Factory hospitals

Twenty years ago, the American farming industry experienced a dilemma: How to grow more soybeans, corn, or wheat from a limited amount of farmland, raise more cattle and hogs in a shorter period of time, fatter and ready for slaughter within months rather than years?













(Image courtesy Wikipedia)

The solution: Synthetically fertilize farmland for greater crop yield; “factory farms” for livestock in which chickens or pigs are crammed into tiny cages that leave no room to turn, cattle packed tightly into manure-filled paddocks. As author Michael Pollan put it in his candid look at American health and eating, The Omnivore’s Dilemma:


To visit a modern Concentrated Animal Feeding Operation (CAFO) is to enter a world that for all its technological sophistication is still designed on seventeenth-century Cartesian principles: Animals are treated as machines—“production units”—incapable of feeling pain. Since no thinking person can possibly believe this anymore, industrial animal agriculture depends on a suspension of disbelief on the part of the people who operate it and a willingness to avert one’s eyes on the part of everyone else. . .


Pollan goes on to argue that the cultural distance inserted between the brutal factory farm existence of livestock and your dinner table permits this to continue:


“. . .the life of the pig has moved out of view; when’s the last time you saw a pig in person? Meat comes from the grocery store, where it is cut and packaged to look as little like parts of animals as possible. The disappearance of animals from our lives has opened a space in which there’s no reality check on the sentiment or the brutality . . .”


The same disconnect has occurred in healthcare for the heart. The emotional distance thrust between the hospital-employed primary care physician, the procedure-driven cardiologist, the crammed-into-a-niche electrophysiologist (heart rhythm specialist) or cardiothoracic surgeon whose principal concerns are procedures—with an eye always towards litigation risk—mimics factory farms that now litter the landscape of the Midwest. The hospitals and doctors who deliver the process see us less as human beings and more as the next profit opportunity.

The “factory hospital” has allowed the subjugation of humans into the service of procedural volume, all in the name of fattening revenues. Never mind that people are not (usually) killed outright but subjected to a succession of life-disrupting procedures over many years. But whether livestock in a factory farm or humans in a factory hospital, the net result to the people controlling the process is identical: increased profits.

The system doesn’t grow to meet market demand, but to grow profits. The myth that allows this growth is perpetuated by the participants who stand to gain from that growth.

See hospitals for what they are: businesses. Despite most hospitals retaining "Saint" in their name, there is no longer anything saintly or charitable about these commercial operations. They are ever bit as profit-seeking as GE, Enron, or Mobil.

Comments (8) -

  • Jenny

    11/9/2008 2:48:00 PM |

    Dr. Davis,

    Have you read the book, Hippocrates' Shadow? You have a lot in common with the physician who wrote it and I think it would be very productive for you to contact him and discuss strategies together.

    I blogged about the book in detail at my Diabetes Update Blog a few days ago.

    We patients can't do much about this, but physicians working together could.

  • Zbigniew

    11/9/2008 8:43:00 PM |

    adequate analogy Smile, but what we get here is a gloomy picture with little hope - while thanks to blogs like yours we may be more lucky than those poor animals.

    So the punchline should be something like "educate, read, b/c if everyone takes care of themselves then everyone will be taken care of"

    best regards,

  • steve

    11/10/2008 2:35:00 PM |

    would be interested in your views of Crestor study, and statins in general: when should they be used, etc?

    thank you

  • Anonymous

    11/11/2008 12:31:00 AM |

    Thanks Jenny, for mentioning the book, Hippocrates'Shadow. This sounds very interesting and I can hardly wait to find a copy.  
    Another great book is "How Doctor's Think, by Jerome Groopman,M.D.
    Dr. Davis, I appreciate this wonderful blog and your excellent advice. You restore some of my lost confidence in the medical profession.

  • puddle

    11/11/2008 3:30:00 AM |

    Thank you, again.  And again.

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html  (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

  • [...] (11)  http://www.newsobserver.com/2012/04/22/2016905/north-carolinas-urban-hospitals.html (12)  http://blog.trackyourplaque.com/2008/11/factory-hospitals.html (13)  http://online.wsj.com/article/SB10001424127887323829104578623720451833006.html (14) [...]

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Can I eat quinoa?

Can I eat quinoa?

. . . or beans, or brown rice, or sweet potatoes? Or how about amaranth, sorghum, oats, and buckwheat? Surely corn on the cob is okay!

These are, of course, non-wheat carbohydrates. They lack several crucial undesirable ingredients found in our old friend, wheat, including no:

Gliadin--The protein that degrades to exorphins, the compound from wheat digestion that exerts mind effects and stimulates appetite to the tune of 400 additional calories (on average) per day.
Gluten--The family of proteins that trigger immune diseases and neurologic impairment.
Amylopectin A--The highly-digestible "complex" carbohydrate that is no better--worse, in fact--than table sugar.

So why not eat these non-wheat grains all you want? If they don't cause appetite stimulation, behavioral outbursts in children with ADHD, addictive consumption of foods, dementia (i.e., gluten encephalopathy), etc., why not just eat them willy nilly?

Because they still increase blood sugar. Conventional wisdom is that these foods trend towards having a lower glycemic index than, say, table sugar, meaning it raises blood glucose less.

That's true . . . but very misleading. Oats, for instance, with a glycemic index of 55 compared to table sugar's 59, still sends blood sugar through the roof. Likewise, quinoa with a glycemic index of 53, will send blood sugar to, say, 150 mg/dl compared to 158 mg/dl for table sugar--yeah, sure, it's better, but it still stinks. And that's in non-diabetics. It's worse in diabetics.

Of course, John Q. Internist will tell you that, provided your blood sugars after eating don't exceed 200 mg/dl, you'll be okay. What he's really saying is "There's no need for diabetes medication, so you're okay. You will still be exposed to the many adverse health consequences of high blood sugar similar to, though less quickly than, a full diabetic, but that's not my problem."

In reality, most people can get away with consuming some of these non-wheat grains . . . provided portion size is limited. Beyond limiting portion size, there are two ways to better manage your carbohydrate sensitivity to ensure that metabolic distortions, such as high blood sugar, glycation, and small LDL particles, are not triggered.

More on that in the future.


Comments (15) -

  • Jordi Posthumus

    7/29/2011 1:01:43 AM |

    This is exactly what Ron Rosedale said back in 2004.

  • Payam

    7/29/2011 4:45:07 AM |

    If the only problem is that they raise blood sugar then are they okay if you eat them with fiber/fat?  If not, please explain why..

  • Anne

    7/29/2011 12:44:09 PM |

    I found that all grains, even when eaten with fat, raise my blood sugar to unacceptable levels. Grains can easily get me to over 200. Get a glucometer and see what these grains do to your blood sugar. I also found that when I want to see what a food does to my blood glucose I have to test every 15-20 min after I eat. If I test only at 2 hours I might miss the spike and be falsely reassured that I can eat that food. My fasting is in the 80's and I try to keep postprandial spikes under 110 and even that may be too high.

    If you are gluten sensitive, it is very common to have problems with oats(even the ones that are certified gluten free). Corn also seems to be a a problem for a good number of people who can't eat gluten.

  • Renfrew

    7/29/2011 12:44:24 PM |

    Sorry for disgressing a bit. Here is an excellent discussion about NIACIN and its effectiveness for decreasing cardiac events:
    http://www.theheart.org/article/1231453.do
    Do we have to give up NIACIN?
    Renfrew

  • Might-o'chondri-AL

    7/29/2011 6:09:41 PM |

    Hi Renfrew,
    Statin used with niacin, anti-fungals, genfibrozil, cyslosporin and erythromycin are already known by Mayo Clinic to have the potential to trigger muscle breakdown, called rhabdo-myolysis. This sends a byproduct called myo-globin into the blood that when reaches kidneys and degrades causes kidney renal tubule obstructive damage.

    HDL traffics mainly with the Apoliprotein A-1 (ApoA1), which is key to bring cholesterol to HDL for binding cholesterol molecules to transport for recycling. Compromised kidneys create a uremic environment which depresses ApoA1 bio-syntheis,  while proteinuria physically overloads the kidney tubule cells; in other words HDL ends up just carrying more triglycerides around and  HDL is not properly performing desired reverse cholesterol transport (recycling).

    Statins , to be fair, are showing  good results in preventing post surgery human acute kidney failure and some other kidney cases.  Of course  niacin  in rats with chronic renal failure ameliorated hypertension, proteinuria, inflammation and oxidative stress (see 2009: Am. J. Physiol. Renal Physiol. 297, F106-F113 and follow similarly related 2010: "Niacin Improves Renal Lipid Metabolism and Slows Progression in Chronic Kidney Disease" in Biochim. Biophys. Acta 1800, 6-15) .  So my non-clinician take is that niacin use, such as Doc's, without co-administered statins is largely preventative of lipo-toxicity; whereas the experiment you read of  dosing statins plus niacin risked a potential drug interaction Mayo Clinic already warned about .

  • conrack

    7/29/2011 7:13:16 PM |

    Allow me to rephrase your question: If the only problem with eating glucose is that it raises your blood sugar then is it ok to eat glucose with fats & just eat donuts?

    Brilliant.

  • Buckaroo Banzai

    7/29/2011 8:57:46 PM |

    I've never heard of table sugar being rated on the glycemic index as low as 59.  Nutritiondata says 68 and I have read 70 in books.  http://nutritiondata.self.com/topics/glycemic-index#values

  • Payam

    7/30/2011 2:15:50 AM |

    Thanks for putting words in my mouth wise guy.  What I was saying is that if I eat a sweet potato with enough coconut oil that it doesnt spike my blood sugar, what is the problem.  Dr. Davis said in the article that it wouldnt " cause appetite stimulation, behavioral outbursts in children with ADHD, addictive consumption of foods, dementia, etc."  If the only problem is that it spikes blood sugar and you avoid that problem, then whats wrong with a sweet potato.  But you already knew what my question was.. you just wanted to take out your frustration on me...

  • steve

    7/30/2011 8:08:17 PM |

    Dr Davis:
    What is a safe level for post prandial glucose measurement?  Is it under 120, under 100 or what?  Also, are you advocating a zero carb-starch diet?

    Thanks,

  • conrack

    7/30/2011 9:50:10 PM |

    Thanks for giving me another opportunity to make fun of your insistence on eating anything made of glucose.  What you were saying is that if you eat a GLUCOSE potato with enough coconut oil that it BECOMES A DONUT, it WILL still spike your blood sugar, that is the problem. (ANY glucose + ANY fat = DONUTS!)  Dr. Davis said in the article "IF they don't cause (conditions & behaviors caused by high blood sugar)" and then said "That’s...very misleading." If you think the only problem (and it's NOT) is that it spikes blood sugar, and you THINK you can, but actually CAN NOT avoid that OR the other problems, then that's whats wrong with a glucose potato. But you already knew what the answer is.. you just wanted to justify & take out your glucose addiction on me…

  • conrack

    7/30/2011 9:58:58 PM |

    Oops, that should read (conditions & behaviors caused by wheat). Got lost in the cuts & pastes.

  • Payam

    7/30/2011 11:39:23 PM |

    Okay, so rather than speaking in generalities, answer this.  I just had a baked potato with cinnamon and melted coconut oil.  Measured my blood glucose every 30 mins for 2 hours and it didn't go over 100.  It could be and probably is because I am a triathlete and I worked out in the morning so my muscle glycogen stores were empty.  So, glucose would preferentially go to muscle.  But what is wrong with eating a baked potato after a workout.  In other words, what are these "other problems" that you mention. (I didn't eat the skin by the way, b/c of the glycoalkaloids).  

    I am not trying to get into an argument with you, I really dont care.  I am just trying to get more informed.  I understand however, that Dr. Davis's information applies more to diabetics and insulin resistant, so maybe for someone active like me, its not as big a deal.  But if a potato doesn't spike my blood sugar, why, specifically, should I avoid it? Thanks

  • Tim Dietz

    7/31/2011 8:40:53 PM |

    I've monitored this blog for quite a while now and either I"ve forgotten the reasons or I've never seen them, but could somebody point me to the article(s) that outline the effects of high post prandial glucose?

    Thanks,

    Tim

  • conrack

    8/5/2011 7:30:52 PM |

    The answer is in the second half of this article posted on August 5, 2011 here: http://www.trackyourplaque.com/blog/2011/08/carb-counting.html

  • Sami Paju

    8/12/2011 3:06:48 PM |

    Hello,

    I would like to add to the discussion one significant issue with quinoa; saponins. They are molecules that are supposedly a major gut-irritant, and when compared to e.g. plant and animal foods have a high likelihood to cause leaky gut and inflammation of the small intestine. And inflammation is rather counterproductive for anyone trying to lose weight.

    //sami

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Making Dr. Friedewald an honest man

Making Dr. Friedewald an honest man

Colleen started with the usual discrepancy between conventional calculated LDL cholesterol of 121 mg/dl and the far more accurate LDL particle number (NMR) of 1927 nmol/L.

Those of you following this conversation or our many conversations on the Track Your Plaque Forum know that a useful and highly reliable rule-of-thumb for converting NMR LDL particle number to LDL is to drop the last digit: 1927 nmol/L becomes 192 mg/dl. (This is, admitttedly, arrived at empirically, not by design. However, it has held up through thousands of NMR analyses and plays out reasonably when you compare distributions of Friedewald LDL and LDL particle number on a population basis.)

In other words, by this simple manipulation, Colleen's Friedewald calculated LDL is off by 58%. This is very common, a phenomenon I witness several times every day.

By LDL particle size, 75% of all Colleen's LDL particle were abnormally small (small LDL particle number 1440 nmol/L). This is a moderately severe small LDL tendency.

So we took all the steps for reduction of small LDL/LDL, including elimination of wheat and cornstarch, exercise, weight loss (which happens inevitably when wheat and cornstarch are eliminated), fish oil, vitamin D, etc.

Another NMR lipoprotein panel showed an LDL particle number of 882 nmol/L and a Friedewald calculated LDL of 87 mg/dl. Using our rule-of-thumb, LDL by particle number is virtually the same as the calculated LDL. This time, small LDL numbered only 237 nmol/L, or 26.8% of the total, a marked reduction.

Isn't that interesting? As small LDL is corrected, the crude Friedwald calculated LDL approximates the more accurate LDL particle number.

It assumes that accuracy of the Friedewald calculation may be more likely to occur as LDL size approaches normal. However, when LDL size is abnormally small--a condition shared by at least 70% of people with coronary heart disease--then the Friedewald LDL becomes increasingly inaccurate.

The opposite can also happen: When all or nearly all LDL particles are large, Friedewald calculated LDL can markedly overestimate LDL particle number. Yesterday, for instance, a patient had a Friedewald calculated LDL of 183 mg/dl, but an NMR particle number of 1110 nmol/L--drop the zero . . . LDL 110 mg/dl. This woman was advised to take a statin drug by her primary care physician, based on the Friedewald LDL. Instead, she proved to have a far lower LDL. She would not have benefitted from taking a statin drug.

As I've warned many times before: Beware the Friedewald calculated LDL.

Comments (3) -

  • Nancy LC

    8/27/2008 9:55:00 PM |

    Oooh, thanks for posting this!  On low carb diets we see people getting alarmed all the time because their LDL goes up (calculated, of course).  However their triglycerides are very, very low and their HDL usually is good, sometimes extremely high.

    But their doctors are all alarmed over their LDL and keep pushing them into using statins.  I'll let folks know that they should ask for an NMR test that directly counts their LDL particles before jumping onto statins.

    BTW: Have you ever run into people getting higher fasting blood glucose readings taking fish oil?  It seems to happen to me.  I was taking a high dose (8g) for my arthritis and my FBG went to over 100 at times, despite a low carb, no grain diet.

  • Jonathan

    8/31/2008 11:10:00 AM |

    "She would not have benefitted from taking a statin drug."  Isn't it true that women have never been shown to benefit from statins?  If I understand correctly, statins have only been shown to reduce total mortality for middle-aged (not elderly) men with full-blown heart disease.

  • Isaac

    11/11/2008 3:07:00 PM |

    Is it really that the Friedewald calculation is wrong, or just that the two tests are measuring different things? Standard panels report cholesterol components in mg/dl, a mass per volume. The NMR test reports nmol/L, a particle count per volume. If the particles are large then there are fewer particles but perhaps more mass.

    This doesn't say anything about which one is more accurately describing cardiovascular risk, but I don't see why the Friedewald calculations are necessarily incorrect; they're just measuring things differently than a NMR test does.

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Track Your Plaque APB

Track Your Plaque APB

I'm posting this intriguing comment from the Track Your Plaque Member Forum because I would like to speak to the Member who posted it.

The Member said:

I tested at 965 last year, and while I have followed the TYP diet and nutraceutical recommendations, I was totally unprepared for my first repeat scan (at the same lab/machine) on January 29, 2008. My result was 4.0, and at first I assumed the rating scale had been changed.

I then noted that 3 of the big four arteries received scores of 0, which means the same in any scale, and that four nodules had disappeared from the scan field.



Wow!!

If this is true, it would represent the biggest success in the Track Your Plaque program--ever! It would be an incredible story to tell, to convince the public and medical community that it is indeed possible, and a cause for popping a bottle of champagne! It would also represent what I would regard as essentially a cure for coronary atherosclerosis, a virtual elimination.

While we have plenty of success in stopping the progression or reducing heart scan scores, we do not have 100% success. I wish we did. The Track Your Plaque program is, to some degree, a work in progress. We learn from experiences, continually adjust to obtain the results we desire. Even as it stands today, the Track Your Plaque program is superior to any program of heart disease prevention known--by a long stretch. But it's not infallible, it's not foolproof.

That's all the more reason I would like to communicate with the Track Your Plaque Member who posted this comment. I would also like permission to view the heart scans themselves. (I can't obtain them nor view them without the individual's permission.) While we often have difficulty judging reversal just by looking at heart scans, presumed reversal to this profound degree should be obvious, even to the naked eye.

I would like to know--in detail--precisely what steps were taken and whether there was anything unique about this person's medical history or in the program they followed. This is all in an effort to learn and help others do the same.

If you are the Member who posted this comment, I would like to hear more. Please post your further thoughts on the Track Your Plaque Member Forum, or privately through our Contact page . Or e-mail us at contact@cureality.com.

Comments (7) -

  • Anonymous

    2/9/2008 11:59:00 AM |

    Maybe he had a heart transplant and forgot to tell everyone. : )  Congrats to the TYPer with the fantastic follow-up score!

  • Anonymous

    2/9/2008 2:58:00 PM |

    This brings up a question I havent been able to find an answer to PLEASE explain. I am a 47 yerr old male with a score of 107. Here's the question: ALL of my calcium score is in 1 coronary artery, the LAD( yes I know the worst one) and yet based on calcium scororing I have absolutly no calcium(at least enough to show up as a score) in ANY of my other coronary artteries. Doesen't the same blood with the same small particle, low HDL and everything else travel through ALL the arteries? How come it only harms me in 1 artery? This doesen't make any sense to me.

  • Dr. Davis

    2/10/2008 5:15:00 AM |

    Unfortunately, there is no known explanation for this phenomenon, though it has been the subject of investigation for decades. The only consistent conclusion has been that flow phenomenon (eddies, currents, and bends) play a role--something you and I have absolutely no control over.

  • Anonymous

    2/10/2008 3:16:00 PM |

    I had the same thing( calcium score 84, all in LAD ) test done at Univercity in Chicago. When nurse called with results her explaination was that I must be a non smoker, which i am, because in smokers the plaque tends to spread more evenly in the coronary arteries and in non smokers they tend to show up in 1 or 2 arteries. She said they had no idea what caused this. She did say that if you did have calcium in your arteries, regardless of score, it was better to have it in only 1 than spread out through them all. In other words an 84 in 1 artery was BETTER then an 84 divided between 2 or 3 arteries. Ever hear of either of these theroies Dr. Davis and why would they be true? From what I've read an 84 is an 84?

  • Dr. Davis

    2/11/2008 12:56:00 AM |

    I know of no basis for such an argument. Plaque burden predicts risk for plaque rupture. I've never seen any data that addresses why one, two, or three artery distribution would factor into risk, given the same amount of plaque.

  • vin

    2/11/2008 2:33:00 PM |

    I hope you will tell us all what this miracle person did to achieve this unbelievable reduction in a very short time space.

  • Chainey

    2/12/2008 3:26:00 AM |

    Hi Dr Davis

    New to your site and finding it very interesting.

    Just thought I would mention that the hyperlink in your post, in the penultimate sentence is faulty.

    By the way, do you know of any low-carb "Diet Doctor" or other advocates (or even their long term followers) who has had a scan and publicised the results?

    I'm about to embark on low-carb, but I'm still nervous about the "lipid hypothesis" - i.e. that I'll be damaging my heart with all the saturated fat.

    I'd really like to see the concrete results from some long-term adherents to these diets.

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