How to sum up three days of great learning, community, and lots of play and dancing? It was great, wish you were all there, and hope to see you all next year in San Diego.
In alignment with our past and our principles, we enjoyed three days of camaraderie (aka networking), education, physical activity and great food. Miami cooperated with balmy weather and blue skies. Our hotel offered a nice meeting room and the culinary staff outdid themselves with 5-star meals: even steaks cooked to order at our outdoor dinner. Someone must have told them: there seemed a never-ending supply of avocado, yes! We shared meals at lovely tables with a view of the ocean. It would have been a great vacation even without the added treat of the curriculum!
Throughout the weekend, we sought to learn from the lifestyle of our ancestors and the insights of modern science. We met over meals, we sat for lectures, we exchanged information in panel discussion sessions, and we of course took time to get up and to get outside in the lovely Miami sunshine. There was a great sharing of expertise and ancestral perspectives. Although a full recap would take the full three days, here’s a bit of a summary of what happened in Miami, day by day. If you want the common points, covered by everyone, scroll to the end!
Dr. Polina Sayess opened the meetings over breakfast! Polina organized and chaired the entire retreat, in particular leading the few membership-oriented meetings. Thank you for your cheerful and energized leadership!
Amber O’Hearn challenged myths about the ketogenic diet (KD), claiming that we have a particularly human affinity for the KD, citing our ability to have survived both starvation and carb-free periods in our evolutionary past. She compared the benefits of ketogenic and calorie restricted diets, both reducing reactive oxygen species and promoting mitochondrial biogenesis: more energy at a reduced cost (oxidative damage). She specifically addressed the concerns of lowered thyroid (actually lower T3 is protein sparing and associated with longevity) and cortisol dysregulation: maybe we really need to look at glucagon when we’re curious about gluconeogenesis. Carb free diet can reverse metabolic syndrome, and result in a mildly anti-inflammatory and slight elevation of cortisol. There is so much more to learn about a carb-free or ketogenic diet, particularly if we look into them as long-term or permanent options, rather than temporary aberrations.
Dr. Felice Gersh won the Shark Tank award for selling her idea: periodic fasting without the pain, via a fasting-mimicking diet. She is a dynamite presenter! Episodes of calorie restriction help keep HGH and IGF-1 levels low, reducing disease burden and optimizing lifespan. Looking back the evolutionary pathway, she suggested that Homo Sapiens out-survived Neanderthals not because we’re smarter but rather that we’re better adapted to famine. There is no denying that fasting is associated with increases in both activity and energy stories, and that the lack of regular protein has an anti-aging effect. She has worked with a specific program using planned diets low in proteins, carbs, sugars, yet high in fat. The fasting-mimicking diet “flies under the radar” of mTor and measurably stimulates stem cell production in a 5-day plan of 1150 calories on the first day and 725 calories day 2-5.
Tony Federico, of PaleoFx and Paleo Magazine associations, spoke to us with important considerations about developing an online presence as a provider, for our own personal benefit and for spreading the word. He challenged us to think carefully on the answers to five pertinent questions:
- Why do I want to have an online presence?
- What does my content look like: design for my target audience.
- When: how often will I post?
- Who will help me, will I have a team?
- How will I do it, including website management plans. Write out the plan and stick to it.
He re-iterated the oft-quoted phrase that quality of content takes precedence over all other considerations, but being consistent and staying personal will always help. See Tony’s Connecting with Patients in the Digital Age presentation here.
Dr. Mark Cucuzella is a powerhouse! Involved in patient care, resident teaching and community building, he brought his optimistic messages eloquently to our meeting. He gets schoolkids and folks with bad knees (me!) out there running, with a gentle technique suitable for barefoot running or running with minimalist footwear.
Ivor Cummins didn’t have to convince anyone present, but demonstrated another way of seeing that insulin resistance is the “big hitter” in cardiovascular disease. He reviewed metabolic pathways in the adipose cell where insulin resistance first appears, even before in the liver. He differentiated (with photos no less) between the unattractive but harmless subcutaneous belly fat that is quite different from the intra-abdominal fat (the type that makes one look pregnant) that screams insulin resistance and serious cardiovascular risk. Cummins’ studies have led him to discredit LDL-C as a risk factor (well, maybe contributing if it’s over 200), and even LDL-P and Lp(a), both of which he believes not to be a problem in the absence of insulin resistance and/or endothelial inflammation. He, with others, believes the coronary artery calcium score to be the best overall predictor of mortality as not a risk factor but rather a disease marker. He wrapped things up with a reminder of the big picture, namely that insulin and leptin signaling respond to a host of factors, including carbohydrates, magnesium levels, smoking vitamin D, sleep, exercise and cholesterol ends up on the sidelines.
Charlie Hudson, our videographer and host of the website Reanderthal, entertained us warmly with images of dancing humans, dancing animals and a new understanding of dance. Why would we as humans choose to participate in this energetically “inefficient” activity, yielding neither food nor progeny but still an important part of many human cultures. Evidently when we combine intense physical activity, rhythmicity, and other people, we create a strong sense of community bonding upon which we can rely.
At least three times a day, we broke out of our chairs. Repeating the phrase that sitting is the new smoking, many of us stood during presentations and all of us took advantage of one or more of the active sessions.
Darryl Edwards reached out to our inner children as well as our stronger selves, and we cavorted before, during, or after every half day of activities. Can you walk like a bear? Do a whole body twist when you’re down in a push-up? How about slapping a moving object just outside your line of vision? All fun and a lot of it more challenging than we realized at the time. Oh, yes, some of those muscles complained the next day!
Nina El-Badry, dancer extraordinaire, led us in a Zumba class on the open patio next to our meeting room. Speaking personally, I have taken a lot of dance and yoga classes in my lifetime, but it’s been a while! The music was great, the routines challenging and fun, and I know it was a great brain workout to mirror our instructor’s moves and learn the routines: all non-verbally, no time out for teaching, just do it! See an amazing performance by Charlie Hudson and Nina El-Badry here.
Mark Cucuzella led a barefoot running adventure one early morning. I must admit I slept in that day, but I took his workshop in Boulder last summer. As a former runner with bad knees, I can testify that his methods are eminently adaptable: it was the first time I’d done anything remotely resembling running in years.
Dr. Jasmine Moghissi led a panel and internet discussion on Cardiovascular (CV) Risk Testing and Modification. Although many on the panel were appreciative of coronary artery calcium CT (CAC) testing, it was explained that CV disease in women often affects the small vessels and events occur from spasm not plaque, making the CAC less reliable as a predictive tool. We wondered how valuable is something like an NMR lipid profile when it is asserted that it mostly reflects your diet in the 48 hours prior to the blood draw, and Jasmine re-iterated that she sees progressive and expected changes in her patients over the long term that correlate well with lifestyle changes made.
Dr. Polina Sayess also took a turn at the presentation podium, reminding us about the best way to motivate patients during our face to face interviews. In addition to general principles, she shared with us an online teaching tool, Change Talk, well described and linked in this document, Change Talk: Childhood Obesity™.
Darryl Edwards reviewed the beneficial effects of exercise, such as lowering elevated markers for blood pressure and inflammation (hsCRP), while it improves long term health issues involving the gut, mood, sleep, lipids, homocysteine, brain health, and blood sugar handling.
Dr. Georgia Ede addressed the question “Who says meat causes cancer?” or rather “WHO says…” in a brilliant dissection of the actual studies used in the infamous decision of the World Health Organization to claim that red meat causes cancer. Although the decision was supposedly based on “all the relevant data, including epidemiological data,” the studies they cited were minimal in number and seriously lacking in relevant quality. In fact none of the rodent studies actually confirmed their hypothesis, and the human studies were strongly mixed. Mixed in the sense that the best markers confirmed no correlation and the worst markers showed a very questionable correlation. (“They were the best of studies, they were the worst of studies,” with a head nod to Charles Dickens.) The studies actually validated what we presume from evolutionary evidence, namely that eating meat is strongly correlated with human health and survival.
Our retreat has developed a tradition of inviting a well-known speaker to touch on areas of personal expertise that are also relevant to the subject of evolutionary medicine. This year, Dr. Ron Rosedale, spoke on the critical connection between protein, cancer, aging and TOR (or mTOR in mammals: the mammaliam target of rapamycin.) His glance backwards in time extends well beyond the dawn of Homo Sapiens to the creation of multi-cellular organisms and looks at the role of nutrient sensors in a living organism. Nutrient sensors manage consumed fuel in such a way as to control the optimal expression of the genome, namely efficient reproduction. Turning attention to lifespan, he developed the scientific basis for his observation that for any given individual, your health and your lifespan will be determined by your metabolic flexibility, and specifically, the amount of fat (preferable) to sugar (inferior) that you burn as fuel over a lifetime. Indeed, for any choice of food or metabolic pathway, one might ask whether it leads to the preferential consumption of fat or sugar, and based on the answer, decide whether it’s a healthy choice or not. Not only sugar, but also glutamine specifically and protein in general can promote insulin and along the way cancer growth and shortened lifespan. He well documents his suggestion that reduced protein intake (adequate for exercise but not optimal for body-building) is an important part of the path to a long and healthy lifespan. Bottom line: TMI to cover in this short post, but somewhere between .5-.6 grams of protein per kg of lean body mass is probably optimal.
Dr. Rick Henriksen encouraged the audience to think (“What should I take, doc, I’m getting a cold! Echinacea? Vitamin C?”) before he shared with us some information on the medicinal use of a handful of well-known plants.
Our final day opened with a tribute to Dr. Staffan Lindeberg prominent evolutionary scholar and leader, perhaps best known for his brilliant observations on the Kitavans, a contemporary society of hunter-gatherers
Stephanie Welch, shoeless of course, shared a global, cultural and scientific perspective on the American (and South Korean!) practice of routine circumcision of newborns. Needless to say, it didn’t make much sense after she shared with us the barely perceptible benefit (less UTI’s in the first year of life) compared to the multitude of problems. Let’s just say the practice is painful, done without consent, and demands that a mucous membrane become an external body surface, ow.
Dr. Deborah Gordon (that would be me) reviewed the origins and specifics of the Alzheimer’s reversal program developed and documented by Dr. Dale Bredesen. While the main impact of his intervention is the adoption of a mildly ketogenic and anti-inflammatory diet, there are many other physiological tweaks to incorporate. Optimizing hormone levels and minimizing inflammation with supplements and lifestyle choices are as important as staying active, incorporating both aerobic and heavy lifting types of exercise. Numerous lesser-known supplements (PQQ, anyone?) and herbals were covered, including some of the lesser known features of the different herbals. You probably don’t want to take all the herbs mentioned, but if you are concerned about your brain and have a high LDL particle count (and it concerns you), you might choose Ashwagandha which helps brain function and scavenges LDL from the blood stream.
Dr. Josh Turknett counseled us on how to win at Angry Birds. Seriously! Okay, his subtitle was clearly The Perils and Pitfalls of Reductionism, and his general counsel was that interventions at a microscopic level (as medications are usually intended to work), will invariably have unintended consequences. Functional Medicine, on the other hand is a systems approach to health and more likely to reap complex rewards rather than surprise hazards. (Oh, the way to win at Angry Birds is not to understand the software behind it, but rather to practice playing the game… a lot.)
We also had an honor of participating in a practice management panel discussion with Mikhail Kogan, MD, a founding board member of the American Board of Integrative Medicine, the director of the George Washington University Integrative Geriatrics Fellowship and co-director of the Integrative Medicine Track Program at the George Washington University School of Medicine. Mikhail is a Medical Director of the GW Center for Integrative Medicine.
Although we may quibble over differences within each point, I think most if not all speakers would have agreed on these points.
- Health derives from a healthy lifestyle, not just a healthy diet or just good supplements.
- Within that lifestyle, a healthy diet is sufficiently low in carbohydrates that it avoids insulin toxicity.
- Good protein is an essential part of a healthy diet, across a spectrum where lower amounts may best promote longevity and greater amounts may provide certain more immediate health benefits.
- Evidenced by the quantity of avocado offered, requested, and consumed, healthy fats seem to be an important part of that healthy diet as well.
- Many supplements exist that can provide support to th
e health of the system, many of them herbal in nature.
- Certain diseases thought chronic are actually reversible, including cardiovascular disease, type 2 diabetes and Alzheimer’s disease.
- It’s great to hang out with friends over good food and in abundant sunlight in the middle of January.