says. “It severely depresses breathing and the heart rate. Combined with alcohol or other drugs that slow the central nervous system, it becomes even more dangerous. It’s a serious issue, we’re seeing more and more deaths.”  


From The Human Brain by Stephen Gislason MD

 

Sunday, July 05, 2015

Cytokines

The study of immunology has revealed a complexity of immune cell types and prolific interactions that overwhelm even the experts. The emerging description of chemical signaling that occurs among immune cells and between immune cells and all other tissues of the body has become especially complicated. As the collected data become denser, even highly specialized researchers have difficulty visualizing what is actually occurring in a diseased body.

The MD examining a patient, using conventional medical tools, is hopelessly inadequate and does not understand what is really going on. Classifications and names have changed with advancing discoveries. There more than 30 members of the interleukin family, for example, subdivided into families. To make a complex matter simple, they can be sorted into pro-inflammatory and anti-inflammatory groups.

Cell Signals

Cytokines are soluble proteins that regulate immune responses. One idea is that cytokines are short range signals. For example, it was though that production in lymphoid tissues is tightly localized and signaling occurs between conjugate cells. Perona-Wright et al assessed cytokine signaling during infection by measuring in vivo phosphorylation of intracellular signal transducer and activator of transcription (STAT) proteins. They stated: We show that interferon-γ (IFN-γ) and interleukin 4 (IL-4) signaled to the majority of lymphocytes throughout the reactive lymph node and that IL-4 conditioning of naive, bystander cells was sufficient to override opposing T helper type 1 (TH1) polarization. Our results demonstrate that despite localized production, cytokines can permeate a lymph node and modify the majority of cells therein. Cytokine conditioning of bystander cells could provide a mechanism by which chronic worm infections subvert the host response to subsequent infections or vaccination attempts.

 Another idea is that cytokines provide long-range signalling and help to organize systemic responses to infection and injury. The nature series of scientific journals sponsors a data base that by 2006 listed over 3700 signaling proteins that carry messages among cells of the body. Dove described the state of signalling science: “Ask a cell biologist to explain signal transduction, and you are in for a long story. The science of understanding how individual cells sense their environments and respond to stimuli fills library shelves, occupies whole departments of colleges and inspires the careers of thousands of researchers around the world. Even so, the field sometimes seems woefully understaffed.

The advent of whole-genome sequencing and gene-expression profiling revealed what most biologists already suspected: we are just beginning to understand cell signaling. For example, cells rely heavily on surface receptor proteins to communicate with the outside world. Often, signals flows through receptors that are coupled to effector molecules called G proteins. Inside the cell, information flow often entails an enzyme finding a specific target protein and attaching or removing phosphates, lipid groups, or other chemical structures. The modified target commonly goes on to modify other targets and so on through baroque cascades of interactions.”

Scientists have described a bewildering complexity of cytokines and variable cytokine production in different humans. We know that humans are not created equal. One significant inequality lies in the ability to produce cytokines of different types. An individual’s cytokine profile will help to determine the response to antigen challenges, susceptibility to different diseases and the severity of the disease, once contracted. Advances in techniques of identifying ever larger numbers of signaling molecules have produced research papers dense with measurement data, often in a curious limbo, where the ephemeral dynamics of cell interactions are scarcely mentioned and not at all understood.

From Immunology Notes by Stephen Gislason MD

Sunday, March 29, 2015

Medical Students, Physicians, Bullying

The difficulties facing medical students and physicians are diverse and persistent. There is no escape from basic human tendencies. The competitive, critical disputatious nature of humans is amplified in medical institutions, despite a superficial appeal to collegiality. Physicians often face moral dilemmas and must cope with the least pleasant aspects of the human experience, often with little or no support from colleagues.

As most medical care becomes concentrated in large, impersonal institutions, a sense of alienation prevails. A pamphlet from the Canadian Medical Association for physicians talks about the “impact of stress on physician health and well being.” Canadian physicians are generally unhappy about the increasing demands on their time and energy while resources and rewards are shrinking. In Canada, physicians work in a government under-funded system that survives on budget cuts and rationing services.

The CMA pamphlet begins with a fuzzy statement that could win a prize in the annals of obfuscation: “Stress is part of everyone’s life. A certain level of stress contributes to optimal performance. However, when it is not managed properly, stress can become overwhelming, leading to physical, mental and spiritual difficulties.”

 I acknowledge that some readers would be more receptive to this kind of talk than I am. However, I would want them to ask what is really going on here? Physicians get tired, discouraged, frustrated and become angry like all other humans. Physicians tend to be more tolerant and giving than most other humans, but each person has limited understanding and limited resources. When demand exceeds supply, physicians, like other people, get discouraged, tired and angry. They may feel and act badly in a variety of ways. If we really want to understand the plight of physicians, the first step would be to pledge never to use the word “stress” just as we have pledged never to use the word “psychological” or the word “spiritual.” These are nonsense words that obscure what is really going on.

Dr. Pamela L. Wible wrote about physicians' bullying medical students and each other. Increasing concerns about physician burnout and suicide have surfaced in the US. Medical students suffer bullying and some end their lives. Wiebe stated: "The truth is, doctors are suffering. Surrounded by sickness and death, we watch families wail, shriek, cry while we stand silently—sacred witness to their sorrow—until we're called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And when do we grieve? Never. Doctors are not allowed to grieve. Today a physician tells me she's been cited for unprofessional conduct. Why? She was seen crying. Her boss told her, "Unless you are dying, crying is unprofessional behavior and not to be tolerated." Doctors are not allowed to cry. So, what do we do with our sadness? We injure ourselves—and each other. When I speak to victims of physician bullying, I explain, "Your instructors are suffering from unprocessed grief—probably victims of bullying themselves. Medicine is an apprenticeship profession. Trained by wounded doctors, they're now wounding you. Your bright eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel their own grief, they lash out at you." (Pamela L. Wible. Physician Bullying: 'Not Allowed to Cry'. Medscape. Feb 20, 2015.)

There are few physicians who would not respond well to expressions of gratitude, respect and tender loving care. Each one needs more time off and an assistant or two to do all the extra chores demanded of them. Physicians spend much of their time caring for others but seldom receive care themselves. The increasing tendency for hospital and government administrators is to treat physicians with disrespect and to blame them for the high cost of medical care. Physicians confront injury, disease, cruelty, ignorance and anger most days and often miss opportunities to celebrate the joyful, creative aspects of life. A basic imbalance for any human is receiving less than he or she is giving. Physicians become overtired, do not eat well or regularly and often fail to enjoy friendly and affectionate leisure time with family and friends…. our description can go on and on. The more we observe specific details of physicians lives (never using the term “stress”) the more we understand how these humans suffer, make mistakes, become dysfunctional and ill or, if they are smart, take a long vacation or quit medicine before they collapse from frustration, disillusionment and fatigue.

See Medical Care Perspectives

Monday, March 02, 2015

Drinking Alcoholic Beverages

The Problem is drinking too much of the wrong drinks

The Solution : Stop Drinking Alcoholic Beverages

Humans like to become intoxicated. Fermented, liquid foods that contain alcohol are used worldwide in parties, celebrations and rituals. It is common for fermented foods to be included in the daily diet. Small doses of fermented foods relax inhibitions and can feel pleasant in social situations. Larger doses are toxic to the brain and disable the drinker.  The regular abuse of alcoholic beverages is called "alcoholism. The stigma  attached to the term "alcoholism" remains an obstacle to understanding this common problem.

There is a tendency to deny or to "normalize" excessive drinking. The use of alcoholic beverages is woven into the fabric of society and excessive use of alcohol is often considered "normal"  Regular ingestion of alcoholic beverage in excess produces many disease patterns involving every part of the body. Even “moderate” alcohol abuse distorts the personality, emotions and intellect of the "social drinker." The cognitive impairments and personality distortion are a direct consequence of brain dysfunction cause by ethanol and other chemical pathogens in alcoholic beverages.  Alcohol abuse is considered to be an addiction and some argue about calling alcoholism a “disease.” The term “addiction” refers both the compulsive aspect of drinking and also to the harm drinking causes. The drinker harms himself, his family and the community at large. A reasonable person will notice the harm he or she is causing and will seek to remedy the problem. An addict ignores the harm and remains devoted to ingesting alcoholic beverages no matter how much harm is caused.

Intoxication with alcoholic beverages generates behaviors that are regrettable and often destructive. Drunk people do much harm to themselves and others. The main drug effect is exerted by ethanol on the brain. As blood levels of ethanol increase, more and more brain functions are shut-down, rendering the intoxicant temporarily demented, with inappropriate behavior, incoordination and poor judgment. Alcohol intoxication routinely promotes fighting, assaults and death by accident or murder.

Dr. Gislason states in his preface to the book, Alcohol Problems and Solutions:

"I have learned that humans generally do things that they should stop doing. In addition, I have learned that reasonable, rational solutions to human problems are seldom pursued for very long. Alcohol abuse is one of the common human aberrations that has an easy, rational solution --- stop drinking. But drinkers routinely avoid the easy, rational path to health and happiness and instead pursue a self-destructive course that causes much harm and great human misery. This is a curious feature of the human mind that requires explanation.

Dr. Sidney Cohen, a drug abuse expert, described alcohol as "the most dangerous drug on earth." There are a variety of drinking patterns and the range of injury among alcohol abusers is great. Some are mildly injured and can recover on their own with the right tools and techniques. Others are critically injured, need hospitalization and prolonged rehabilitation with custodian supervision.  The challenge to a heavy drinker is not just to stop drinking for a while, but to stop forever.

Alcoholism is a complex and diverse problem. My book attempts to understand the problem of alcoholism and points to a comprehensive solution that requires alcohol abstinence and diet revision along with moral and mental resolve to restore a sane, sensible way of living. "

From the Book "Alcohol Problems and Solutions by Stephen Gislason MD

http://www.nutramed.com/alcohol/index.htm

Monday, January 05, 2015

Diabetes Care - Self Management

The tasks involved in self-management are relatively easy, once you have learned how to do it. There is more and more help available as the concern about increasing prevalence and cost of DB2 increases. The American Diabetes Association published revised Standards of Care for diabetes, emphasizing that high-quality diabetes care must be individualized to reflect the needs, interests, and abilities of each patient. The primary goal is to reduce blood glucose levels to normal. You self-monitor blood glucose levels at home and have HbA1c monitored very 3 months. The secondary goal is to monitor for and, if detected, promptly treat any developing complications.

Reducing caloric intake is a key to success

If you follow common arguments about diabetic diets, then all diabetics should eat a low carbohydrate, low fat, low protein diet. The only way you can achieve all three goals is to eat a low food diet. Indeed reducing caloric intake is the key to success. Another key to success is to increase your energy expenditure by leading a more active life.

The Alpha Nutrition Program is a standard method of diet revision that proceeds in a simple, logical manner. You eat more vegetables, less fat and balance your new diet according to the best nutritional ideas. The program leaves out foods and food products that are higher risk and includes foods that have protective and beneficial effects.

The Alpha Nutrition approach includes Alpha DMX a specially designed elemental nutrient formula. We invented Alpha DMX to solve the problem of nutrient deficiency when you reduce your caloric intake. With 25 grams of Alpha DMX per day, your nutrient intake reaches recommended daily intakes goals for all vitamins and minerals even if you eat no food.

The Cardinal Rules of DB2


Eat less, exercise more.

You adjust the food you eat and your activity level to bring glucose utilization into balance with intake.

You monitor blood glucose frequently at first until you understand what different foods do in your body.

You use exercise to lower blood glucose if the levels go too high.

If your blood glucose is too high, you can skip meals, take Alpha DMX twice a day and snack on low calorie foods such as celery, lettuce, apples and carrot sticks.

The basic problem with proposing diet revision, as therapy is that eating behaviors are deeply rooted in a psychosocial matrix and are not rationally determined. Diabetic food management requires rational determination of eating behaviors and food selection. The social basis of eating patterns often conflicts with individual needs and opposes the attempts made by an individual to modify diet as a means of restoring or maintaining health.

The idea of "a diabetic diet" as a fixed set of instructions and a restricted food list is stubborn and fits with a passive-dependent attitude - "fix me" A new attitude of approach to diet revision is required especially when you have a chronic illness. The new attitude is based on self-responsible, self-monitored and self-directed change. The Alpha Nutrition Program assumes that you are in charge and you make your own decisions. The professional role is to support your effort to self-manage and assist you in trouble-shooting when symptoms recur or when irrational eating behavior is dominant and you need help complying with the healthy path.

Diabetes Center at Alpha Online

Order Managing Diabetes

Diet Revision Improves Diabetes, a Food Disease.

People with diabetes 2 have a food-disease. They have the task of changing their food choices and managing their diet carefully. This is a difficult task. We develop a perspective on diabetic management and reveal issues that are not well understood. We will suggest intelligent strategies for self-management of diabetes 2. Renewed concerns about the safety of popular drugs that lower blood sugar should focus attention on non-drug strategies.

Understanding diabetes has become more difficult as more is learned. In all biology, increasing complexity is revealed by ongoing research. Since glucose is the principle source of energy for all life, complex systems of glucose regulation have evolved. Eating behavior is steered towards high sugar foods that, once eaten, require prompt metabolic responses to utilize and store glucose for later use. Diabetes 2 involves a complex of disorders that start with appetite dysregulation and continue through disordered metabolism of glucose, cholesterol and fatty acids. Diabetes 2 is a progressive disorder. Early corrective action is highly desirable.

The Supreme Importance of Diet Revision

When you are diagnosed with diabetes 2, do not try to hold on to old habits. They made you ill. You have to change your food choices. You need to lose weight and exercise; 20 minutes per day of walking and resistance exercises that makes muscles work will correct many metabolic abnormalities, reducing the risk and the negative consequences of diabetes.

Standard medical treatment protocols for Diabetes 2 always mention diet revision and then quickly proceed to drug options. While food control is always mentioned, the critical, decisive importance of diet revision and exercise is not emphasized. Diet revision is neglected in favor of drug treatments. Diet revision means changing your food choices and learning how to self regulate by adjusting food choices and food amounts.

The odd reasoning in medical practice is that even though eating the wrong food contributed to or even caused the disease, you can just go to the store and buy a drug that will excuse you from changing the cause. Although some of the chemicals for sale at the pharmacy may reduce some consequences of eating too much of the wrong food, a smart person will get busy and remove the cause of the disease.

If you follow common arguments about diabetic diets, then all diabetics should eat a low carbohydrate, low fat, low protein diet. The only way you can achieve all three goals is to eat a low food diet. Indeed, reducing caloric intake is the key to success. Another key to success is to increase your energy expenditure by enjoying a more active life. When you exercise more, your muscles grown in size and strength and become more metabolically active. No drug can compete with beneficial changes in metabolism that exercise creates. Exercise acts on all the key metabolic organs and all the signaling molecules that control metabolism.

A diabetic treatment plan in its simplest form:
  • Diet Revision: Follow the Alpha Nutrition Program
  • Reduce total caloric intake
  • Alpha DMX 12 grams, 2 times per day
  • Exercise everyday

  • See Managing Diabetes, a book by Stephen Gislason MD