Do you do an emotional workout?

It’s 11am and I’ve already (unintentionally) done my emotional workout for the day. It started with a phone call where I learned about a senior doctor (supported by two colleagues) bullying medical students. (not in my town fortunately!)  They berated the students, accusing them of arrogance, stupidity and weakness. The students were told “Know your place!” all because the students asked to be excused from an activity so they could study for their upcoming exams. Haven’t these doctors been reading the news?

ANGER– Which I have re-narrated as “passion for justice”. When will we turn our medical culture around? I felt ashamed of and angry with some members of my profession.

Then I read about the outpouring of generosity for the homeless student who wants to be a criminologist and is living in a tent under a bridge (It must be SOOO cold!) I shed a tear or two.

THANKFULNESS TO OTHERS for being so compassionate. I felt good to be a human.

Then I remembered all the work I had to do today! I had a little panic.

FEAR- I had a little chat with fear, thanking it for reminding me not to waste the whole day, and re-examined my expectations. I wouldn’t try to do so much. The panic was a little less overwhelming

Then I decided to head down to the local coffee shop for coffee and a croissant (yes I know it’s pro-inflammatory! and yes it might have been avoidance!) The new Florence and the Machine album was playing, the sun was streaming in, and some kind patrons were rescuing a terrified wandering little dog outside. I read a funny clip in the Herald Sun from a lavatory in Japan

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LAUGHTER AND JOY

That’s it. Workout over. On with the working day!

Must get a physical workout in later!

Wow.. I got a comment and a suggestion!

Well, I got all excited. The comment went like this…

“What you said made a lot of sense.  But, think about this, what if you added a little content?  I mean, I dont want to tell you how to run your blog, but what if you added something to maybe get peoples attention? ……”

This was a momentous occasion! My first unsolicited comment. The fact that it was from “pornography addiction” was a little strange, but I could cope with that…

Hang on… (starts to sniff a spammer)

Simple google search result and bingo!

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Oh well. I’ll wait patiently until I get a real person. At least the bots are reading!!

Appreciation

My friends are all heading overseas, or are already there. Well, not all, but many. I’m envious, but have decided to turn this into a positive. What if….. I was a tourist here, in Geelong? What would I notice? How would I experience life differently. I was pondering this, when I saw this…

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What a beautiful eucalypt! Subtle sunset colours in its upper branches at the end of a wonderful crisp wintry day. I was biking home from work. What a privilege to live as an unpersecuted person in Australia. Tomorrow I hope to catch up with some friends who are still here. I’m not envious any more, and I’ll do some more of the “What if…..?” technique, as today it seems to have put me in touch with the simple things I might have missed.

Musical meanderings

It’s late and I’ve been youtubing. A bit of a musical voyage shared with my daughter. We sat up chatting about the changes over the years in how commercial music is experienced. Who remembers the excitement of the first music videos: being able to SEE the artist performing- how fantastic was that?

I remember too the first arty videos. I felt a bit cheated. I wanted to see the performers, not video effects! Watching the beautiful artistry of Antony and the Johnsons “Epilepsy is dancing” compared with the awkward Supremes “Baby Love”  I wonder now what I was disappointed about.

Anyhow, it was a wonderful 90 minutes. An eclectic collection, including

Donna Summer: Heartbreaker

Bee Geees: ditto (yep..they wrote it)

Antony and the Johnsons: Bird Gerhl (magic)

Righteous Brothers: Unchained melody

Bats for Lashes: Laura

Sia: Breathe me (one of the most beautiful songs I know; she’s a genius)

Christy Moore: Ride on (also beautiful)

Marilyn Manson: Sweet dreams, Tainted love (both great covers)

Richard Clapton : Capricorn Dancer (dated, but nostalgic video)

The Canadian tenors (with surprise appearance by Celine Dion): Hallelujah

The fray: How to save a life (sad, moving)

The cinematic orchestra: To build a home

There were a few more daggy ones but if I were reading this that would be more than enough information. End of self indulgence. Bye for now.

Why haven’t I told anyone about this blog?

So far, I’ve only told a couple of friends, and my family about this blog, and today my son asked me why. It was interesting to ponder.

The reasons, I decided were as follows

1. Even though I may come across as arrogant or opinionated, some of my ideas are pretty “out there” – I haven’t really started on these ones, but as a teaser, I believe that depression, while a terrible human experience, has a function which is a bit like immunisation.. you suffer for a greater gain. I believe that we can emerge from depression with a much greater self understanding and compassion, and, if this is acknowledged by our loved ones and carers, the likelihood of further episodes is minimised. Anyway.. that’s one of the weird ideas I’m not going to put out there in a big way.. yet.

2. Thinking that one day there might be a bigger audience keeps me honest. I have to be responsible and accountable for what I write. That’s important. So that’s why I’m not just writing this into a file on my computer.

3. There are some really great bloggers out there. I’m not one of them, so in some ways I’m a bit of an imposter in the space. So I’ll just leave my voice in this little hidden corner of the internet, to be discovered by the curious.

So here I am.. blogging away to my audience of 4 or 5 people. It’s fun.

 

Rethinking medicine- the microbiome, diet and disease

Ok. This is my third post and it’s really the first one that has anything to do with the URL “unorthodocs” which I derived from being a doctor and finding my ideas really on the “fringe”. This has been the case for most, if not all, of my career. As a GP I found myself admiring people with so called “borderline personality disorder” when my peers were in a different frame of mind. I became interested in narrative therapy as a very respectful way of dealing with suffering rather than the diagnostic model which believed in chemical deficiencies, ideas of “normal” and “abnormal” and pharmaceutical supplementation. (I’m not dead against this, obviously, but against the overuse of this model, especially when it doesn’t help). In the 1990s I became interested in what we thought then was “food sensitivity” despite much scoffing by some of my peers.

Anyhow, times have changed. The stuff that was scorned is suddenly OK again. Colonic enemas, once quackery, are being reappraised as we contemplate faecal transplants for some conditions now that we have a new of understanding  of disease.

The new model is complex. It can’t really be simplified. But here goes (forgive any oversimplification- but it’s not possible to do this simplistically- we really stuffed up previously with oversimplifying eg: “Saturated fat is bad for you”, “cholesterol causes hardening of the arteries” etc.)

We all come with a genetic makeup. Some genes protect us from disease. Some predispose us- there’s a lot of luck here, but diversity is important for survival, so we are not made as clones. This is not new thinking- I’ll get to the new stuff soon.

We also come with a microbiome: that’s bugs in us and on us. (In fact they are mainly “on us” as the gut is technically part of the exterior world, and that’s where the most bacteriae reside).

Our microbiome is unique to each of us. It depends on our early exposure (Caesarean section anyone? Would you like a five-fold increased risk of food allergy with that?). If you are born by vaginal delivery you get a microbiome very much based on your mother’s gut microbiome rather than her skin microbiome. That’s probably good.

Our microbiome is then modified by our lifestyle- predominantly our diet, but also by exercise, antibiotic exposure and other medications that we previously didn’t realise also kill some bugs and favour others.

Our microbiome directly or indirectly alters our metabolism, our desires, food preferences and cravings. (Google “neuropods” if you are interested!). We westerners eat an excess of food. It can also create inflammation in the body, directly starting off processes that underly much of our troublesome diseases.

A healthy diet for you may not be so for me. We have different genes, and they might even be because we are descended from different cultures or geographical areas. We’ve adapted differently. Then add in what might be our uniquely healthy microbiome. Our optimal internal bacterial community will differ depending on whether we are descended from populations whose staple is maize, wheat, rice, millet or others. And it will move and change dynamically with our diet.

The microbiome and disease.

There is lots being written about the microbiome. A lot of it is not new, but a lot is. Rather than write a huge essay, here is a start-

There are some bacteria that are appearing as culprits in the generation of dementia, depression, diabetes, infertility, inflammatory bowel disease. These diseases may be more related than we think. They all involve inflammation. Firmicutes species (some types only) Proteobacteriae and Clostridium difficile seem to appear in the police lineup with suspicious regularity. Currently we have a few suspects, and a lot of crimes. Matching them up will require supercomputing, not conventional research trials.

Anyway, it’s not just the microbiome that’s new on the block in our understanding of disease. There’s a few people around challenging the orthodoxy in our understandings. And their ideas are looking plausible. Some are greatly more plausible than what we doctors thought was fact:

Diabetes and insulin

What if we are wrong about diabetes? What if insulin is as much the problem as it is the solution? What if diabetes is an adaptation to overnutrition? (ie- get so sick you have to stop overeating, and spill glucose into the urine to avoid it being driven into overloaded and inflamed fat cells) If overloaded reserves are the cause of organ damage, treating with insulin may be harmful. Maybe we should be advising increased fat intake and reduced carbohydrate intake (a reliable way of reducing total calories) thereby reducing the need for insulin (see the Ted talk by Peter Attia, or the work of David Lustig, Jimmy Moore’s podcasts, or David Gillespie’s books here, and read them all discerningly- no commentator is perfect.)

Cravings

Still on diet here… what if cravings are mediated by the bacteria, and it’s not just as simple as willpower? What if we are blaming people for a neuropsychoimmunological response that is beyond their control, just like we blamed people for TB before we understood it was caused by a bacteria? (I read an article making this connection, but I can’t find it to make the attribution here)

At medical school we were told about dopamine and cravings. We were told what parts of the brain were involved. We were told about addiction, but we didn’t know about the microbiome and how it might be calling the shots here. We were told that the vagus nerve (brain to gut) was a superhighway with 2/3 of its traffic going from gut to brain, but not why.. no-one really knew.

But back to medicine. We have a number of epidemics currently. Two of the most serious are metabolic syndrome (“diabesity”, “fatflammation”, “carbohydrate-storage-disease” call it what you will) and the second is abuse including domestic violence and sexual abuse. Both have solutions but require paradigm shift. I’ll talk about abuse in another blog.

Suggestion – Change our food guidelines.

I think we should abandon our reductionist dietary guidelines that confuse us by dissecting food down in some semblance of  a scientific experiment. We could stop doing trials that distract us from the obvious, and stop trying to control variables that can’t be factored out and ultimately leave studies wide open to criticism. Instead we could adopt sensible National Food Guidelines like Brazil’s. Or just to keep is simple, we could avoid any “food” that doesn’t rot or wasn’t in existence before the industrial revolution- they are most likely not a real food.. more likely a  “food like substance”. We should, as Katz found when he compared all diets, eat food, as close to nature as possible with a predominance of fruit, nuts, vegetables and fibre. We should eat just enough to satisfy hunger.

Meat is problematic. Apart from the ethical issues, it’s pretty hard to find meat that isn’t based on grain-fed animals or fish. Grain isn’t great for animals or many humans, but grass fed meat is expensive, less available, and we can’t make enough to feed the world.

I think we should ignore consensus derived guidelines and stick to evidence based recommendations, or if there are none, regress to traditional pre-1900 diets appropriate to our genetics.

Warning- if you are diabetic, always discuss dietary change with your medical team. The following isn’t medical advice.. your doctor is the place for that. I do advise looking at the following ideas and discussing with your trusted doctor.

Hopefully people can find an up-to-date doctor. When this post was written, many doctors hadn’t heard of the microbiome, but now many are familiar. If you have cravings and are not diabetic, have a look into the evidence about withdrawal from sugars and processed carbs (including bread) . It seems likely that healthy fats, nuts and fermented products can assist by reducing the number and power of the bad carb-dependent bacteriae that feed the cravings. Carb withdrawal is becoming pretty popular. Even for type 2 diabetics, who of course will need all dietary changes supervised as insulin is likely start becoming more effective if you start reversing the diabetes. This can lead to hypoglycaemic attacks (hypos) which can be extremely dangerous if medication isn’t adjusted accordingly.

There’s a lot of exciting research being performed and new strategies are emerging to prevent or treat diseases when previously we could only despair our therapeutic impotence. The drug companies are also excited. See this article in Nature. I prefer to be excited about lifestyle and dietary change without popping pills, but each to his/her own. The microbiome will be/ (is, 2019) big, and people aren’t even talking yet about the virome (your average spinach leaf is teeming with viruses which can kill bacteria called phages, and it seems they attack the bacteria that cause us harm). It will take decades to nail the virome and make it into pills, so in the meantime, let’s just stick to green leafy vegetables like grandpa and grandma said.

 

Airport ponderings re: friendship

I’m sitting in an airport with an hour or so to kill. (How fortunate and environmentally irresponsible are we in Australia that jet travel is available to the masses- $38 to travel 900km!)

Nevertheless, putting aside my greenie guilt factor, I’m contemplating friendship, and the dynamic exchange of values. Rather like a tide washing back and forth. There’s a bit of intercontinental drift too.. Some of my friendships have just drifted away, without any active encouragement or discouragement- “that’s just the way it is”. Others are consolidating and as this happens it helps me to contemplate love. There’s much to love. I don’t understand it, but I’m enjoying learning more about it and myself.

So I’ve just had a few days with a dear friend whom I love. He’s a pretty chilled out guy. Quite different to me, so I learn a lot from him. And we have our differences which we exchange. Somehow I feel that if we were partners we’d get to a base level disagreement that would deconstruct or self-destruct our friendship, but the luxury of friendship is that you can actively make decisions to ignore, or tolerate, or learn from the differences. Why is this so much harder in our chosen relationships (which are often formalised by marriage, defacto agreement, whatever)?

Coincidentally, while spending time with my friend, I received a belated invitation from an another (“old”) friend to an event. He’s very like my current friend in a way, but it’s complicated. We spent a lot of time together in our formative years and we have so many of these experiences to reminisce about, but I feel I failed in my part of the friendship. There were some differences that I wanted to explore, and his “model” of friendship meant NOT exploring these. “You just tolerate these things quietly in friendships” (Not his exact words: I can’t remember them, but that the message was explicit). I miss this friend and I grieve not knowing what is going on in his life, but I haven’t made the steps to bridge the gap of time, and it’s widening. I haven’t had a meaningful conversation with him for many years now, so what to do?

Expediently I could say “We’ve just drifted apart”, but what is that? I’m a very social person, and I’ve “moved on”- I hate that expression.. look at the offence Julie Bishop has caused with invoking the good old “let’s look forward” after the execution of Andrew Chan and Myuran Sukumaran, and I totally see why. Its reminiscent of John Howard not getting why an apology to our indigenous population was needed- when you are “moving on” you lose an opportunity to reflect and learn from the past.

So what have I learnt? Not sure, but I know I value my friendships deeply, and I feel that I’m too fickle- I love my friends, but I know that some of the “special” friendships have changed. Making someone special has huge spiritual benefits, but can also generate expectations and raise the risk of letting them down. (My greatest fear!) Then there’s the complex ingredient of their life choices of friends and partners- what to do with all the factors there? Loyalty, politeness, tolerance, jealousy, anger, bemusement, amazement and shock and awe are some of the experiences I’ve had watching my loved ones in their relationships. One thing I know about committed friendship is that the commitment process is wonderful self learning.. if painful. Makes me humbly ponder, and often overthink (more about overthinking soon). I wish I could just package it as “That’s just the way it is”. I’d be much more “chilled”.

Let’s not be resilient together.

So welcome to my new blog. It’s going to be a bit random because previous attempts caused me to obsess too much trying to get it right. So this is the first post, and for some strange reason I wanted to start with a little rave about resilience.

Just sayin’ – I’m not a big fan of resilience. I think it’s too often used as an excuse for treating people badly, and it’s over-revered. Everyone has a breaking point, and maybe the world would be a better place if we concentrated more on reducing the stresses on people than telling them they need to be more resilient. By pointing the finger we forget that those of us with power or privilege can be a little softer.

You see the extremes of the strength-worshippers in some of our leaders who pride themselves on their ability to resist bending in response to pressure, even to their own and our detriment (2014 budget anyone?)

So let’s be gentle and fragile together. I work in health care, but at the moment it’s more like health scare- it can often be a daunting place. Maybe if we didn’t believe so much in resilience we would acknowledge our own fragility and we might provide a whole lot more emotional support for patients, and for all those working in health care including our nurses and doctors.

Hmm.. I just re-read this post and realised there’s a risk this blog could be a bit preachy. Better not let that get out of hand!

That’s enough for now, so ‘bye.

Michael.