Many of the patients I see in my work as a Hospitalist have spend the better part of their lives doing unhealthy things to bring them where they are today. Whether it’s smoking, drinking, eating a poor diet or lack of exercise, over time they all lead down the same lonely road to disease, disability and a premature exit from this world. They are usually in the hospital for only a few days and often they are quite ill. This isn’t the best environment to work on they type of long-term lifestyle changes that can turn their health around. We are expected to patch them up and send them back to their primary care physician. Because I spent over 30 years in primary care working with patients to improve their health, I have vowed to give every patient I see 20 minutes of my time, focusing on lifestyle issues that may be of benefit moving forward once they are over their acute illness.
Twenty minutes isn’t a lot of time. After all, they already have a primary care physician who has spent a great deal of time trying to nudge them in a healthier direction. How can I help them with a measly 20 minutes in this type of environment? When faced with this dilemma, I came to the following conclusions:
- I first needed to show them I care about them on a personal basis. If patients sense that you don’t care, they will not trust you or comply with your recommendations. Thus the first thing I do when taking care of a patient that I have never seen before is to learn about them on a personal basis and then try to make a connection. What do they do for a living? What hobbies do they enjoy? Where do they find passion in life? What is their ethnic and social background? I then use this “hook” to establish a personal connection.
- I next look through their medical history to see what challenges I am dealing with. Do they have insulin resistance, metabolic syndrome or obesity? What type of lipid pattern do they have? Do they have any history of psychiatric problems? I measure their homocysteine level, thyroid function, uric acid level, fasting glucose and insulin levels, ferritin level and vitamin D level. Armed with this information I am fully prepared to target my message to each individual before I sit down and talk with each patient.
- During my initial evaluation I go through the 22 symptoms of CARB syndrome. They recognize some of these questions and others they have never been asked before. Sometimes I get rather strange looks from patients as I go down the list, but after my 20-minute talk they begin to understand the importance of my questions. They are also amazed that I seem to know so much about them before they offer a lot of details of their medical history and at times I have been accused of reading patient’s minds. That’s because CARB syndrome is an illness with a predictable set of symptoms and clinical course.
- After establishing this personal connection, I work hard to find 20 minutes where we talk about nothing other than ways they can improve their health. I first deal with the illness that brought them to the hospital and then I spend an additional 20 minutes to focus on their future health. Believe me, finding an additional 20 minutes for every patient in an acute care hospital is not an easy thing to do, but I make it a priority. During this time I sit down and look them in the eye.
- I then discuss lifestyle changes that I think would benefit their particular health issues. Because many of these patients have obvious CARB syndrome, I always start with dietary issues. This is the easy part. Move towards a diet based on meat (preferably grass-fed), wild fish, seafood, vegetables, berries, nuts and some fruit. Eliminate all sugar and HFCS and greatly reduce intake of grain-based carbohydrates. I usually recommend a low carbohydrate, moderate protein, high fat diet. The fats should be healthy fats like coconut oil, olive oil, omega 3 fats and avocados. Protein should be limited to one gram per kilogram of lean body mass. I may modify these dietary recommendations if patients have certain medical problems.
- I then discuss an exercise plan that takes into account their age and general health. For younger people this might include a combination of strength training and high intensity interval work. For older and frailer elderly patients I might recommend a gradual walking program. As they say, use it or lose it.
- Before my 20-minute talk, I type up a single sheet of paper listing books to read, web sites to visit and supplements to consider taking. The nurse always gives patients a set of specific instructions relating to their acute illness before leaving the hospital. I always tell patients that my list is optional and it involves a great deal of self-study. Then they can make their own decision about whether or not to follow my recommendations. I have found that patients who take responsibility for their own health always seem to do better than those who expect someone else to take care of them.
The Value of High Quality Information
I searched for many years to find information that actually works. Telling someone with obesity and CARB syndrome to eat less food and exercise more is doomed to failure. Patients are much more likely to comply with information that is effective. I also have found the CARB syndrome disease model to be very useful in managing patients with complex combinations of medical and psychiatric problems. The model allows me to look at patients in a different way and to use my therapeutic tools more effectively than my colleagues.
Let me give you an example. The other day I ran into John (not his real name), a patient in his mid-fifties who I had in the hospital about six months ago. At the time he had morbid obesity, tipping the scales at over 400 pounds. He also had obstructive sleep apnea and fatigue, and his brain wasn’t working very well. Despite the fact that he is a smart guy, he was having trouble with concentrating and focusing and his moods were a little wobbly. In other words he fit the picture of someone with CARB syndrome. John had two good friends who were determined to help him lose weight.
I gave my 20-minute talk to John with his friends present. They listened intently and took notes. After I was done speaking, I handed John a single sheet of paper with specific recommendations about various books and web sites that he might find interesting. I often recommend books like “The Sugar Fix” and “The Fat Switch” by Richard Johnson and “The Paleo Answer” by Loren Cordain or “The Paleo Solution” by Robb Wolf. I also often recommend “Good Calories, Bad Calories” or “Why We Get Fat—and What to do About It” by Gary Taubes. I invited them to visit my web site at: https://carbsyndrome.com
I also listed several supplements that he might find helpful. Because he had so much daytime fatigue from his obstructive sleep apnea, I feared that his cognitive function wouldn’t be good enough to comply with my recommendations, so I also prescribed a low dose of Provigil, the “stay awake drug”. This drug is often prescribed for patients with obstructive sleep apnea so they can function during the daytime.
When I ran into John the other day, I almost didn’t recognize him. He has lost over 100 pounds and looks 10 years younger. His brain function is also markedly improved. He once again has “the look of health” on his face. His moods are much more stable and he is much more alert and focused. His thinking is clearer and his communication lag time (CLT) has dramatically improved. For more information about “the look of health” and the CLT–an interesting new measure of brain function, read my blog post “The 22 Symptoms of CARB Syndrome”. It’s as if John has become a completely different person. In a sense he is a new person. He once again has a spring in his step and a smile on his face. He is back in the game of life after spending decades on the sidelines.
As a matter of fact John’s improved brain function may have saved the life of one of his friends who had been helping him. Todd is 80 years old but looks about 60. He is also a brilliant retired neuroscientist who really showed interest in the CARB syndrome project. One morning Todd just didn’t seem right. His behavior was a little off and his short-term memory seemed out of sync. He had no weakness, sensory loss or other typical stroke symptoms. John immediately recognized that something was not right with Todd so he brought him to the emergency room. Todd had a transient ischemic attack or temporary stroke and we were able to intervene before any permanent damage occurred. It takes really good brain function to pick up on such subtle symptoms and John’s brain was once again working on all eight cylinders.
I certainly don’t have this much success with all the patients that I treat and I must give John most of the credit for his transformation. Yet I do believe my 20-minute talk did indeed play a key role in transforming his life. To have this much success in 20 minutes you need to come armed with very potent information. The CARB syndrome model has provided me with an extremely potent weapon to fight disease and disability.
Because I can’t personally treat everyone, I’m asking you to assist me in this regard. Use the information on this site to have a 20-minute discussion with yourself. Before doing so, have your physician run the following tests:
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- Lipid profile
- Homocysteine level
- 25 hydroxy D level
- Fasting glucose and insulin levels
- TSH, free T3, free T4
- Ferritin level
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Although there may be other useful tests, this group is a good place to start as a window into your metabolic health. I wouldn’t worry too much about your total cholesterol. Ideally your LDL or “bad” cholesterol should be below 100 and your HDL cholesterol should be above 60. Your homocysteine level should be below 8 and your 25 hydroxy D level should be above 40. I like to see fasting glucose levels below 80 and insulin levels below 6. For optimal health your TSH should be below 3. Optimal levels of T3 and T4 vary by the laboratory, but for most people you want these numbers to be in the higher end of normal. I like to see ferritin levels below 60. If your numbers are off, use the information on this site to bring them back into line.
Once you are fully armed with your numbers, it’s time for the 20-minute talk with yourself. Where are you headed with your own health? What type of quality of life do you want to experience? How long do you want to live and how do you want to function in your “golden years”? Only you have the power to take control of your health. All you need to do so is to have access to high quality information. I am dedicated to sharing this information with you on this web site. As was the case with John, what you do with the information is up to you.