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The General Public is Meant to be Deceived: The American Food Conspiracy

Everybody knows how to operate smartphones and understands complex modern phenomena, but many Americans are frighteningly ignorant about basic human nutrition.

I am convinced this is the result of a powerful conspiracy, fueled by the (junk) food industry. Here are just a few examples:

Milk has been advertised as a healthy beverage. It is not. No other species consumes milk beyond infancy. Milk based products like ice cream and yogurt are on top of that often sweetened beyond their natural properties.

Fruit juices make it possible to consume the calories of half a dozen pieces of fruit faster than eating just one. Naturally tart juices, like cranberry, are sweetened the same way as soft drinks (high fructose corn syrup), and therefore no healthier than Coca Cola.

Things made from flour—like bread, crackers, boxed and instant cereal, pasta and snacks like pretzels or chips other than plain potato chips—raise blood glucose levels faster than eating table sugar: The breakdown of flour starts in our mouths because of enzymes in our saliva while sucrose doesn’t break down until it reaches our small intestine.

Sugary foods, even candy like Twizzlers, are advertised as “fat free”, which is a relic from the days when fat was believed to be bad for you. Many fats, like those in olive oil, salmon, tree nuts and avocado are extremely healthful.

Another example of tangential descriptions is when flour based snacks are promoted as “baked, not fried”. Flour is bad, no matter what you do with it and, in fact, the presence of fat slows down the blood glucose rise from highly processed carbohydrates.

Serving size is still used to deceive people. A small bag of chips may seem to have a modest amount of calories until you realize it is supposed to be two servings. Fortunately, some packaging now states how many calories are in the whole package. Serving size should be abandoned, since it has no basis in what people really eat.

Artificial sweeteners are still promoted as if they are a way to consume fewer calories. Unfortunately we now know that they often alter our intestinal flora which in turn can release hormones that make us hungrier and craving sugar even more.

Additives are often promoted as healthy, from probiotics to vitamins to extra protein. There is little evidence to support this.

Words like “all natural” are often used in food advertising, but mean nothing in terms of whether they are good for you or not. Poisonous plants, like hemlock, are natural but that doesn’t mean we should eat them.

So many people have trouble understanding the three types of calorie containing foods that exist: protein, fat and carbohydrates. That’s where I often have to start. And sometimes, when I ask people “walk me through your day, tell me what you eat”, I end up pointing out “it’s all carbs”.

This kind of basic information should be kindergarten stuff, not adult education.

The Art of Tinkering: The Man With Cold Fingers

Recently I solved a medical dilemma by changing the medication that seemed to have nothing to do with my patient’s problem.

Ethan Blake is a thin-boned, soft-spoken man with atrial fibrillation and a history of high blood pressure. He lives alone and prefers to shovel his own driveway. He also loves to walk his springer spaniel in the woods behind his house. He is in great physical shape.

At his routine followup early last month, he lamented how his fingers were always cold and painful when he goes outside in the winter.

He takes a blood thinner because of his atrial fibrillation and metoprolol to control his heart rate. He has also been on lisinopril for blood pressure since before he developed his arrhythmia.

We know that some people get cold extremities because of an underlying autoimmune condition. We then call his problem Raynaud’s syndrome. When it is an isolated phenomenon, we call it just that – Raynaud’s phenomenon.

His metoprolol could cause cold fingers all by itself, or it was at least likely to aggravate Ethan’s symptom because it constricts blood vessels. A different rate controlling medication, the calcium channel blocker diltiazem, does not constrict blood vessels but would not in itself do much to improve Raynaud’s phenomenon. The calcium channel blocker nifedipine is routinely used in Raynaud’s but does little for heart rate and could drop his blood pressure too much in combination with his other medications.

Switching from metoprolol to diltiazem could be tricky. Theoretically, during the transition, his heart could either start racing or slow down too much. You would have to do it gradually, because stopping metoprolol suddenly could cause a rebound surge in heart rate, like if you were to release the emergency brake on a moving car while flooring the gas pedal.

It seemed like a tricky situation.

I looked at Ethan’s historical vital signs. He has lost weight slowly over the last few years and his blood pressure lately has been on the low side, often 110/60.

A thought struck me: What if I had him back off on his lisinopril to get a blood pressure in the 130s? Would that increase the perfusion of blood to his long, thin fingers? Then I wouldn’t have to fuss with a switch from metoprolol to diltiazem or the addition of nifedipine.

I explained my theory. He was eager to try it.

Over the month of December, Ethan tapered his lisinopril from 40 to 10 mg while he kept track of his blood pressure. When I saw him the other day, his fingers were warm and he told me they felt quite all right outside most of the time. His blood pressure was 134/68.

We decided he could try stopping lisinopril completely and let me know what happened.

I wasn’t sure when we started out that my plan would work. It seemed a bit tangential to just let his blood pressure rise a bit when the seemingly obvious problem was constricted blood vessels. But as an amateur plumber I also knew that the main water pressure and the pipe size can conspire to cause poor flow in the faucet.

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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