20 replies to this topic

[calmcookie]

Let me first apologize if anything I've written on the board has come across as attacking ... of ANYONE. That has never been my intention and it's of no value.

I care deeply about health education and preventative strategies. I think Roger has raised an interesting point about motivation ... and I agree with MM, that people do not change until they are READY to change. I've spent over 20 years counselling diabetes patients in a conventional hospital setting. The whole focus of this work is HOW do we assist people to alter their behaviour (their ACTIONS ... their daily habits). If these patients are NOT able to change, then they end up with terrible consequences - blindness, dialysis, strokes, chronic wounds, amputations, years of suffering. It breaks my heart to witness this. Okay, I'm a bleeding heart liberal ... but I'd rather be that, than a burned out caregiver



Motivation ... is a complex, yet fascinating topic. We need to ask "WHAT," exactly, controls behaviour? I cannot write everything I've learned about this, but suffice to say -

What we believe to be true about life / health / ourselves (OUR CORE BELIEFS ... and everyone has a set of CORE BELIEFS) dictates what ACTIONS we choose to take and our ACTIONS result in specific outcomes.

Beliefs determine our behaviour and behaviour (actions) determine our results. Results, to me, are everything. If we're not getting the results we desire, then the only thing we can do is examine our beliefs and see if they really are true. This, is difficult.

When the question is "How do we help people to ACT in different ways, so they get a different OUTCOME ... the ONLY way to do this is to alter the SUBCONSCIOUS BELIEF SYSTEM. It's not the rational mind that controls behaviour ... as others have rightly pointed out ... people "know" they should quit smoking, they "know" they are fat, they "know" many things on a rational conscious level. However, that said, many people have no idea what foods contain protein, or what the good fats are or how to read food labels ... the average "joe" on the street really doesn't know ... so, education does play a part.

But it is the SUBCONSCIOUS MIND that controls behaviour and actions ... and there IS a way to alter the subconscious. More later ... have to run.

Best to all, C.C.

Edited by calmcookie, 15 February 2006 - 08:55 AM.

[calmcookie]

... and, I'm not so naive as to think I can change the world. As a wise woman once said "we cannot do great things in this life, we can only do small things, with great love."

Edited by calmcookie, 15 February 2006 - 09:10 AM.

[maineman]

CC,

Lovely thoughts. Well said. Look forward to more of these ideas.

One thing you said, quoted below, is perhaps at the core of the debate between science (medicine) and alternative or "faith based" remedies:

"Beliefs determine our behaviour and behaviour (actions) determine our results. Results, to me, are everything. If we're not getting the results we desire, then the only thing we can do is examine our beliefs and see if they really are true. This, is difficult."

It's the "results" part. In science (medicine) we look at OBJECTIVE results. Granted, this is boring, but this is what it is all about. In the non-science approach "results" can be anything, and are most often SUBJECTIVE.

If I have a smoker who is alive at age 80 and feels good, do I tell other smokers to model their behavior after her?

There was a joke I learned in first grade: Johnny is smearing peanut butter around his yard when his neighbor asks him what he's doing. "I'm keeping the tigers away", says Johnny. "There are no tigers around here", says the neighbor. "You see? It's working" says Johnny.


Anyway, once we can all understand the objectives and rational of scientific research, we'll all be better able to frame our debate.

Take the recent study on low fat diets and women's health. The Objective Data showed no benefit in cancer risk over the period of the study. Period. No bias. Just analyze the data. What good scientists will now do is scrutinize the study design, analyze whether the questions being asked were valid and whether the results can, in fact, be pegged to the question and the study. Other studies will branch off from there and ultimately we'll get closer to the truth.

In the meantime the study DID NOT say that eating a low fat diet is good or bad, or that the benefits of eating well don't offer value in other ways (like FEELING better every day), etc. It simply said that you cannot expect to reduce your cancer risk from this type of diet. Simple, elegant.

There was a huge study around 10 years ago that looked at VItamin A and Vitamin E in prevention of Breast Cancer. The study compared women who were given A and E, with women who were encouraged to eat a diet high in A and E and to another "control" group who ate whatever they want. The study involved a large number of women and lasted many years. The outcome?

No breast cancer reduction was found. In fact, there was a tiny, but statistically irrelevant, reduction in the number of cases of breast cancer cases in the group who simply ate better vegetables.

How did we approach the results? FIrst, we did not go in with a bias. We were not "hoping" for one outcome or the other. Frankly, most of us were disappointed! Wouldn't it be great to be able to take a vitamin or eat a vegetable and prevent breast cancer? Unfortunately it was not to be. How did the Vitamin/Health Food Store Industrial Complex respond to the results? They claimed it was not "valid". Claims were made that the women weren't given the "right" vitamins made from the "right" ingredients, etc.

In Maine we have a fabulous organization that does ground breaking research. They came to Maine to do their studies because Maine is such a small state (around 1 million people) and they can track data. This group has done Nobel - quality work on thyoid disease in pregnant woment and more. One study they did several years back was on the management of low back pain. An enormous health problem. The study was designed by doctors (orthopods, neurosurgeons,etc) along with massage therapists, accupuncturists, physical therapists, chiropractors, etc. ANyone who had a hand in the care of back pain in Maine helped design the study so that once the results were in no one could cry foul. This was a huge study. The results?

Once it was determined that there was not a "surgical emergency" (i.e. "slipped disk" in need of repair), the patients were stratified to one of the study arms which included bed rest/heating pad, chiropractic manipulation, physical therapy, accupuncture, etc.. In these types of studies "outcome" is determined by a subjective decrease in pain reporting by the patient and Objective findings including days missed from work, and time back to "full function".

In the first month after injury patients with "hands on" therapy (massage, etc) all reported "feeling better". At the end of the 6 month and 1 year mark, the patients who had ANY treatment, including bed rest only were statistically the same. There was a DECREASE in performance by patients treated with PASSIVE modalities (massage and chiropractor).

A very interesting study. The patients who thought that "something was being done" (touch, massage, manipulation) all "felt better" but in the end it made no difference.

Anyway, just a few boring examples from the Annals of Medicine in re: "RESULTS" and why we may differ on the advice we give to people who are seeking our help.

mm

[OEXCHAOS]

MM, A bit off topic... I had a friend who died of esophgeal cancer some years ago and about that time I read about the effects of dropping weight quickly...i.e. yo-yo dieting with quick weightloss and gain. I seem to recollect that this increases many health risks, including cancer. Have you any recollection of this study or was it just an untested theory? Also, as a correlary, would this type (and others) of behavior by health-concious but diet unsavvy folks royally screw with large scale studies of the effects of, say, a low fat diet? M

[maineman]

Mark, good questions. The data on Yo Yo style "extreme" dieting is inconclusive. We do have many case reports of heart arryhthmias as a result of Very Low Calorie diets and High Protein diets. There is no known correlation between rapid weight swings and cancer. Intuitively rapid weight swings can't be good for you, though, and none of us like to see it. We caution our patients to take the slow and steady wins the race approach. Your second point is valid. In fact, last week's study we keep talking about, the Low Fat in women's health, spends a great deal of time discussing the fact that the data includes "reality" if you will. I.E. many women were unable or unwilling to follow the dietary guidelines. Perhaps in a rarified environment of 100% compliance the data would have looked otherwise. There has been a slow rise in esophageal cancer over the past few years. Most, not all, have had a history of cigarette smoking. Most, not all, have been active consumers of alchohol. The exact etiology is not known. Luckily early detection has improved, treatment has "improved" but is still rigorous to say the least. I just lost a good patient/friend last week. We pulled him through just over 2 years from the time of diagnosis. Not great, but he was thankful for the extra time. If you are interested in obesity and dieting the best review was in the New England Journal of Medicine Volume 337:396-407, August 7, 1997. Let me know if you'd like a copy. mm

[calmcookie]

MM,

Thank you for your kind reply. I enjoy this debate and will respond further, tomorrow.

And Mark ... there is a relationship between a plunging cholesterol level and cancer.
As bariatric specialist, Dr. Micheal Eades, writes, on page 363 of his book "Protein Power" "a grave sign of serious illness, such as cancer developing or crippling arthritis, is a rapidly FALLING cholesterol level." The conventional notion that we always want to lower cholesterol, is erroneous. As I'm sure MM knows, a healthy body is always seeking balance ... homeostasis. Not too much and not too little ... of almost anything.

Until later, C.C.

Edited by calmcookie, 15 February 2006 - 01:53 PM.

[maineman]

Oh man, here I am being the "bummer" again. I hope I am not sounding like a sourpuss. Not my intent. There has been a myth out there for sometime about dropping cholesterol and cancer. It is completely false. An erroneous assumption/conclusion. A chicken/egg thing. Here's the deal: people dying from most cancers (remember there is no "CANCER" but rather vastly different entities) become cachectic as the cancer wins. This results in malnutrition and for some, falling cholesterol levels. (and protein and albumin etc. etc) But LOWERING your cholesterol levels DOES NOT CAUSE CANCER. PERIOD. Speaking of cholesterol this has been the most exciting aspect of modern medicine. By far the number one cause of death, even in healthy people eventually, is cholesterol related illness: plugged arteries. Heart attacks, strokes, peripheral vascular disease. The reseach on cholesterol has been stellar and the data is flawless. Our ability to interfere with cholesterol levels has changed the shape of human health. Even since I've been practicing we've seen a massive decline in major heart attacks among people who take our advice. This has been as overwhelming as polio vaccination and penicillin, and maybe more, in terms of the number of lives saved. Here's what you need to know: the LDL ("bad") cholesterol has to be below 130 if you are otherwise healthy (meaning no high blood pressure, no diabetes, no cigarretes). If you really want to prevent atherosclerotic disease you should try to get the LDL closer to 100. Much below 100 is not only hard to do, but may not have much more benefit. You can get the numbers there by strict cholesterol lowering diet (hard to do) or moderate dieting and safe, highly effective medicine. It's worth it. mm

[calmcookie]

MM ... I did not say that lowering cholesterol causes Cancer ... nor do I believe this. Dr. Eades does NOT say this either. Again, too much to write ... not enough time ... more tomorrow.

Edited by calmcookie, 15 February 2006 - 02:56 PM.

[calmcookie]

"Strict cholesterol lowering diets?" Actually, the cholesterol in foods has VERY LITTLE impact on LDL or HDL cholesterol. Eggs, liver, shrimp ... all HIGH in cholesterol, will not raise LDL. The work of Australian Endocrinologist, Dr. Martin Sulway has proven this ... beyond doubt.

Exercise can certainly have a positive affect on HDL, but what has the greatest impact on the bad stuff (LDL), is the NUMBER of grams of carbohydrate consumed. And it is hyperinsulinemia ... caused by high carbohydrate diets / stress and genetic tendencies that raise cholesterol levels. Period.

And SAFE drugs ???? .... ohhhhh, do not get me started on Lipitor!!! Okay, I'm getting steamed ... calm down CALM cookie!!!! Stress is not good for health

Edited by calmcookie, 15 February 2006 - 03:30 PM.

[maineman]

"Strict cholesterol lowering diets?" Actually, the cholesterol in foods has VERY LITTLE impact on LDL or HDL cholesterol. Eggs, liver, shrimp ... all HIGH in cholesterol, will not raise LDL. The work of Australian Endocrinologist, Dr. Martin Sulway has proven this ... beyond doubt.

Exercise can certainly have a positive affect on HDL, but what has the greatest impact on the bad stuff (LDL), is the NUMBER of grams of carbohydrate consumed. And it is hyperinsulinemia ... caused by high carbohydrate diets / stress and genetic tendencies that raise cholesterol levels. Period.

And SAFE drugs ???? .... ohhhhh, do not get me started on Lipitor!!! Okay, I'm getting steamed ... calm down CALM cookie!!!! Stress is not good for health

Okay. I give up. CC, that's 3 for 3 on this answer...
1.the dietary reduction in cholesterol is one of the most important breakthroughs in modern medicine. Data beyond the shadow of doubt. A massive world wide reduction in all atherosclerotic disease. Your first statement is simply false. High cholesterol foods raise your cholesterol. (Dean Ornish is wrong, too?)

2. Exercise has a small but statistically insignificant effect on HDL. HDL is the genetic component.
Carbohydrate consumption is completely separate from cholesterol. Your hypothesis is wrong. Your statement is wrong. (Not my "opinion" but common scientific fact).

3. Yes, safe drugs. But please, skip the statins and have your heart attack. Its your choice. WHen you have calmed down and want to see the data.... I'll repeat this: statins will go down in history as bigger than polio vaccines and penicillin. Combined.

CC, best of luck.

Maineman