Health Care?

Grace asked in a comment to yesterday's post, "Do we let insurance companies determine our treatment?" The answer to that is a resounding, YES!!!

In the natural medicine world, the low-carb world, and even before that in the women's health world, the onus for the sorry state of mainstream American health care has been placed on "Big Pharma." (For example, see Dr. Eades post for Friday.) It was the pharmaceutical companies that paid for the research to validate their products and then sell doctors on the benefits of the product which almost guaranteed that whenever you consulted your doctor with a problem, you went home with a prescription for some drug. Then they started going straight to the consumer and procured the legal right to advertise to further increase their sales. If you do any research on the web into any medical condition or treatment, you will find that the studies that have been done were done with a pill in mind. It seems that nobody can afford to do research just for the sake of finding out how things work. Melatonin is a case in point. Who is going to pay for research into the efficacy of a product you can buy at the grocery store?

But recently I read another book, Adrenal Fatigue, by James L. Wilson (which I will blog more about later. Yes, I'm off on another tangent.), in which he makes a very good point that our insurance companies are also shaping the medical world of today. You can't get diagnosed with a disease that isn't on their list of diseases and expect them to pay for the remedies. If a disease has no ICD code (International Classification of Disease), it simply does not exist. According to Wilson, adrenal fatigue is not on their list, only the more serious Addison's disease. If your tests show that you do not have Addison's, then doctors rule out an adrenal problem even though you may be presenting them with a classic case of adrenal fatigue which used to be treated quite commonly. (Ever describe your symptoms to your doctor and only gotten a blank stare in reply?)

Also, even if you have a bonafide medical condition (according to their way of thinking), they get to determine the therapies. They are now starting to refuse to pay for things they consider "not medically necessary." This morning's LA Times (in the Business section, it's all big business) has an article about a woman who after receiving therapy for carpal tunnel syndrome, was told it was not medically necessary and Blue Shield, her insurer, refused to pay for it. They are also refusing to pay for her annual MRI to make sure her breast cancer has not returned.

I myself was caught by this one recently. As part of the diagnosis procedures to determine what was going on with my digestive system, since my reflux symptoms were unusual, I had a routine colonoscopy and endoscopy. Colonoscopies are recommended for someone my age, but I had never had one due to the fact that 15 years ago I had a sigmoidoscopy at Kaiser Permanente without anesthesia and it was an excruciating experience. My gastro doctor said not to worry, I would be anesthetized this time. Doing the procedure without anesthesia was "barbaric" according to him. Now after the procedure has been done, my insurance has deemed the anesthesia "not medically necessary" on the advice of some doctor who was not there, has never seen me, and doesn't know my case personally. Hence, they have refused to pay the anesthesiologist's bill. And since this anesthesiologist is a Blue Cross provider (my insurance is Anthem Blue Cross), they say I do not have to pay any bill she sends me either.

I have been wondering what to do about this for several weeks. I feel like I am caught in a battle between the doctors and the insurance company. At least the doctor who did my second-guessing is an anesthesiologist himself, although it would have been better if he had been a gastroenterologist. The doctor who reviewed the lady's case in the Times article was a pulmonary specialist and not even in the AMA. But I wish I had been forewarned. Now I am afraid to have anything out of the ordinary done because my insurance, which does not come cheap, may decide afterwards that I didn't need it.

Is it any wonder Americans are turning to alternative means of health care?

The Sleep Cure

It seems like such a simple thing. Just go to bed early in a very dark room, and stay in bed late. And viola! (as we musicians say) you're cured. Now there's a remedy that sounds like it's worth a try. But as I am finding out, it's not so easy to do (especially for a musician).

It all started with an article in the LA Times about a study that was conducted by a doctor named Pereira who compared the effects of a cocktail of naturally occurring substances including melatonin with omeprazole (Prilosec) on GERD. (You will need a subscription to access the full article.) In the study, it was found that the melatonin worked just as well, if not better, than the omeprazole. I clipped this article out not realizing that in a month or so I would be hit with an attack of severe acid reflux myself.

In researching the connection between melatonin and GERD, I discovered several other studies that attested to the efficacy of melatonin to sooth the esophagus and protect it from digestive juices that might find their way there. It also suppresses stomach acid from being formed in the first place, which makes sense, since your stomach shouldn't be producing acid while you sleep.

So in the all-American modern medical way, I thought, Hey, just take a pill—melatonin can be had at my local grocery store. But I also found that taking melatonin can cause your pineal gland to stop producing its own so I wanted to be careful.

Then I discovered Lights Out by TS Wiley which I have mentioned previously. If you can follow my thread here, this led to the realization that we have so separated ourselves from our animal heritage that we have forgotten how to sleep! We have forgotten that it is not normal to stay up late at night with the lights burning and push ourselves to work day after day with only 6 or 7 hours sleep, not even 8, when our paleolithic ancestors would be sleeping or resting for the full 12 to 14 hours of darkness that happens in winter.

So I decided to try to get more sleep, encouraging my pineal gland to make more melatonin, and thereby curb my reflux symptoms. I indulged in my body's desire to go to bed very early—9 pm most nights and made myself stay in bed, in the dark, until 7 am. Actually, you don't have to be asleep to make melatonin, you just have to be in total darkness. And I got a little help in the beginning with a melatonin supplement. It worked like a charm! In fact, I am off the supplement now and sleeping better than ever. If I have acid reflux symptoms during the day (I believe it will take awhile, like months, to fully recover), I watch my carbs and take the other various remedies (DGL, bitters, etc.) that I mentioned earlier.

Oh, and by the way, no TV before bed. The light is too bright. Only gentle, non-stimulating activities—meditation, not exercise; reading, not web-browsing; knitting, not practicing. But... next week I will have children's concerts in the morning and rehearsals at night that last until 10:30 pm. No going to bed early, and no staying in bed late. It will be tough.

Causes of GERD

OK it's time to get down to the nitty gritty.

Theories (hypotheses? I get them confused) on the causes of GERD (gastro-intestinal reflux disease) are abundant. They say you have GERD if your reflux is persistent, not if you only have occasional problems with reflux. I will call it all GERD because it makes things easier for me. One thing the following theories have in common is that they eschew acid-reducing pills and medications like Mylanta, Zantac, and Prilosec. These are not only bad for your stomach and digestive tract, but bad for your overall health. You need acid to digest proteins. You need acid to make the whole cascade of events that happens later to occur as it should.

The low-carb theory blames it all on carbs, natch. In the book, Heartburn Cured, by Norm Robillard, the author states that if you cut your carbs really low, down to 25 to 35 g per day, you will find lasting relief almost immediately. Before I went low-carb, I was consuming 200 to 300 g per day, so you can see why cutting down to 25 would make a huge difference. Don't try to do this yourself without reading Protein Power Lifeplan to help you with the transition. I stumbled along and gradually got that low over the course of 2 years. You can check your current carb intake on the USDA MyPyramid Tracker website.

Once you have completely eliminated your symptoms, you can then experiment with adding more carbs back into your diet until symptoms return, then stay at that level or a little below. In my experience, this method will work for most people suffering from GERD. As Robillard points out, it's the carbs that create gas, especially in the small intestine, which then pushes up on the stomach from down below, which forces open the LES (lower esophageal sphincter) and allows stomach acid to flow up into the esophagus. The book is short and easy to read and includes an easy to follow description of the digestive process.

For a more thorough description of the whole process, I recommend Why Stomach Acid is Good for You by Jonathan Wright. This book has more detail and some excellent diagrams to help you get familiar with the digestive organs and the digestive process. Wright's suggested remedies are more mainstream, though, i.e., looking for specific foods, like spicy foods, etc., that might be your own triggers. I found that for me this is not the case. There isn't any one food that sets me off, but carbs in general do add to the problem. However, his solutions other than using HCL (hydrochloric acid) and pepsin are quite helpful. I am reluctant to use HCL without a doctor's assistance.

The HCL probably would work, though, because as Wright says, it isn't that you have too much stomach acid, it is that the acid is in the wrong place (your esophagus). He claims that most people have too little stomach acid and the remedy is to increase the acid signaling the LES to stay shut tight. There is some evidence that he is right, so I have followed his recommendations for taking bitters before a meal to increase stomach acid. He also recommends DGL (deglycyrrhizinated licorice) which I have tried (definitely an acquired taste) and other natural remedies like vitamin C and L-glutamine. Even chamomile tea will sooth the esophagus.

Another theory can be found in the book by Konstantin Monastyrsky called Fiber Menace. His theory is close to the low-carb theory but he puts the blame on the fiber that comes with carbs and not on the sugar content. He has a point when he says that fiber swells up inside our digestive tract with the liquids we drink with meals and may cause blockages. I have followed his advice to drink water, or some other liquid like herbal tea, an hour or one-half hour before a meal and not afterwards. That gives the liquid time to clear through the stomach before filling it with food. The liquid our stomach uses to make the chime that is sent to the small intestines comes from our blood. BTW, if you are having constipation, read this book before you reach for the Metamucil!

But the thing that has really gotten me off the Zantac and on the road back to my normal good health is melatonin about which I'll have much more to say later.

The Sea

The sea was calling me. I just had to go. I acted on impulse and convinced Kathy to join me. It was a glorious day after the rain. The plants had a fresh green look and the birds were out in full force to feed while the weather was clear. The air smelled by turns sweet and then pungent with various aromas—the wonderful scent of artemesia (California sage brush), the bracing salty air, and old broccoli. "Something is fermenting here," commented Kathy. "We are so fortunate to live near the California coast," she repeated over and over. We were feeling as glorious as the weather and the vista.

We walked for two hours enjoying the fantastic views, observing the plants and birds. Kathy can't resist snapping off a sample here and there. But she doesn't touch the endangered species and she does spread the seeds. The bird species observed included three of the sleek, gray California Gnatcatchers with their "mew, mew" call, dozens of White-crowned Sparrows, and several Yellow-rumped Warblers who were down on the ground pecking like the sparrows. A majestic Raven and his/her mate had a front row seat of the view of Catalina in the distance. A Red-tailed Hawk slowly rose on the warm air rising from the cliffs.

Why does it take so long to get ready for a short excursion like this? We couldn't decide what jackets to bring. Would it be cold? Windy? Or sunny and warm? We needed water, binoculars, my camera. Kathy needed her emergency diabetes supplies, sunglasses, the right hat. We were outfitted for a trek through the wilderness, but we were only going for a morning walk! And still I did not take into account the mud. Kathy had an extra pair of shoes, but I did not and drove home in my stocking feet (is that against the law in CA?) to avoid getting the car all muddy. When I got home, it took me half an hour to clean the mud off my new Nikes.

In Lights Out, T.S. Wiley says that our impulses are governed by serotonin. Without serotonin we would run amok and in today's world we need more control than ever. At night, melatonin is made out of the serotonin. We sleep it off and start each day afresh. Dark controls melatonin while light controls cortisol and dopamine. When you are feeling great, on top of the world, you are high on dopamine. Since serotonin is a downer, the best state to be in is one with high dopamine and low serotonin during the day. Serotonin blunts your perceptions while dopamine puts everything into high focus. But serotonin levels match insulin levels. So if you eat a high carb diet, your insulin goes up and so does your serotonin.

All very complicated, all very fascinating.

Desert Plants, Birds, Bunnies, and ?

On the last day of my stay in Arizona, we paid a visit to the Desert Botanical Gardens outside of Phoenix. It was a lovely day and the low afternoon sun offered many picture-taking opportunities. So I thought I'd share a few with you.

The Saguaro is the quintessential Arizona plant and this one was a fine specimen. The Saguaro is also a very useful plant and one of its uses is as a bird house or even an apartment building!

I hadn't brought along my big lens for the camera, but took some bird photos anyway. I was surprised at how well they came out when I got them on the computer. These are all fairly common birds of Arizona. The Curved-billed Thrasher has a lovely song, the Cactus Wren was everywhere (naturally), as were the Bushtits.

We strolled down Quail run hoping to see Gambel's Quail, the desert member of the quail family, but while I kept hearing quail, we didn't see any. Then we discovered that what we were hearing was an audio tape display on the birds of the area. Someone had kept pushing the quail button. Then we remembered that the last time we were at the gardens, the quail were all on the hill above the cafe! They know where the food is. So we headed up there, sat down quietly at a table, and sure enough the quail came out and gave us a show. Nick had a lot of fun sneaking up on them to take their photo.

Leaving the cafe, a strange cat crossed our path as we meandered down the hill. We are not sure what it was, but it wasn't an ordinary house cat. Notice the raccoon-like rings on its tail. Unfortunately, I didn't get a shot of its head. It had huge whiskers and it's belly was drooping and almost dragging on the ground. Searching the Internet, the best we could come up with was that it was a wild cat. What it was doing in the Arizona desert, I don't know.

Better Late than Never

I received one last Christmas gift last night from my local florist. She had been trying to deliver this beautiful table arrangement to me for a week. It's from my brother in Massachusetts who was unaware that I was spending the holidays in Arizona with my son and family. Communication with both of my brothers is not as frequent as it should be. So here it is bro, and thank you very much! I will certainly enjoy looking at it while I eat, especially with the candles lit.

It's the third day of the new year and I have been able to do my exercises twice already. I feel great! Got a good night's sleep last night which helps, too. The illness I have been grappling with since September is a severe case of reflux and except for Christmas Eve (the perfect gift), I have not had a good night's sleep for months. Typically, I fall asleep just fine, but then wake anywhere from two to five hours later and can't really get back to sleep. This illness has had me stymied as to the cause, except for the proverbial old age, since I have been low-carbing for almost four years now and low-carbers aren't supposed to have reflux problems. Also, my symptoms have been non-standard to say the least.

Even though one of the main purposes for my starting this blog was to relay the information I had gleaned from four years of reading and experimenting with a low-carb diet for my friends and family who suffer from the various diseases of 20th and 21st Century man, I have been reluctant to write about this problem of mine mostly because I didn't know what was going on. Since I am feeling better and since I also feel like I am finally getting a handle on this, (Hah! I've said that before many times over the last few months) I thought I would end my silence and let you in on the nitty gritty. A second reason for not blogging about it is the subject matter. Things gastro-intestinal are just not talked about in polite company. Anyway, take this as a warning that what I say I may refute a week later, and that the going will be rough and not pretty.

As always, I have been reading and one of the latest books I have just finished is all about sleep! Lights Out, by T.S. Wiley is a very thought-provoking book about the mess modern man has gotten himself into since the invention of the light bulb. The short message is that we stay up too late, especially in the fall and winter, and do not make enough melatonin. Why is this so important? Well, there has been research that shows that our digestive tract is full of melatonin, and furthermore that melatonin protects the digestive tract, especially the esophagus from stomach acid that may have found its way there. The reason I am feeling so much better now is because I have started a regimen of very-low-carb eating (it's the carbs that create gas), getting to bed in a very dark room by 9 pm most nights (not an easy thing to do!), and taking a supplement that includes melatonin. No Prilosec. No Zantac.

There's a whole lot more to the story, but I'll have to give it to you in pieces. I need to try and organize it a bit and find links to my sources. We are due for three big rainstorms here in LA starting today, and I need to do a few things around the house to get ready.

2008

Happy New Year to one and all!

I decided it was time for a change. I hope you like my new layout. It is a sea theme and doesn't really have much to do with knitting except for all those lucious, warm fisherman's knits I could make. I'll put that on my list.

Now is the time for lists of New Year's Resolutions. After just getting back from Arizona where I spent a wonderful and relaxing (well most of the time it was relaxing) Christmas with my son and family, I am ready to tackle new things. At the top of my list of resolutions is to get my health back on line (more about that later) and get back to doing my exercises regularly. Then I want to reduce some of the clutter around the house so that there is room for new projects. In the knitting area, I want to get Anya at least started for my daughter, finish the Maltese shawl for my daughter-in-law, and knit myself a pair of socks. I've never done socks.

Books to read include finishing Maynard Solomon's Beethoven. I also want to finish listening to the lectures on Beethoven's piano sonatas by Robert Greenberg. I never realized how fantastic Beethoven's sonatas were—so rhapsodic, like he was improvising when he wrote them, but yet they are so well-crafted. I can see I will be buying more CDs in the near future also.

And then I want to travel. I have lots of frequent flyer miles and itchy feet. No definite plans yet, but something will happen. Stay tuned.