Older Bolder Life

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Staying Healthy

A Few Quick Thoughts From the Road

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Pushed by a bizarre set of circumstances I’ve been on the road for the past five days; these are very strange days in which to travel, and I thought it’d be worthwhile to share a couple of quick observations.

The full story is immaterial, but to provide a bit of background, last week it became clear that I needed to procure some documents in storage in the suburb of a large city in the Pacific Northwest. Reflexly I attempted to arrange a direct flight out of DFW, and was thwarted on essentially every attempt with regard to local regulations imposed by the destination regional airport options and the communities in which they were based. The only viable option evolved to driving, which would / has involved basically traversing half the country in a mater of days by car.

My personal status of having recovered quite successfully from a dalliance with COVID-19 made me a bit more comfortable with travel-related exposures, though the decision was one my lovely wife and I pondered carefully.

Three quick observations (and I do mean anecdotal, personal observations) of note, and it goes without saying that conditions, risks, and restrictions vary MARKEDLY from state to state.

Food on the Road. In states more tightly locked down, food options in terms of accessing prepared, restaurant foods travelers are accustomed to seeking out largely don’t exist. I noted even fast-food type establishments that primarily serve drive-through menus were not consistently open, and when available (Laramie, WY for example) restaurant seating and service was able but limited.

My circumstances were a bit unique, in that in the few weeks prior I’d pre-planned a push into a 3-month run of fairly tight nutritional ketosis, therefore I packed 90% or more of my food into our trusty cooler and have thrived on a one meal per day approach, with excellent energy, endurance, and mental acuity/clarity.

I’ve outlined some of our favorite road trip foods here and here.

Fuel on the Road. Despite some reports to the contrary from friends, there’s been no difficulty whatsoever finding fuel along major travel routes, at what – from a historical perspective – are damned inexpensive prices.

Interestingly, only one fuel system (Costco) appears committed to cleaning pumps between users (and not consistently from store to store), therefore personally I took the highest level precautions (gloves, meticulous sanitation after) whenever stopping to refuel.

Lodging on the road. Relative risk to a traveler seeking lodging is all over the map when it comes to lodging; after some research I chose to seek out a chain with at least the highest level standards of cleaning and resting rooms (do your homework) as per their articulated plans, and found rooms spotless every time. It’s also incredibly easy to carry sanitizing wipes in and wipe down every surface you will touch, a likely unnecessary precaution but one I chose to exercise every time.

Overall, I’ve noted via observed traffic and lodging demands that travel remains, pending the region, MARKEDLY reduced.

Caveat emptor as you get out and about.

Images: Entering the Columbia River Gorge above and New Mexico vista below.

Out of the Box: COVID-19, The What If Syndrome, and Context

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Out of the Box: A Cautionary Warning

What follows is a brief collection of what many would call out of the box thinking today; some (you might call them the screamers) would in fact label what follows absolute heresy.

If you’re not in the mood to have your thinking about current events challenged a bit, then move along, there’s nothing to see here. Likewise, if you’re unwilling or unable to put on big boy (or girl) pants and question the endless parade of dire and oft conflicting information we’re all assaulted with daily, then click on over to your favorite foodies’ website for the plat du jour (something I enjoy doing every day myself).

Of note, what follows is in NO WAY an effort to delegitimize or downplay the severity of the SARS-CoV-2 invasion and the impacts of the resultant COVID-19 syndrome. Quite frankly it can wreak devastation for the most susceptible, and it has invoked one of the most unusual mass responses ever seen in global history.

Finally, an apology for the length of this post; it’s a big meaty topic.

The What If Syndrome

Over a year ago I had a client approach me, a very successful and uber-intelligent physician, seeking some help after witnessing first hand my personal transformation over the past few years. He claimed to have “done everything right” as prescribed by traditional medicine for four plus decades, from eating stone ground oatmeal every morning to (over) exercising diligently to cutting saturated fats from his diet and much more. Yet with all of his at times painful compliance, his lipid profile was a mess and he was, predictably, having some issues with statins after having taken them for years with little efficacy.

I provided him a raft of information and reading resources, including some of the most scientifically grounded and respected scientists, researchers, and thought leaders in the medical, sports, and ancestral health worlds.

Specifically (given his traditional medical background) I encouraged him to read some of the works of Drs. Gundry and Shanahan, medical professionals who’ve seen the light and have integrated rational nutritional principles into thriving medical practices. His almost immediate response was to note how critically these clinicians deviated from “accepted and classical thought”, and given such, their recommendations couldn’t be trusted and shouldn’t be followed.

His final comment to me on the matter, before simply giving up before even really getting started, was something akin to this: “What they’re saying is basically heresy, but what if they’re right?”

What if they’re right indeed is a principle that applies more than ever to those raising a cautionary note about end-of-the-world predictions and current events.

Trying to Make Sense of Today with a Bit of Context

There are hoards of commentators opining these days about COVID-19; those who speak (and write) the company line are those you see plastered across various media outlets, distilled down into sound bites for the masses.

Perhaps not so ironically those who dig deeper into the details and the available data, analyzing information in real time at a granular level, not using models to hypothesize, aren’t so embraced by traditional media outlets, therefore it takes a bit more work to find this information.

From my personal perspective, as a retired physician able to understand and digest the medical side of the data fairly comfortably, I’ve found it most illuminating to read with interest the works of several folks who are otherwise experts at analyzing big blocks of data – ironically several of the most insightful have been economists.

Take for example this piece – Coronavirus – It’s Not Heart Disease, It’s a Plane Crash – written by Chris MacIntosh and published this morning. From the piece –

Cardiovascular disease kills over 17 million people annually. It’s the main cause of death globally apparently. I thought it was stupidity but now Google tells me no, it’s “CVD”. Cardiovascular disease. So much for that then.

Looking deeper we find what causes it. Too much macaroni cheese, and donuts, which actually means I was right all along. Stupidity IS the main cause of death. Furthermore, we know what we can do to stop it. Buy a pair of running shoes and actually use them for – you know – running, instead of mooching about the mall from one junk food outlet to another.

Anyway it causes millions of deaths every year and in a minute I’ll tell you why we don’t collectively say…ok that’s it. Enough is enough, you’re all quarantined and everyone must, for the next 4 weeks, self isolate in the gym on a diet of lettuce and bottled water. Which if you think about it would save millions of lives, not to mention millions of dollars in healthcare.

I tell you what makes folks freak the pha-kout though. Air travel. Google explains to me that nearly a third of folks are afraid of flying.

Here’s deaths by transport for 2017.
Highway: 37,133
Rail (Trains): 761
Marine (boats & other watercraft): 694
Commercial Airlines: 0

And did you know that there was a 1 in 3.37 billion chance of dying in a plane crash between 2012-2016. There was a 1 in 20 million chance of being on a commercial airline flight experiencing a fatal accident from 2012-2016 and when there was a crash 98.6% of those crashes resulted in exactly zilch fatalities — Of the 140 plane accidents during 2012-2016, only two involved fatalities (1.4%). Ironically folks will gleefully gorge themselves on burgers and fries before boarding a plane, terrified it’ll fall out of the sky. It’s like popping a slow release cyanide pill and then getting onboard one of the safest forms of transport in the world and thinking to yourself…this thing may kill me. Irrational? Yup.

And the reason for this fear is the same reason folks are terrified of nuclear power (the safest form of power known to man).  When a plane crashes or a tsunami hits, or a Fukushima happens they all do so with an unexpected speed. This is why our reaction to these events is disproportionate to the events themselves.

Contrast this to “CVD” which doesn’t do its dirty work in one fell swoop. It’s not like the heart attack man swoops down in one month and takes them all. It kills one in your street, another few across town. Then it ventures into the next neighborhood before taking up residence in the old age home and poof poor Betty’s gone…and then Bernie across the hall. We don’t like it, but we just accept it and learn to live with it…like politicians…or herpes.

So now to the dreaded bat flu which has brought the entire world to a screeching halt – literally.

What makes this virus special is its speed, or in medical speak R value.  Let’s put this into context, so far it’s killed about 100,000 people or less than a fifth of what the seasonal flu kills annually. Ultimately it’s going to kill a whole lot more, but we should be asking ourselves will it even come close to donut disease (CVD)? Probably not. 17 million remember. And what if it did meet or even exceed donut disease? It’d then be a really bad year but not out of the realm of something we’ve all learned to live with – at least with respect to CVD…

He goes on to quote from Dr. John Lee’s (retired professor of pathology and former NHS consultant pathologist) recent article in The Spectator –

In announcing the most far-reaching restrictions on personal freedom in the history of our nation, Boris Johnson resolutely followed the scientific advice that he had been given. The advisers to the government seem calm and collected, with a solid consensus among them. In the face of a new viral threat, with numbers of cases surging daily, I’m not sure that any prime minister would have acted very differently.

But I’d like to raise some perspectives that have hardly been aired in the past weeks, and which point to an interpretation of the figures rather different from that which the government is acting on. I’m a recently-retired Professor of Pathology and NHS consultant pathologist, and have spent most of my adult life in healthcare and science – fields which, all too often, are characterised by doubt rather than certainty. There is room for different interpretations of the current data. If some of these other interpretations are correct, or at least nearer to the truth, then conclusions about the actions required will change correspondingly.

The simplest way to judge whether we have an exceptionally lethal disease is to look at the death rates. Are more people dying than we would expect to die anyway in a given week or month? Statistically, we would expect about 51,000 to die in Britain this month. At the time of writing, 422 deaths are linked to Covid-19 — so 0.8 per cent of that expected total. On a global basis, we’d expect 14 million to die over the first three months of the year. The world’s 18,944 coronavirus deaths represent 0.14 per cent of that total. These figures might shoot up but they are, right now, lower than other infectious diseases that we live with (such as flu). Not figures that would, in and of themselves, cause drastic global reactions.

Initial reported figures from China and Italy suggested a death rate of 5 per cent to 15 per cent, similar to Spanish flu. Given that cases were increasing exponentially, this raised the prospect of death rates that no healthcare system in the world would be able to cope with. The need to avoid this scenario is the justification for measures being implemented: the Spanish flu is believed to have infected about one in four of the world’s population between 1918 and 1920, or roughly 500 million people with 50 million deaths. We developed pandemic emergency plans, ready to snap into action in case this happened again.

At the time of writing, the UK’s 422 deaths and 8,077 known cases give an apparent death rate of 5 per cent. This is often cited as a cause for concern, contrasted with the mortality rate of seasonal flu, which is estimated at about 0.1 per cent. But we ought to look very carefully at the data. Are these figures really comparable?..

He goes on to document an astounding and very concerning practice being conducted currently – mainly a dramatic and significant change in the methodology of reporting deaths related to COVID-19. The point – context matters – and at least some of the powers that be have been changing the game (and the context) on the fly, most often to worsen the impact of the data. (One of course would ask why? I have no idea, and will leave that to others to pontificate on.)

Math Still Matters

One of my mentors in business (for context, we were analyzing multifamily real estate projects) was fond of saying over and over again that “math matters, and it’s almost aways a bitch to dig into the details”. He was, of course, right, and every time I’ve ignored his advice and gone with emotion/desires over the hard reality of the math, the project has bitten me in the *ss. (We humans just do dumb things sometimes.)

It’s rare to find a genuine mathematical genius today, particularly one who can translate what are often obscure and complicated mathematical constructs into language we mere mortals understand. That said, I’ve been following one for years – Karl Denninger writing over at the Market Ticker. He most often writes on economics, though is a dedicated low-carb guy, a tech genius and former tech CEO, and very well versed on current events. He’s brutally forthright and willing and able to sling stones at any giant standing today.

Over the past several weeks he’s been spot on with several math-based predictions related to COVID-19, and his frequently updated rolling calculations of R0 (R naught) values – using data from state health agencies and the CDC – is probably some of the most important and enlightening data in the world right now (and predictably, as it opposes the narrative being propagated by most of the media, is for the most part ignored).

KD writes with animated clarity, if you’re not up to being challenged, or offended by frankness, don’t click over there.

On the other hand, if you really want to get to the bottom of things, and incorporate useful real data you can use to make decision for your family, click over there and spend an hour reading back through several weeks worth of posts.

Stay healthy my friends, and spend a bit of time outside the box today.

My Personal Experience with COVID-19

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Quick Background to my COVID-19 Story and a Caveat

For the past week or so I’ve debated back and forth as to the value of sharing my own experience with COVID-19, mainly due to the fact that I’m personally (as a retired physician and current health educator) quite concerned that anecdotal reports of individual cases have the potential to (perhaps significantly) skew perceptions about the evolving COVID-19 story we’re all impacted by.

My hope is that my personal experience might be useful in some way, and the caveat of course is that any viral process can and likely will manifest uniquely in a given individual. As with most things YMMV, but clearly by the current data most of us will have a mild clinical syndrome when eventually encountering COVID-19.

Finally, for years now I’ve tracked my daily general health in my main workout record, usually summarized in a word or two if needed, as well as my workouts for the day, steps recorded by my fitness tracker, as well as heart rate responses in workouts (most often max, range, and average) just for the hell of it, and as a longer term record of my fitness changes. That tracking, in hindsight, has proved useful in piecing together my story.

My Personal COVID-19 Timeline

Looking back at my records, I noted on 2 March that I’d manifested symptoms of an upper respiratory infection (URI), though felt well enough to complete two aggressive workout days, though with a slight elevation in my HR responses to workouts. By the third day I felt much more fatigued than usual and took a rest day (unusual for me midweek), though for the next several days (March 6-9) noted improving URI symptoms, and I continued my walk/resistance training workouts on schedule, albeit with slightly elevated HR responses compared to my longer term average, and a bit more effort required to grind it out (particularly in strength training).

Interestingly on the 10th I experienced a bought of fairly impressive cramps and diarrhea, and the next day (11 March) developed a constellation of symptoms that became a bit concerning – a moderately severe diffuse headache, symptoms of conjunctivitis (burning, itchy eyes, redness, conjunctival swelling w/o drainage), anosmia (marked decrease in sense of smell), marked decrease in ability to taste (likely largely due to anosmia), impressive fatigue, and myalgias (diffuse body aches), along with a slight increase in URI symptoms (typical stuff).

The headache and conjunctival symptoms lasted for 9 days (through the 20th), with the muscle pains lasting a bit longer, finally resolving by the 24th.

The sense of overall fatigue was damned impressive, and looking back my sleep requirements increased from a typical 7.5-8 hours / night to 9 hours plus.

Of note, personally over the past several years I’ve found it damned useful to walk and workout per my routine, and felt well enough during this time frame to continue 80-90% of my workout routine, again with slightly elevated heart rate responses to exercise as compared to my normal. Now over a week out, energy and endurance have return to normal, and all of the symptoms noted above have resolved.

And yes, my lovely wife experienced a very similar course within a few days of my symptom onset, though her symptoms resolved within 7-8 days.

Interaction with the Health Care System

Of course during this SARS-CoV-2 / COVID-19 outbreak I’ve been researching and reading daily a fairly large and diverse bundle of information. My symptom constellation met many of the clinical criteria documented by the CDC and other professional associations, yet I did not meet criteria for actual testing.

I have a number of friends still in medicine, and ended up tracking down a friend who’s an infectious disease specialist in SLC; after conversations with he and his delightful PA, they agreed that in all probability given my symptom complex I indeed had COVID-19, albeit a mild case, and indeed was not eligible for testing at that time. My own internist agrees, and interestingly asked that I not present in the office for evaluation given case loads that week, though his team was reasonably diligent in following up to asses my status.

I’m damned curious to know if I’ve indeed seroconverted (developed measurable antibodies) and with the testing currently unavailable, I’m on a research protocol list to have blood drawn at some point down the line.

I have a few thoughts to offer at a later date on the COVID-19 “bigger picture”, though at this point suffice it say that my experience will likely be representative of what most of us will see when confronting this syndrome head on.

Hang in there, be vigilant and practice common sense precautions (wash those hands and don’t touch your face!), and fine tune your nutrition and fitness routines while you’ve got a little extra time on your hands.

Two Quick Things to Remember Today…

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As many in the world stand agog at the disruption and chaos invoked worldwide by the SARS-CoV-2 virus and the COVID-19 infection it causes, please take time today to remember a couple of simple yet critical things.

Remember, and Reach Out to, the Elderly and Infirm in Your Neighborhood

While it’s clear that there is far, far more we don’t understand about the behavior of the SARS-CoV-2 virus and the intermediate and longer term responses of the human body to the COVID-19 process, it’s brutally obvious that the virus has thus far has been devastating to those in their 8th and 9th decades of life in particular.

Take a bit of time today and reach out to your more mature family, friends, and neighbors – make sure they’ve got the immediate essentials needed to manage these first of what indeed may be a number of days at home, and offer words (and deeds if needed) of encouragement and support.

The more mature among us, hopefully wiser as well, have seen various life challenges come and go, and most understand that ‘this too shall pass’ is much more often true than not.

And Remember Those Who “Keep Us Alive”

Reader JK in Houston sent in a link to an article recently posted in National Review – Remembering Who is Keeping Us Alive – a worthy, quick read today.

From the article –

…The point is that in our age of necessary shutdowns and staying home, one thing we must do is eat — and eat well to stay healthy. And that means lots of people have to go to work and produce food and transport it to the major cities, and not always in isolation on the south 40.

Farmers do a lot more than just drop a seed in the ground and then by rote watch it sprout into a corn stalk, as one of our nation’s richest and most influential figures lectured us not all that long ago. For millions to subsist at home, to force the virus to sputter out, they must eat, as well as have power, running water, law enforcement, and sanitation. And that means millions of Americans must go to work as usual and sustain the elementals and existential forces of American life for 330 million, usually out of sight and out of mind, as we concentrate on the required quarantining of universities, offices, bureaus, sporting events, etc…

Hang in there, be smart, turn off the news, and do some remembering today.

Older Bolder Coronavirus Update 2 March

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There’s been a fair amount of water under the bridge since I first posted a few thoughts about the COVID-19 story unfolding with ever increasing speed and vigor around the world two weeks ago.

While not intended in any way to be a comprehensive primer on the COVID-19 outbreak, here’s a quick rundown of key points I’ve been sharing with friends, family, and clients this past week in response to questions that keep rolling in.

There’s Still a Lot We Don’t Know (and for a Variety of Reasons)

One of the hallmark features of this COVID-19 story has been the lack of hard data available for public perusal, beginning from the earliest days in January when eyes and ears around the world began to pay attention to what was happening in Wuhan Province.

The authorities in China have a long and checkered history of not disclosing information which shines a revealing light on life there, and there of course has been and continues to be extensive criticism of early management of the COVID-19 outbreak and the lack of critical and accurate information provided the rest of the world as the virus has advanced beyond China’s borders.

To be sure, there’s much, much more information available today than two weeks ago, for example, the genome has been well mapped and tracked as the virus mutates (typical viral behavior) as it migrates through new hosts.

Vital information detailing the actual disease process induced by the viral infestation, how truly infectious the particle is, the impact of various co-morbidities on the natural history of the resultant illness, and even testing protocols have yet to be fully developed and dispersed.

Digging into the clinical details takes time; hard data is coming, but it’s simply not available at the granular level we’ve all come to expect in North America.

Hello, I’m Here from the Government, and I’m Here to Confuse You About COVID-19

Sadly, and impressively, the Chinese authorities haven’t been the only agency withholding information. The debacle unfolding in Washington State is a stunning example of such – it’s becoming clear that at least one of the early infections among the nursing home patients and staff was identified as early as six weeks ago, and not explored and addressed with purposeful intent and care in its earliest stages. (References: 1 2 3 4 )

Impressively, the mis-handling of the nursing home nexus in Washington has exposed thousands in the community unnecessarily; heads should roll once the relative crisis there has been averted.

Several states are withholding numbers and locations of patients under monitored or isolation protocols, and the frank – and let’s be damned honest about it – overt politicization of the issue by many at the national level is absurd, inflammatory, distracting, and harmful. RUN from anyone attempting to make this a political game – it is most certainly not – and you can be damned sure that any politician, regardless of stripes or tenure, doesn’t have your or the nation’s best interests in mind if they’re playing the COVID-19 politics card. RUN, and don’t look back.

Who Should Genuinely Be Concerned About COVID-19 Today?

As to who should be genuinely concerned about the COVID-19 outbreak today, those with preexistent lung and / or cardiopulmonary disease, especially if symptomatic, remain at the very top of the “should I really worry list”. By the relatively limited available data, most fatalities related to COVID-19 have occurred in this group, and those older than 80.

I’m hearing some chatter among physician friends that those with T1DM appear to be at higher risk, and of course anyone with impaired immune function for what ever reason needs to exercise due caution.

Another issue you won’t hear discussed in main stream media venues is a probable fecal-oral vector; this is very likely part of the nursing home catastrophe in WA, and would raise the potential for critical issues in locales such as San Francisco, where you need an app to navigate city streets to avoid current defecation sites. Cities with large homeless populations – LA, SF, Portland, Seattle, Austin, etc. – will need be watched carefully, and if they’ve not yet disclosed outbreaks by now, count me among those betting it won’t be long.

So What’s a Prudent Family to Do This Week to Deal with COVID-19?

So what’s a prudent family to do this week?

You’ve no doubt heard much of this same stack of advice from many other sources, and you’ll hear it / read it again and again this week as well. There are of course easy points to add to a list like this – don’t travel to high risk countries, cruise ships aren’t a great choice right now (at least in the Orient), and it’s worth keeping an eye on outbreaks as they develop around the country – at least as they’re reported – using your local health department or the John Hopkins mapping tool here.

Standard, time-tested and proven protocols for managing flu season risk are good to brush up on. Even better – simple hand washing and avoiding touching your face (especially around the eyes) – lower flu season risk dramatically and are available to everyone.

Might you have to sequester yourself in your home for a short time? Perhaps, if you live in the epicenter of a community eruption such as the one very likely coming in Kirkland, WA (the nursing home story we’ve been talking about) or have someone in the family with very high risk factors.

In many locales it’s probably too late for a full-on “prepper” stock-up, though putting together two weeks of food, water, personal hygiene items, medications, and home care products isn’t a complex game. As I write this late yesterday afternoon, there are reports across media outlets of runs on grocery stores (Costco in particular for some reason) all day yesterday.

I agree with those who suggest the supply chain disruptions caused by this event may be more seriously impactful on daily life than the risk of the actual infection, which for most will most likely be a flu-like event. Supply chain problems are just beginning to develop now, and will worsen down the line; having a store of food and supplies offers a buffer for these issues as well.

Still smoking? The data suggests that smokers are at particular risk for COVID-19 infection and more serious clinical syndromes – it’s past time to stop. Get it done, and now.

Have a potential option to work from home? It might be a good idea to chat about options and work through a few details with your employer before the (potential) sh*t hits the fan at some point down the road.

And finally, if you’re overweight, have the metabolic syndrome, are carb-dependent, and out of shape, any effort you expend starting NOW to overhaul your nutrition plan and begin to rebuild your fitness will pay off in the months to come, regardless of what issues this viral syndrome brings to your own neighborhood.

Pay attention, plan well, get moving.

Ancestral Nutrition (Esp. Low Carb) in the Crosshairs: Two Fascinating Examples

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Like many of you, I find it most interesting when critics sling their arrows at the revolution happening in the human nutrition world these days.

I’m specifically referring to the tidal wave of evidence suggesting that consumption of overly processed, carbohydrate-centric, and fat-phobic diets has led to an unparalleled decline in overall health and disease markers over the last 40 years or so, and the rather stunning results that people from all walks of life have had when reverting back to more “ancestral” eating patterns.

And for the sake of discussion, let’s stipulate that these ancestrally-aligned food plans, when compared to the standard American (or Western) diet, are lower carb, feature moderate protein intake, and high amounts of healthy fats. There are a lot of different ways to skin this dietary cat if you will, but for discussion today we’ll focus on a LCMPHF approach.

Like many of you, I read different versions of what are often very repetitive talking points hammering ancestrally-oriented nutrition plans; many of the criticisms are based upon myths, hearsay, and some even overt misrepresentation.

Here are two that particularly caught my eye of late, in part, due to their sources.

An Interesting Perspective From the Foodie World

Late last month, Bon Appetite’s healthyish published this article – Before You Go Paleo, Keto, or Whole30, Think About These Side Effects. The thrust of the piece was that rigid food rules can have unintended consequences, with the author focusing on food obsession and a sense of loss and deprivation, which led to her personal failure when attempting to use Whole 30 to revamp her nutritional paradigm.

The author shared –

…Through my work as an eating psychology coach, I’ve seen that we can’t undo the cycle of dieting and weight gain until we understand what’s underlying our constant desire to drop pounds. At its core, dieting is a coping mechanism, and not a healthy one. We’re not born wanting to change our bodies, but billions of dollars are spent telling us that we should.

I’ve come to believe that, to end the diet-binge cycle, there has to be an inherent acceptance of the bodies we’re in. We don’t have to love it, but we can start with accepting it…

Bottom line – she missed the entire focus, and point, of eating a more ancestrally-aligned food plan. The game is not about deprivation, and it’s not about weight loss. The game is all about optimizing your health and function.

Is weight loss part of that process? It sure as hell can be (or should be) for some of us (obesity rates remain impressively high, just look around at the grocery store today…). But that’s not in any way, shape, or form the primary objective of eating ancestrally. The goal is optimizing health.

An Angry Perspective from Conventional Medicine

Early last month, MedScape, a physician and health provider news aggregator and CME site, published an interesting online piece titled The Low Carb Community is Its Own Worst Enemy.

You’ll need a free account to read the piece in full, and I heartily recommend that you do so when you have 20 minutes to spare. You’ll need that much time to read through the comment section as well; it’s packed with fascinating perspectives and as much vitriol as I’ve seen in some time directed toward the ancestrally-oriented community.

In part, the author’s premise (of note, he’s a family physician working in a bariatric clinic in Canada) is that physicians and leaders of the “low carb community” manifest all sorts of unprofessional and unbecoming behaviors. To wit, from the article –

Of interest – the author calls out what he classifies as vitriol and misrepresentation with, ironically, vitriol and misrepresentation. The comment section is similarly filled with all sorts of fascinating opinions…

I agree wholeheartedly with those who suggest that the increased attacks flowing toward the ancestral or non-standard American / Western diet folks these days are most likely evidence that we’re honing in on significant issues, issues that have been sadly mismanaged by the bulk of conventional medicine and nutrition gurus for several decades now. Why use the term mismanaged? Simply looking at obesity rates and incidence of T2DM is enough to prove the point.

Two quick additional points. The vital key is using the best food and nutrition plan you can find to best suit your personal physiology today – as your system adapts and changes, your nutrition plan very likely will need to as well. Customize, customize, customize.

Second, not all those good folks practicing conventional medicine are out to persecute you as a Paleo guy or keto gal; modern medicine offers so much in terms of potential contribution to your overall health, it’s frankly insane to throw the proverbial baby out with the bathwater here. A thoughtful, skillful, listening primary care doc deserves a seat on your health and wellness team, and they’re out there – you might have to do a bit of prospecting to find one, but they’re out there.

Getting Kids Outside Makes Them Happier Adults

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Our 9 month (and change) old grandson Brantley took his first trip into Yellowstone National Park this past weekend, touring the Mammoth Hot Springs with mom above, and otherwise looking pretty mischievous while enjoying some of Spring’s first bright days in Montana and Wyoming. (Images via our son, Jake.)

That little excursion on Saturday brought to mind something I’d run across in the Adventure Journal – Study: Kids Who Spend Time in Nature Become Happier Adults.

It’s based on this research piece published a few weeks back in PNAS (Proceedings of the National Academy of Sciences US), and backs up what many of you who love being in the outdoors have know for years – humans thrive when connected to the physical world around them, getting their hands dirty, skinning their knees and elbows, soaking up the sun, and literally connecting with the earth around them.

I’m truly astounded at how disconnected many children and youth are from the natural world today; make sure kids (and grandkids!) you influence in your world are getting a healthy dose of “outside” each and every day.

Two Prime Examples of A Traditional Medical Swing and A Miss: Practice Guidelines for T2DM and Obesity

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As a former clinical physician I’ve always been fascinated by the promulgation of clinical guidelines, ostensibly crafted by leading minds in a given field convening to articulate treatment and diagnostic pathways to follow based on, what we’d all presume to be at least, the latest and greatest empirical evidence.

The overwhelming challenge is of course that human pathophysiology varies widely from person to person, given their unique genetics, history, constellation of conditions, nutrition, and even behavior. One-size-fits-all guidelines are often somewhat muddled in real-world application, and can lead to inappropriate, sub-optimal, or even harmful treatments being offered.

I personally know physicians who would be offended at the paragraph above, yet examples are stunningly commonplace of clinical guidelines run amuck today. For example, I have an 86-year old family member who’s currently being pressed to take statins for an incorrectly interpreted lipid panel, with her internist refusing to pursue the most specific testing, reporting it’s not allowed in his employer’s guideline directives.

For further example, here are two clinical guidelines released in the past few weeks that miss the mark impressively.

From Canada, T2 Diabetes Clinical Practice Guidelines for Physicians

From the Canadian Family Physician, Diabetes Canada 2018 Clinical Practice Guidelines, was published in January, detailing an intensive and comprehensive, pharmacologically-focused treatment pathway with stunningly little discussion of dietary guidelines focused on rational management of carbohydrate intake.

The article was presented on MedScape here (free account required); as always the comments were illustrative (and saddening), with one RN insisting that T2DM is best managed by increasing complex carbohydrates and limiting protein, a stunningly incorrect approach. Critically these articles referenced failed to address diet/nutrition in any detail, which has been increasingly shown to be impressively effective in management of T2DM.

Obesity Management in Primary Care

The second example is this: European Practical and Patient-Centred Guidelines for Adult Obesity in Primary Care.

The recommendations are multi-faceted and listed in some detail; they to their credit suggest pursuit of a “typical balanced Mediterranean style diet”, though suggest that at least of quarter of caloric intake come from starchy foods including cereals, legumes, and grains, with robust consumption of fruits as well, despite ample evidence suggesting these very foods can be obesogenic for many.

Of particular interest are the recommendations regarding targeted weight loss objectives (5-10% weight reduction), which while helpful would be woefully inadequate for many, and the responses on the Medscape summary of the guidelines, including one physician claiming the obesity epidemic to be unstoppable/untreatable.

The Take Home: Don’t Be Distracted By One Size Fits All Guidelines

Two Points of Interest. First, one-size-fits-all clinical guidelines, whether written by the AMA (or some other bastion of traditional medicine) or your favorite alternative health guru, need to be interpreted for you personally with great care.

Some recommendations you’ll come across, like the two examples above, have such glaring foundational flaws (missing fundamental nutrition and diet principles), one doesn’t have to venture too far out on the proverbial limb to suggest genuine harm is being done to many as they’re overmedicated, passing time waiting for complications of their lifestyle ‘diseases’ and treatments to manifest.

Some recommendations you’ll come across, and I’m thinking social media driven “advice” here, touting magical ingredients, supplements, workouts, etc, are not only anecdotal, but occasionally frankly duplicitous, evening bordering on the absurd. The keto world on social media is a hotbed of “experts” right now, prompting Mark Sisson to even refer to folks doing “caricature keto” in this post covering The Curious Phenomenon of Keto Crotch.

You physiology is unique to you; pay attention to what your body is telling you, and find supporting team members, including a good physician(s) when needed, who are willing to do the same.

And secondly, when anyone offers you recommendations based upon their guidelines, it’s absolutely fair game to apply several common sense tests: Do the recommendations make sense? Do the recommendations start with the least risky intervention or activity? What potential risks (or comorbidities) are involved?

An easy example – it’s my opinion that treating T2DM with pharmacological agents without a well-thought out, well-designed interval in a low carb (or VLC) diet trial is, given the information available today, clearly inappropriate. Another easy example is the liberal use of statins in clinical practice today, without adequate trials of dietary modification, particularly given statins’ long list of problems/side effects and questioned efficacy in reducing all-cause mortality in populations without proven heart disease, the risks very well may outweigh the benefits (more on statins to come another day).