After Your Surgery

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Once back in your room, you struggle to make out those clustered shapes about you through blurred, goo-filled eyes, and attempt to speak. But, all you hear is raspy crowing. The shock of waking up from deep anesthesia is definitely something you have to experience to appreciate.

Depending on the type of surgery you have had, food will appear on your tray that day, or many moons later. In the meantime, you will be fed evidence-based sugar water. (Don't go to the hospital and ask your doctor if your IV is evidence-based sugar water. It will only confuse him or her.)

The first day will be one of maximum stress. Pain will, most likely, be intense and your entire body will be struggling to return to normal. As a result of surgery and anesthesia, your immune system will be profoundly suppressed, and will remain so for more than two weeks. Your liver will be stressed from all the medications as well as the anesthesia it has had to detoxify. If your detoxification capacity was low to begin, it will be even worse after surgery.

For major surgeries, it will take anywhere from forty-eight hours to three days for your GI tract to crank up again. The pain and surgical manipulation temporarily paralyzes the intestines. Once it wakes up, and the doctor is satisfied with the music he hears through his stethoscope, he will start you off on some liquids. Unfortunately, these liquids are often broth—another name for MSG and hydrolyzed protein.

In the liquid form, MSG is rapidly absorbed, instantly raising your blood glutamate levels. From your blood it enters your brain, making you feel confused and disoriented. Your thoughts are jumbled and you may have a sense of racing thoughts that won't stop. In addition, the MSG will disrupt your GI tract, making you nauseated and possibly producing diarrhea. Some people will even experience severe intestinal cramping. Your evidence-based doctor will assume your symptoms are just the result of surgery or anesthesia.

As if that isn't bad enough, the high glutamate will stimulate the glutamate receptors in your pancreas causing a rush of insulin, which can produce a profound hypoglycemic response that will leave you trembling, intensely hungry, and profusely sweating, and may make concentration difficult. The nurse will call your evidence-based doctor, who will then pull something out of his hat to explain it away and satisfy the nurse so she will leave him alone.

The high glutamate level also will increase your pain by stimulating pain receptors in the spinal cord. This will require more pain medication, which will further suppress your immunity. (All pain medications suppress immunity.) If you receive blood, your immunity will be suppressed profoundly. This is because transfusions stimulate the generation of the eicosanoid PGE2. Multiple transfusions can suppress immunity to the same degree seen in AIDS cases.

Because of the stress of surgery, your body has been depleted of a significant store of B vitamins, as well as several minerals. Magnesium depletion secondary to high rates of IV infusions, long-term poor dietary intake, and stress can lead to multiple complications. One problem, confirmed in several case reports, is the precipitation of severe confusion, disorientation and even coma secondary to magnesium loss following surgery. Recovery usually occurs following magnesium-replacement therapy.

Magnesium is especially important to those who undergo neurosurgical, cardiac, or vascular operations. One big problem cardiovascular surgeons face is a dramatic magnesium-level drop following use of the cardiac pump. This greatly increases the risk of fatal cardiac arrhythmia and neurological complications. Most cardiovascular surgeons are aware of this and make attempts to correct the problem during and after surgery.

Some of my cardiovascular-surgeon friends have told me that it actually is very difficult to replace magnesium once it begins its precipitous drop. This is because the magnesium in the tissues, where most magnesium resides, is extremely low long before the patient arrives for surgery: the surgeon is then forced to play catch-up. To prevent this complication, you should start magnesium replacement long before surgery.

Unfortunately, it may take as long as six months to replace magnesium by oral supplementation. The only solution is to have magnesium given in an IV before surgery. Since serum levels of magnesium are an unreliable measure, the doctor will have to check urinary levels of magnesium. When a large spillover persists, your tissues should be saturated with the mineral.

Very few neurosurgeons are aware of the need for magnesium during surgery, even though an incredible amount of research demonstrates that magnesium is one of the most powerful and important brain protectants known. Low magnesium greatly increases excitotoxicity, free-radical generation, and the risk of seizures in neurosurgical patients. And, as we have seen, low magnesium is common in the healthy population and even more common in the unhealthy population.

Steroids and diuretics—both mainstays of neurosurgeons—cause profound magnesium depletion. I have seen patients being given several grams of steroids and large doses of powerful diuretics for prolonged periods of time, in an effort to combat brain swelling. The doctors were not even aware that their treatments were making the situations much worse.

Most neurosurgeons also fail to provide their patients with nutrient supplementation, despite the fact that their own journals carry numerous articles about free radicals, lipid peroxidation, and brain protection. There is abundant evidence that a combination of flavonoids, magnesium, selenium, zinc and the antioxidant vitamins can protect the brain significantly both during and after surgery. Yet, surgeons often fail to apply this knowledge to the care of their patients.

Wound Healing

It has been known for many years that nutrition plays a major role in proper wound healing. Animals made deficient in vitamin C and the bioflavonoids heal poorly, and the strength of the healing itself is poor. Supplementation with ascorbate increases the tensile strength of the scar, speeds healing, and inhibits infections.

While profound degrees of vitamin C deficiency are rare, subclinical deficiency is common, resulting in impaired wound healing. The stress of anesthesia and surgery increase vitamin C depletion, which can occur over a matter of hours. Proper wound healing also requires zinc, which plays a major role in collagen synthesis.

Several studies have shown that curcumin (extracted from turmeric) can increase the rate of wound healing and promote the healing of injured muscle. It also is a very powerful and versatile antioxidant. Other fruit- and vegetable-based flavonoids, such as hesperidin, rutin, and quercetin, are powerful antioxidants, chelate excess iron, and have antibacterial activity. They also stimulate the immune system.

A proper balance of high-quality proteins and calories is also important. The highest quality protein is from egg whites. If you are not allergic to egg-white protein, I suggest eating the whites of two to three eggs twice a day several weeks before your surgery and for one month afterward. Chicken, turkey, and well-cooked pork also supply quality proteins. Beef should be avoided because of the real risk of Mad Cow Disease (prion disease).

What about vegetarians? The problem with the vegan diet is that vegetables do not supply all the essential amino acids needed for healing and immune function. It is important that vegetarians and vegans eat a wide variety of fruits and vegetables to get as many of the essential amino acids as possible. Many are gulping down amino acid concoctions to replace these lost amino acids, but I discourage this practice since most are high in free glutamic acid, which can produce the same damage as MSG.

Soybeans do supply some missing amino acids in the vegan diet, but it lacks other essential amino acids and has additional problems. It contains protease blockers that can interfere with enzyme function and inhibit the thyroid. The soybean has one of the highest glutamate levels of any plant, and when solubilized or hydrolyzed, the glutamate is freed to do its damage. This is particularly true of liquid soy products, such as soymilk and free amino acid products. Some liquid soy products even have extra hydrolyzed soy protein added, which increases the glutamate content considerably.

We have known for some time that the body requires an adequate calorie supply to be able to incorporate protein into muscle and tissues. Protein intake alone results in no protein deposition at all: this is why most pharmaceutical companies and makers of liquid diets initially added a lot of sugar to their products.

The problem with sugar is that it stimulates insulin release that can produce spells of hypoglycemia or, in the diabetic, hyperglycemia. It also suppresses the immune system, promotes the growth of bacteria and yeast, and eventually increases free-radical injury. To combat these problems, manufacturers have switched to maltodextrin, which is absorbed more slowly.

If you are on an unrestricted diet while in the hospital, you should avoid sugars and eat complex carbohydrates, such as whole-grain rice and breads, and sweet potatoes. Good luck trying to find these in your hospital! I find it humorous that hospitals today, in an effort to pretend to care about nutrition, have hired dietitians to monitor the food that patients are eating. In fact, these well-meaning staff members go around scribbling little notes on patient charts about protein and caloric requirements—which is good—but then they never choose foods that are nutritious.

I am always appalled when I see a patient's food tray. It usually contains a glass of tea, tap water, beef or chicken smothered in gravy, the usual green peas and a little pile of mashed potatoes with a trough filled with brown gravy. The peas taste like wax, the potatoes like wallpaper paste, and the gravy like greasy wallpaper paste. To the side is a dessert topped with ice cream or whipped cream.

For breakfast, there's sugar-coated cereal, milk, several slices of burned, grease-soaked bacon, toast, eggs, and several packets of margarine. The bacon is full of saturated fat and replete with carcinogenic heterocyclic amines, as well as nitrates and nitrites. The toast is usually made from white bread, and the eggs have been cooked in corn oil or some other immune-suppressing oil. The margarine is full of trans fatty acids and the milk is full of antigenic proteins.

None of these meals is conducive to good health, healing, and recovery from surgery. Unfortunately, many dietitians know little or nothing about types of fats, quality proteins, food additives, fluoride, carbohydrate metabolism, or immune function. Our evidence-based doctors are not much better. All they care about is that the patient is eating. To them, food is food. After all, patients in hospitals eat exactly what doctors and dieticians eat.

I once asked a hospital dietician to exclude MSG-containing foods for my patients. She returned days later to tell me that all the food delivered to the hospital came in huge crates and ingredients were not listed. The only solution is to have your family prepare your meals and bring them to the hospital. That is the only way you will know what you are eating and that it is nutritious.

The Cancer Patient in the Hospital

Fiber

The American diet is notoriously low in fiber, a substance which plays several important roles in preventing cancer. Higher fiber intake increases stool bulk, shortens the time food and digestive products stay in the colon, and helps remove various digestive toxins. Vegetables and fruits are excellent sources of fiber. Red beet fiber in particular has been shown to lower bowel cancer risk.

In general, one should consume about 25-35 grams of fiber a day—easily accomplished if you stick with the recommended eight to ten servings of fruits and vegetables a day. (Juicing will remove the insoluble fiber.) Fruits and vegetables are better sources of fiber than bran and grain products, but they should all be included in the diet. Other high-fiber foods include: apples, bananas, oranges, prunes, raisins, raspberries, strawberries, broccoli, brussels sprouts, cabbage, carrots, parsnips, spinach, sweet potato, legumes (beans), and whole grains.

Iron and Disease

I have already noted that iron plays a vital role in the development, growth, and spread of cancer.554 Several experiments have shown that iron also increases the development of cancer in experimental animals exposed to carcinogenic chemicals. Even slight elevations in iron intake—at levels considered to be normal—significantly increase cancer growth. In one experiment, iron-fed animals developed two to five times more tumors than animals fed a low-iron diet.

As a powerful free-radical-generating substance, excess iron can damage all components of cells, leading to cancer formation. It is also associated with risk for increased heart attacks and strokes, degenerative brain disorders, arthritis, and other degenerative diseases associated with aging. Iron absorption is increased by ascorbic acid (vitamin C), red meat, and elevated estrogen levels. Cooking in iron skillets will substantially increase the iron content of food. In the past, iron skillets were so effective at increasing iron intake that they were used to treat anemia.

Some fruits and vegetables also inhibit iron absorption and prevent iron overload.555 The most effective are oranges, grapefruit, onions, apples, cranberries, and various berries. Tea, both green and white, is also useful. This is why it is important to eat mixed meals, that is meals containing fruits and vegetables as well as proteins, carbohydrates, and fiber.

While anemia can lower immunity, taking iron during an active infection or with a known cancer can increase the growth of both. If you are anemic due to low iron, replacement must be done slowly and should be carefully monitored by blood tests. Significantly low iron levels also can interfere with immunity.

Patients with cancer need special nutrition and, unfortunately, they rarely get it. Many of my cancer patients tell me that when they ask their oncologist what they should be eating, they are told, "Just eat anything. All that matters is that you eat." More evidence-based medicine.

The idea that even a single specialist treating cancer patients might have no idea about the impact of foods on cancer growth is appalling. Hundreds of scientific papers have been published, most in the last decade, on the affects of nutrients on cancer-cell growth. Yet, oncologists don't read them; instead, they read the articles about the latest chemotherapy agent or new combination therapy. After all, vegetable farmers are not going to take them out to lunch or invite them to exotic resorts in Hawaii.

Let's look at a typical cancer patient's visit to the hospital. Once a diagnosis is suspected, the doctor will most likely admit you for a biopsy, with the option of surgical removal if the biopsy is positive. It all depends on the type of cancer. Once again, it's sugar water in the vein. If the biopsy comes back with a diagnosis of a highly malignant cancer, the doctor may opt to proceed with surgery immediately.

A very complicated surgery may last for many hours. With prolonged anesthesia, you will be exposed to the fluorine-containing anesthetic gases in addition to the stress of the surgery, which will severely depress your immune system. If blood loss is significant during surgery, you might receive one or more units of blood. This not only exposes you to possible blood-borne diseases, such as hepatitis, HHV-6, Epstein Barr virus, cytomegalovirus, or even HIV, but the transfusions themselves will depress your immune system severely for several weeks.

Any viruses transmitted by the transfusion will be incorporated in your cells and organs and never leave. With immune suppression, the viruses will proliferate. This not only makes you feel worse, but can also depress your immune function even further. Patients are rarely told that blood transfusions may contain dozens of viruses that are never included in screening programs.

After surgery, you will have one or more IV infusions in your arm, dripping more sugar water plus antibiotics and other medication, but no nutrients. At that time, the stress of surgery and anesthesia, plus the pain, all combine to increase adrenal stress hormone release, mainly Cortisol and epinephrine. These hormones will depress your immunity and increase metabolism. The trauma of surgery will greatly increase your metabolic rate, increasing free-radical generation, and putting a huge demand on your antioxidant systems. Unfortunately, it also will severely deplete your B vitamins (including B12), vitamin C, and magnesium stores.

Your evidence-based doctors will not do anything to replace your lost nutrition at this critical point. They will be too busy pumping you full of more medicines. Mind you, most of these medicines are necessary in your situation; it's just that your body needs more than what it's getting and, as we have seen, detoxification depends heavily on your nutrition.

If your surgery is extensive or involves your GI tract, you will not be fed for some time. In the past, all you would receive would be sugar water intravenously, even if you could not eat for a month. Today at least, evidence-based doctors have finally learned that sick people need nourishment. It took a long time to get there, but they have finally arrived.

Depending on the type of surgery you have had, and how sick you are, you may require what is referred to as hyperalimentation. This consists of high-intensity, intravenous nutrient feeding. In an effort to get you to assimilate your proteins and amino acids, the infusion will contain 50 percent glucose, a very high concentration of sugar. As we have seen, glucose in high concentrations further depresses immunity and increases free-radical damage.

In the early days of hyperalimentation therapy, doctors eventually learned that people also needed fats in their diets, especially if the IV feeding continued over a prolonged period of time. More and more reports of patients exhibiting fatty-acid deficiency symptoms were being seen. The manufacturers of these infusions then created a fat solution called IntraLipid, composed mainly of triglycerides.

The problem with fat infusions is that they can inhibit the immune system as well, the very thing you do not want to do in the surgical patient, and especially in the cancer patient. Gradually, we have learned that the type of fats makes a lot of difference. Omega-3 fatty acids enhance tumor immunity and reduce inflammation, and omega-6 fatty acids depress immunity and promote inflammation. You need a mixture of both, because omega-6 fats are essential.

Once you are back on a regular diet, you must avoid oils containing omega-6 fats and replace them with omega-3 fats and extra virgin olive oil. This means no corn, safflower, sunflower, peanut, or canola oils. The omega-3 oils should not come from flaxseed oil; rather they should come directly from a combination of EPA and DHA oils (fish oils).

A high intake of fruits and vegetables is vitally important, especially cruciferous vegetables, such as cauliflower, broccoli, and brussels sprouts. Kale, blueberries, blackberries, raspberries, strawberries, and spinach are also all important in protecting you against free-radical damage and inhibiting the growth and spread of your cancer.

Eat at least ten servings of a variety of vegetables every day. Blenderizing would be even better since it releases phytochemicals for maximum absorption. While you're in the hospital you can have your family bring your mix to your room in a portable cooler. The fruits should be as special sugar-free blends.

While fruits contain numerous antioxidants and cancer-inhibiting compounds, they also have a lot of sugar, and cancer growth is sugar-dependent. For this reason, cancer patients should avoid fruit altogether. Furthermore, don't resume fruit consumption until your cancer is well under control.

What to Eat at Home

Once home, you can control your diet more easily. Maintain a diet of ten servings of fruits and vegetables a day, preferably blenderized, and avoid bad fats and simple sugars as much as possible. Follow the dietary guidelines outlined in the Program For Vascular Health in chapter ten.

A Word About Doctors

Throughout this book, I have given the medical profession a pretty hard time, especially concerning how medicine is practiced—so-called evidence-based medicine, and I contend that much of that criticism is well-deserved. Yet, doctors also deserve a lot of praise at the same time. Most doctors are extremely hard-working, dedicated, very intelligent men and women. Their level of skill in diagnosing and treating disease within the bounds of their training is exceptional.

As a neurosurgeon, I have known many surgeons, in many sub-specialties, who serve their profession with the skill of the most talented of artists. They work very long hours at a pace few others in our society could even attempt, and they do this almost every day and night of the week. They sacrifice many of their weekends, lose enormous amounts of sleep, and have little time to spend with their families.

As if they are not under enough stress, the government, litigation lawyers, and insurance companies have placed them under a burden that is close to destroying the profession. This not only includes a dramatic loss of income, but threats of stiff jail sentences for minor coding errors and other bureaucratic mistakes, no matter how innocent. Doctors are so stressed out that they are retiring early, changing professions, and turning to drugs and alcohol in alarming numbers.

As a result of all this, patients are also suffering. Because doctors' expenses have skyrocketed and operating funds dwindled, they have to see twice as many patients as they normally would. This means that each patient will be hurried through so that they can see the next one. As a result, the patient has little time to discuss anything with the doctor, and the doctor has little time to even get to know patients.

To save on expenses, doctors form huge groups, which means you may see a different doctor on each visit. The doctor you see knows nothing about you, other than the few notes scribbled by the last doctor. This crazy system was largely created because of the insurance companies and the Medicare/Medicaid system. Medicare pays about forty cents on the dollar and Medicaid about twenty cents. The paperwork necessary for these payer systems costs the doctor a large share of his income.

1 have dug ditches, tarred roofs, laid concrete, worked digging holes to plant telephone poles in the scorching Louisiana summer heat, and worked as a carpenter's helper in a sweltering attic, but nothing is as stressful, physically demanding, and exhausting as performing surgery.

To get some idea of just how difficult it is, go over to your kitchen table and stand there for three hours. No, you can't just stand there. Lean over the table about thirty degrees for the entire time. After three hours, you can walk around the block, and then come back to your table lean over again for another three hours. Do this from 7:30 a.m. until 7:00 p.m.

After you finish your last standing episode, walk around the block one more time. (Walking around the block is like making rounds, which you have to do between surgeries.) To make it realistic, you would have to get in your car, drive through the traffic, park, and then walk around the block somewhere else. You see, doctors often make rounds in several hospitals. By then it is eight or nine o'clock at night. Then you can go home and eat some cold supper. Your family has already eaten and the kids are fast asleep in their beds, so you sit by yourself and eat alone.

This gives you a little time to read the paper, sift through the mail and maybe watch a little television before bedtime. After all, you will have to get up at 6:30 a.m. so you can do it all over again. Finally, you lie down in your soft bed, totally exhausted, adjust your pillow, and quickly sink into a deep sleep. Just as you enter the wonderful world of dreams you're jolted awake by the phone. After all, you are on emergency call. Groggily, you answer the phone, only to realize that you have to get out of your nice warm bed, get dressed, and drive to the emergency room.

So, get out of your bed. Sure it's 3:00 a.m., but you have an emergency to see. Continuing our exercise, go get in your car, drive around for twenty or thirty minutes, and then come back to your house and once again, stand by the kitchen table for another four hours. You can't leave to go to the bathroom, eat, or get a cup of coffee. Just stand there—leaning over, of course. Isn't it nice to see the sun coming up, shining through your window?

Feeling a little achy? Eyes rather heavy? Go ahead, stretch that aching back and quickly grab something to eat. After all, you still have a long day of surgery and seeing emergencies ahead of you. Your first surgery case is at 7:30 a.m. Sharp. Let's see, you stood up all day in surgery the day before, walked an equivalent of two miles on rounds, slept for three hours, and then performed surgery from 3:00 a.m. to 6:00 a.m. Feeling a little tired? Muscles aching? Joints screaming at you? Too bad, you have work to do. This is just a sample of the life of a surgeon. Many times, the stress, workload, and all-nighters are much worse than this.

The problem with the medical profession is not necessarily a lack of dedication or laziness or arrogance, even though, admittedly, there are doctors with some real personality problems. The problem is with the educational institutions which train doctors, and the AMA which influences them. Medical education underwent a significant change with the discovery of various pharmaceutical drugs used to treat disease. Closely connected with this is an overwhelming faith in science and technology as a means to solve all of our problems.

With the growth of pharmaceutical giants and the development of newer drugs for a variety of previously unbeatable diseases, medical education began to incorporate this new knowl edge into its educational curriculum. Pharmacology courses became a mainstay and biochemistry and nutrition took a back seat. Biochemistry was looked upon as nothing more than an obstacle when I was in medical school. In fact, some instructors viewed it as nothing more than a way to weed out academically weak students, almost an initiation.

I single out biochemistry because it is intimately connected with nutrition. Nutrition is a scientific discipline concerned with the ways food consumption fulfills the biochemical needs of the body. I remember that most of my fellow classmates just wanted to get through what they called "the nonsense" and move on to the clinical material. After all, they wanted to be practicing doctors, not scientists.

Once the basic sciences requirements were fulfilled, all of the material to which we had been exposed—the biochemistry, physiology, and biophysics—went out the window, forgotten to make room for the really "useful" stuff. During the clinical years of study, we were taught diagnosis and the treatment of disease. Not surprisingly, all of the treatment was directed towards pharmaceutical medicine and no attention was given to nutritional support or treatments. Everything we had learned in biochemistry was ignored—unless it was useful to explain the mode of action of a pharmaceutical drug.

The pharmaceutical giants saw this as a tremendous opportunity. Using their financial power, they could influence what was being taught to budding doctors. First, they made enormous grants to the medical schools. With federal funding cuts, their money became the life-blood of the schools as well as a source of grants to professors for basic research. Who pays the piper chooses the song.

Ever looking for a way to enhance their influence, pharmaceutical manufacturers began to entice doctors to participate in expensive paid vacations, either to visit the factory or give lectures and attend meetings in exotic places. In addition, they started paying doctors to conduct clinical tests of their products.

Recently, pharmaceutical companies have launched an even more clever plan. Whereas, in the past they depended on frequent visits to the doctors' offices by drug reps to convince doctors to use their drugs, now they've bypassed doctors altogether and advertise directly on television and the radio, urging people to tell their doctors they want to try the advertised drug. Obviously, the plan has worked beautifully.

The problem is that doctors, both academic and those in private practice, are exposed constantly to propaganda from the major pharmaceutical companies. Doctors' entire educations have been based on a belief in pharmaceutical agents to treat disease, with no consideration given to the role of nutrition. This is not to say that the pharmaceutical companies haven't tried to get in on the nutrition business, because they did. The problem was that their product cost infinitely more than a similar product that could be purchased from a local health food store at a fraction of the cost.

As a result, many abandoned their natural-products lines. But, a problem arose. While the pharmaceutical industries grew, so did the nutrition industry. Nutritional science has undergone a virtual explosion in the last two decades, and in the process we have discovered numerous ways to prevent and treat nutritionally diseases that in the past were considered incurable. This terrified the pharmaceutical industry.

Not only was this information appearing in numerous scientific journals and books, it was flowing to the general public through numerous sources: newsletters, popular books and especially the Internet. The truth is that the Internet has revolutionized medical care in this country. Patients with a variety of diseases are now searching the internet and finding enormous amounts of information, and have access to renowned experts and basic research that before remained obscure.

The problem that has arisen from this trend is that patients are often better informed than their doctors about their particular illness. Most doctors, either consciously or unconsciously, assume they represent the best that medical knowledge has to offer. They firmly believe that medical centers, bastions of research and scientific breakthroughs, are the repository of this knowledge and that since their source of training and continuing education arises from these elitist centers, they should be listened to, and patients should mind the business of being good, unquestioning patients.

As a result of this belief, there is often a clash of wills when knowledgeable patients intervene on the turf of the doctors. The doctor may be thinking, "Who is this person to dare challenge me? I have had the best medical training in the world." It also is embarrassing when a patient presents the doctor with information with which he or she is unfamiliar. Instead of saying, "I don't know," which would challenge their preeminence in the field, doctors will frequently mumble something about such information either being unproven, or that studies have disproved it, or there is no evidence of a benefit. In truth, they often know absolutely nothing about the topic. Again, this is a result of years of indoctrination by the medical elite, who, in turn, are under the influence of pharmaceutical companies.

You must also appreciate that doctors have very little time for outside study, especially in fields unfamiliar to them. In order to become knowledgeable in the field of nutrition, they would have to relearn a lot of biochemistry and pour through a tremendous amount of nutritional literature. In their busy lives, they simply don't have time for it. Most practice medicine based on what they learned in their residency. The only education they receive afterwards is usually sponsored by pharmaceutical companies or medical supply companies.

If you scan most clinical journals, you will see that they are filled from cover to cover with ads from pharmaceutical companies and medical supply dealers. These are very expensive ads. In addition, many of these companies give grants to the journals in which they advertise. Unfortunately, this is also true of many nutrition journals as well. Doctors tend to read the articles that deal with new drugs being developed, new surgical techniques, and advances in diagnosis. The scattered nutritional or biochemical articles are rarely read.

The number of articles about nutrition now published in these journals is growing so fast that pharmaceutical companies are getting worried. As a result, they and their medical-center cohorts have launched a drive to scare the public into abandoning nutraceutical treatments. I have discussed this issue throughout the book: most of these scare stories are bogus and should be ignored.

Now that you understand better why doctors think the way they do, you can understand better their reluctance to comply with your wishes to include nutrition in your care. The information is foreign to them, and most have no idea what the scientific and clinical literature has to say supporting their use. I just ask that you appreciate how hard doctors work and that most are extremely sincere in their desire to get you well.

There is no doubt that advances in medicine and surgery have saved millions of lives and relieved a tremendous amount of suffering. But, we can do much better if we combine nutritional treatments with conventional medicine and surgery. In many instances, nutrition can cure diseases that do not respond to conventional medical treatment.

The Role of Fats in Health

Most of us think of fat as something that we should get rid of, diet off, or have removed by surgery. Likewise, dieticians and the media have convinced us that we should reduce the amounts of fats we eat to 30 percent of calories ingested or below, often making little distinction as to which types of fats are harmful and which are good. With the advent of Dr. Atkins's "new" diet, all this was turned on its head and suddenly we were told we can eat all the fats we want; that it is sugar that is the real enemy. So, what are we to believe?

Well, Dr. Atkins was half right. Sugar is the biggest enemy we face in the world of nutrition and health. Yet, the answer is not to engorge ourselves on fats of every type. Over the past thirty years, scientists have learned a great deal about fat metabolism and how different fats affect our health. It turns out that fats play a major role in most of the cell's metabolism and when certain fats are eaten in excess, they can act like powerful drugs.

One of the things you have learned by reading this book is that the human body is one of the most complex systems in the entire universe. Even a single cell's complexity is so enormous that despite some of the most sophisticated instruments and gifted scientific minds in the world, the cell's function remains shrouded in mystery. Tens of thousands of reactions, special molecules, and DNA mechanisms interact in a way that baffles even the most brilliant of our cell biologists.

What we do know is that fats play a major role in our cells' functions. Most of us are familiar with saturated, monounsaturated, and polyunsaturated fats, but cells also contain very specialized fats such as ceramide, sphingomyelin, phosphotidylcholine, phsophotidylethi-nolamine, phosphotidylserine, phosphotidylinositol, gangliosides, cerebrosides, triglycerides, arachidonic acid, docosahexaeonic acid, ecosapentaenoic acid, and dozens more.

These fats control cell membrane function, regulate immunity, control ion channels and receptors, regulate inflammation mechanisms, regulate transcription factors, control blood pressure, regulate DNA gene expression, and are precursors of steroid hormones. In addition, they are intimately connected to and help regulate every other system in the body. In essence, our dietary fats can play a major role in how well our bodies function.

A Short Course on Lipid Chemistry

Those of you not interested in how things work may want to skip this section. I find that a growing number of people are interested in how things work the way they do. In addition, it helps us understand better why we need to follow certain dietary programs and take certain supplements.

Lipids include fats, oils, and waxes. We will be concerned with fats and oils. All lipids are insoluble in water because water is polar and lipids are non-polar. This is why oil floats on the surface of water and if you shake it up, it forms thousands of tiny lipid bubbles. Most fats and oils exist in foods as triglycerides. These are molecules made up of three (tri) chains of fat linked to a glycerol molecule (glyceride). Glycerol is a three-carbon molecule.

Figure 1: Triacylglycerol (triglyceride) composed of a glycerol side chain and three attached fatty acid units.

Fatty acid units

Figure 1: Triacylglycerol (triglyceride) composed of a glycerol side chain and three attached fatty acid units.

Fats are, in fact, fatty acids. What makes them acids is that on one end of the long chain of carbon and hydrogen atoms they have a carboxyl acid structure (COOH). Common fatty acids include palmitic, stearic, oleic, linoleic, and linolenic acids. It is these fatty acids that are chemically joined by their acidic tails to the glycerol molecule. The lengths of these fatty acids vary—some are short like the three carbon butyric acid, others are medium length such as the seven carbon caprylic acid, and still others are long chained such as docosahexaenoic acid at twenty-two carbons in length.

Bonded to each of the carbon atoms are varying numbers of hydrogen atoms. If all the carbon atoms have a full complement of hydrogen atoms the fat is called saturated. If one or more of the pairs of carbon atoms is missing a hydrogen atom, it is considered unsaturated. When hydrogen atoms are missing from two adjacent carbon atoms a double bond forms. This causes the fat molecule to bend, something like a boomerang. Saturated fats are straight. Fats with a single double bond are called monounsaturated fats. This is seen with oleic acid found in olive oil. Fats having more than one unsaturated bond are called polyunsaturated fats. Examples include fish oils, arachidonic acid, and linoleic acid.

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