Tag Archives: diet.

Insane Medicine – Acid in our bodies is a problem – Metabolic acidosis (MA)

Acid is not good
Acid is not good

acid house acid mushroom

  • Our bodies are always in a battle with too much ACID. I discussed this briefly before and am revisiting this topic again because of the metabolic impact metabolic acidosis (MA)  has on our bodies (that is, too much acid)
  • In the process of digesting meats and animal proteins, our body produces acids as well as internal processes that contribute to high acid levels. Our body uses bicarbonate and other  mechanisms to neutralize the excess acid.
  • Metabolic acidosis (MA) affects every system in our body. MA at a chronic level activates bone resorption and can increase the rick of osteoporosis. Treatment of MA can decrease this risk when it is present. Skeletal strength is impaired by MA because the body cannibalizes it’s own muscle to help neutralize the extra acid. Likewise, MA will impair insulin release and insulin receptor functioning. This results in glucose intolerance and diabetes. MA will also cause the progression of kidney failure and impair the functioning of thyroid hormones and it’s receptors.
  • We see metabolic acidosis in 1 out of 30 patients with normal  kidney function. the number affected increases as kidney function declines.
  • BMC Nephrol, 2013 Jan 9;14:4 : Use of bicarbonate to normalize MA can prevent progression of chronic kidney disease. How much bicarbonate and what type of bicarbonate is used? Sodium bicarbonate, in amounts starting at 1300 mg twice a day to get the serum bicarbonate levels to 24 mg/dl. Baking soda has 850 mg of sodium bicarbonate in a teaspoon.
  • Sodium bicarbonate intake does not worsen high blood pressure because the sodium load resulting from the sodium bicarbonate cannot be reabsorbed in the kidney through the usual NACL cotransporter.
  • The body normally excretes extra acid loads produced in the body in the form of ammonia, which is produced from glutamine (an amino acid) When metabolic acidosis is present, the body quickly runs out of glutamine from its usual sources and gets extra glutamine from muscle breakdown. The glutamine then goes to the kidney to be broken into ammonia which absorbs the extra acid.  So metabolic acidosis leads to increased muscle breakdown and weakness.
  • Diet affects the production of acid, especially with the consumption of animal proteins, which results in a lot of acid production in the body. This speeds UP the loss of kidney function in predisposed individuals. It has been shown that fruits and vegetables create little acid production in the body and a vegan diet as such decreases the rate of kidney function decline in patients with kidney failure.


Here is the summary:

  1. Treatment of metabolic acidosis, when the serum bicarbonate level is below 20 mmol/L, using sodium bicarbonate at doses of 1300 mg twice a day to increase serum bicarbonate to 24 mmol/L has positive impacts in multiple fronts as below.
  2. Increased bone density results from treatment of MA, thus decreased fractures and falling.
  3. There is better glucose control by treating MA due to better insulin sensitivity and insulin receptor responsiveness.
  4. Treatment of metabolic acidosis decreases the progression towards kidney failure in susceptible individuals with chronic kidney disease.
  5. Treatment of MA results in better muscle strength and muscle mass.
  6. Eat more fruits and vegetables to decrease your intake of acids.
  7. Have your doctor asses your blood for low bicarbonate (Less than 20 mmol/L)
  8. Consult your doctor prior to initiating any medical regimen as discussed.

Insane Medicine – Even older people should watch their diet

Successful aging requires continued effort for the best outcome. Do you want to live to one hundred and be bed-bound or live to one hundred and be active? Successfully aging people need to consider healthful behaviors to maintain their independence and health. Conditions that affect people over sixty can be modified and lessened by nutritional strategies:

  1. Cardiovascular diseaseHigh blood pressure, cholesterol/triglycerides, and obesity are modifiable by diet and medication. Weight control allows for better mobility, less pain, and fewer heart attacks. Obesity is associated with sleep apnea, as well, which reduces quality of life because it makes you fatigued in the day time and generally weak.
  2. Cerebrovascular Disease: Such as strokes and dementia are impacted by high blood pressure and diet. First off, quit smoking to decrease your risk of dementia and stroke. Decrease your sodium intake to decrease your blood pressure (1500 mg of sodium a day is about right for an average diet.) Use herbs and spices to flavor your foods. Foods such as cold cuts, cheeses, breads, pizza, pasta dishes, snack foods, and soups have higher levels of sodium, so beware. Consider following the DASH diet: http://www.nhlbi.nih.gov/health/health-topics/topics/dash  and http://health.gov/dietaryguidelines/2015-scientific-report/ 
  3. Diabetes Control: Diabetes affects everything from your eyes to your kidneys. There is a four-fold increased risk of death from heart disease or stroke if you are diabetic. Take your medicines, track your hemoglobin A1C (sugar control measure) and eat  food with a low glycemic index. Eat food with less fat and avoid high-sugar content items, but include more vegetables and whole grains to maintain glucose control. It takes a lot of effort if you are diabetic, so don’t let diabetes take your life one leg at a time!
  4. Cancer: Get your recommended screening examinations. Also, maintain a healthy weight since obese people have higher risks of cancer!
  5. Chronic Kidney Disease: Another disease modifiable by diet control – CKD risk is increased if you have hypertension, diabetes, obesity, or cardiovascular disease. A healthy diet and physical activity will maintain your weight and blood pressure, minimizing aging’s impact on your kidneys!


  • Eat bright colored vegetables (carrots, brocolli) and deep colored fruits (berries) for phytochemical, healthy support.
  • Chose whole, enriched, fortified grains and cereals, i.e. whole wheat bread.
  • Chose low and non-fat dairy products: Yogurt and low-lactose milk
  • Use herbs and spices to add flavors to meals
  • Lots of fluids: no sodas
  • Exercise

Insane Medicine: Mediterranean diet and Plant based diets to stop your heart from stopping!

Mediterranean diet-
Mediterranean diet-
The Mediterranean Pyramid
The Mediterranean Pyramid
Mediterranean Pyramid
  • Adherence to the Mediterranean diet has been proven in trials to be associated with a decreased risk of early death, decreased heart disease risks, decreased cancer risk, and decreased incidence of dementia and other brain diseases. Eat healthy and you live healthy!
  • Stop Smoking. Be certain to exercise.
  • The Mediterranean diet has been shown in a 2013 New England Journal of Medicine study to decrease cardiovascular events. The diet allows moderate alcohol (wine), low meat/meat products, but moderate fish intake. Vegetables, fruits, nuts, legumes, and olive oil were the important components in this diet. The study revealed a 30 % risk reduction of cardiovascular events (stroke/heart attacks) among high risk people.
  • It was believed that the Mediterranean diet creates an environment in the body in which insulin sensitivity is improved, blood lipids status are improved, resistance to oxidation and inflammation occurs, and vasoreactivity is  decreased. The key components seem to be olive oil and nuts.
  • The Lyon Diet Heart study in 1994 showed that a canola based oil spread used for omega 3 fatty acid intake along with increased breads and fruits,  but less butter, cream, deli meat, and unprocessed meat decreased the chance of a heart attack from 4% to 1 % (relative risk).
  • Interestingly, the origins for the notion that meat may be a problem for our hearts resulted from the demonstration that Norwegians lived longer from the ravages of cardiovascular disease during the German occupation in World War 2 because their livestock was taken away. They were forced to eat a plant based diet that was more healthful!
  • The most interesting article showing that a plant based diet can really make a difference is a study by Essyeltyn et al. linked below. This study demonstrated that following a plant based diet eaten by 198 patients with high risk coronary artery disease (CAD)  decreased the event rate of new heart attacks and strokes to 0.6% in follow up, whereas those who ate a regular diet had a 62% rate of new heart attacks and strokes!! So what does this diet include? Here is the list:

Plant Based diet: (Esselstyn et al.)

  • Legumes
  • Whole grains
  • Lentils
  • Vegetables
  • Fruit
  • Flaxseed meal (omega 3 and omega 6 fatty acids)
  • multivitamin and B12.
  • Excluded are: NO oils, fish, fowl, meat, dairy, nuts, avocados. No fructose, no sucrose, no fruit juice, no salt, no syrup, and no molasses.


Why do the plant based diet? If you are at the end of your rope in cardiovascular status, such as untreatable heart disease or high stroke risk, this diet is VERY EFFECTIVE! It is harsh, but very effective, allowing a much better quality of life and longer life.Check the links below.




http://www.ncbi.nlm.nih.gov/pubmed/25198208    A way to reverse CAD? J Fam Pract. 2014 Jul;63(7):356-364b.

“A way to reverse CAD?” by Esselstyn et al (J Fam Pract. 2014;63:356-364,364a,364b

http://www.jfponline.com/home/article/a-way-to-reverse-cad/f74f8ebb9261a837f3511f407516c7e5.html  – the article by Esselstyn

http://www.nejm.org/doi/full/10.1056/NEJMoa1200303     Primary Prevention of Cardiovascular Disease with a Mediterranean Diet


Inhibition of dimethyarginine dimethylaminohydroxylase causes vasoconstriction.

Insane medicine – Replace saturated fats in your diet with Vegetable oils (Linoleic acid) to lower cardiac risk!

Replacing saturated fat with vegetable oil is associated with lower coronary artery disease risk based in a study in Circulation recently released (Circulation. 2014;130:1568-1578).

  1. Exchanging 5% of consumed calories from saturated fat sources (red meat and butter) with foods containing linoleic acid (an n-g fatty acid that is polyunsaturated and found in vegetable oil, seeds, and nuts) can decrease coronary heart disease events by 9%. So swap out your saturated fat sources with polyunsaturated fat to help out your heart!
  2. Linoleic acid (polyunsaturated fat) intake was inversely associated with heart disease, such that the more linoleic acid taken in, the lower the risk of heart disease. At the best outcomes, there was a 15% lower heart-risk and 21% lower death rates in those who consumed the most linoleic acid sources.
  3. Replace butter, lard, and fat from red meat with liquid vegetable oils when you prepare and cook foods.  By replacing saturated fat in this way, total and LDL cholesterol is reduced.
  4. Sources of Linoleic acid (an omega-6 polyunsaturated fat) include: soybean, sunflower, safflower, and corn oil, as well as nuts and seeds.
  5. Fats have 9 calories per gram. Use 1.5-3 tablespoons of vegetable oil daily to get 5-10% of calories from linoleic acid (100-200 calories total) It is important to replace saturated fat with these sources of polyunsaturated fats (linoleic acid) and not just adding this to the total fat intake.
  6. Linoleic acid does not promote inflammation based on a neutral effect on inflammatory markers or arachidonic acid levels (which increase in inflammation).

Cooking oil examples:

Safflower oil – 78 % PUFA (Linoleic acid)

Sunflower oil – 69% PUFA (Linoleic acid)

Corn oil – 62%

Soybean oil  – 61 %

Peanut Oil  – 34%

Canola oil  – 29%

Lard – 12 %

Palm oil – 10%

Olive oil  – 9%

Butterfat  – 4%

Palm kernel oil  – 2%

Coconut oil – 2%


General notes about fats:

  • Greater intake of trans-fats (hyrogenated oil for example) relative to polyunsaturated fats (PUFA) is associated with higher cardiac risk. N-3 omega fatty acids and alpha-linoleic (ALA), also an n-3 fatty acid) are associated with good cardiac risk. Linoleic acid (LA) , an n-6 PUFA most commonly eaten in the Western diets, also has been shown to be beneficial in preventing cardiac risk, but less investigation had been done regarding this fatty acid. Linoleic acid reduces LDL levels, which is a positive effect for decreasing cardiac risk. LA can be elongated into arachidonic acid, which is inflammatory and thrombogenic (blood clot forming). Studies have shown that LA is in fact not pro-inflammatory in the body. It does not increase C-reactive protein . It also has no effect on other inflammatory marker such as cytokines, fibrinogen, soluble vascular adhesion molecules, plasminogen activator inhibitor type 1, or tumor necrosis factor-α.
  • There appears to be a linear response to increasing LA intake – as one takes in more LA, there is less coronary events (heart attacks) and less death! Thus n-6 fatty acids (Linoleic acid) has cardioprotective effects! Increasing LA intake by 5% led to 9% less coronary heart disease and 13% less death!
  • It had been assumed that LA is converted to arachidonic acid (AA), which is inflammatory. AA  is the main precursor of eicosanoids with inflammatory and thrombogenic properties, such as prostaglandin E2, thromboxane A2, and leukotriene B4. It has been found, however, that the conversion of LA to AA is tightly controlled in the body, thus there is no increase in inflammation.


Insane Medicine – low fat diet or low-carb diet?

Low fat diet or Low-carb diet? That is the question:

  • Low-carb diets tend to lose more weight since they take in less calories, but they must change their diet more radically than a low fat diet. A low fat diet would be fat intake of less than 30% fat a day.
  • Low-carb diets result in HDL increases and triglyceride decreases. This was not the case for low fat diets.
  • Findings show that all diets, whether low-fat or low-carb result in some effectiveness. You must chose one that you can adhere to. For some people, it is easy to cut out fat and eat more protein. Either case, increase your good-carbohydrates as found in fruits, beans, whole grains, and vegetables. Also chose food with better fat, i.e. fish, nuts, seeds, vegetable oils.