Hard work beats Big Pharma. Every time.

Wow! Just wow!
My patient’s Hgb A1c went from 13.5% to under 7% with a little free metformin and lots of low carb, healthy fat (LCHF) hard work in just 7 months.
Beat that Big Pharma! 
I’m so proud of them.  It is just a joy to walk with my patients as they get healthier and healthier.
-Dr. McColl

10 Paleo Thanksgiving Recipes to Delight the Pickiest Eaters | MyDomaine

Instead of crossing your fingers for at least one edible dish this Thanksgiving, ask your host if you can prepare one of these paleo Thanksgiving recipes.
— Read on www.mydomaine.com/paleo-thanksgiving-recipes

Anti-aging molecule produced by fasting

A recent study showed that the effect of aging on arteries can be delayed by a molecule your body makes during a fasting.

Fasting-induced anti-aging molecule keeps blood vessels young

When the body fasts from food intake it enters a unique period that restores and resets many of the normal body functions.  The general flow of energy shifts from a net storage mode to a net utilization mode.  Energy, often in the form of triglycerides, having been cleared from the blood stream by a few hours of no food intake is now being called out of storage to fuel various organ systems.  As the triglycerides come out they are converted into three ketone byproducts; one of which is beta-hydroxybutyrate.  This particular molecule was shown to induce cell growth and proliferation within the vascular system in a recent study.  Rejuvenation of the cells within a blood vessel can help keep them flexible and compliant as opposed to the chronic pressures for them to stiffen and calcify during atherosclerosis.

Ketones and ketosis have had a bad rap over the years but as research and experience progresses, we see many beneficial effects.  It is something I teach regularly to my patients and have found it to be a powerful tool that can reverse diseases like diabetes, high blood pressure, and high cholesterol.  Weight loss is a given with measurable ketosis but, more importantly, people feel so much better.

Consider what a primary care practice dedicated to proper nutrition AND exceptional medical care could do to help you reach your health goals.  Don’t let an eight minute appointment turn into a lifetime of prescriptions.  Find a physician with a heart of a teacher who can help you understand how medications might not be necessary with a few simple changes.  Contact our office for more information on our nutritional education program.



Opinion: “Carbs, Good for You? Fat Chance!”

Nina Teicholz, author of The Big Fat Surprise, published an opinion piece in the Wall Street Journal yesterday concerning the recent ‘low carb equals an early death’ study.  Junk science and flashy headlines are really bad for public health.  Let’s focus on good studies that show causal effects.

What I see every day in my practice is how good nutrition reverses and cures many chronic diseases, restores vitality and health, and allows patients to regain their lives.

Carbs, Good for You? Fat Chance!

Eat real food.

Anyone that’s looked at my Wellness Prescription handout knows that the first step of good nutrition is to eat real food. After that, we need to engineer a low enough carbohydrate diet to achieve our health goals. Typically, I recommend newbies start at 100gms per day, but I always individualize that level with each patient at their office visit and adjust it as they grow in experience and success.

With all the reaction to the new ‘low carb is killing you’ study, I liked what cardiologist Aseem Malhotra, MD had to say about it during a recent interview. Essentially, eating fake food is always not good for you even if you are generally low carb. However, real food that is low carb is the best of all. If you don’t know what that is or how to implement it in your life, come see us at Trinity DPC. We talk about this stuff all the time.

We have two upcoming ‘Food as Medicine’ discussions that are free for members and $20 a person for non-members.  Carly Slagle, RD and Dr. Hone are hosting a meeting in Maryville on August 23rd from 12 to 1pm.  In Hardin Valley, Carly and I will be hosting a discussion on September 4th from 1 to 2pm.  Call our office you have any questions.

How a Low-Carb Diet Might Aid People With Type 1 Diabetes – The New York Times

How a Low-Carb Diet Might Aid People With Type 1 Diabetes
— Read on mobile.nytimes.com/2018/05/07/well/live/low-carb-diet-type-1-diabetes.html

Here is a very encouraging observational study on treating Type I diabetes, those that produce little to no insulin due to a failure of their pancreas typically at a young age, with a low carb diet. The results are good and not unexpected in my experience.

I see phenomenal improvements in health, blood sugar control, and reductions in medication use when my patients adopt the low carb, ketogenic meal plan taught at Trinity.

Editorial: Added Sugars Drive Coronary Heart Disease

This is a good editorial so I’ve quoted it in its entirety.

‘I know of no single acceptable study that shows a high intake of sugar in a population that is almost entirely free from heart disease.’1—John Yudkin

Coronary heart disease (CHD) is responsible for one in every six deaths in the USA,2 and it eventually manifests as an acute myocardial infarction (MI). In the USA, almost 1 million acute MIs occur each year2 with approximately 15% of patients dying as a result of their acute event.2 If one manages to survive an acute MI, depending on the age of onset, the average survival time ranges anywhere from just 3.2 years to up to 17 years.2 Thus, CHD and acute MI are leading causes of early mortality in the USA.2

Asymptomatic hyperglycaemia is a risk factor for cardiovascular disease (CVD) and CHD, as well as death from CHD.3 Hyperglycaemia can develop during an acute MI, even in patients without diabetes,3 which may be caused by an increase in catecholamines, a reduction in the release of insulin, development of insulin resistance and increases in cortisol and growth hormone.3–5 However, many patients with MI already have diabetes and simply have yet to be diagnosed (ie, latent diabetes), where the acute stress worsens their diabetic state leading to hyperglycaemia.3 Indeed, one study showed that 73% of patients presenting with an acute MI have abnormal glucose tolerance, with 50% having diabetes.6 After 6 months, 43% still had abnormal glucose tolerance, which is approximately threefold higher than that found in matched controls (15%), the difference between the two being significant.6 Thus, hyperglycaemia does not seem to be an acute or temporary finding in patients who have experienced an MI, with many of these patients having continued abnormal glucose tolerance even when followed for several years after their event.

The Whitehall study, a prospective cohort study encompassing 18 403 patients, showed that blood glucose after a 2-hour oral glucose tolerance test was related to the age-adjusted CHD mortality after 7.5 years.7 In non-diabetics, a 2-hour blood glucose at 96 mg/dL or higher was associated with a twofold increased risk of CHD mortality.7 An elevated insulin response to an oral glucose load has been found in patients with atherosclerosis of the peripheral, cerebral and coronary arteries.8 9 In the Busselton, Australia study, insulin levels 1 hour after ingesting a 50 g oral glucose load were significantly related to the 6-year CVD incidence and 12-year CVD mortality in men aged 60 and older.10 In both the Helsinki policeman study11 and the Paris civil servant study,12 insulin levels taken in the fasting state after an oral glucose load (75 or 90 g) were associated with the occurrence of MI and CHD death 5 years later in men aged 30–59. However, the insulin:glucose ratio had the closest association with CVD. In all three studies, the relationship of insulin with CVD was independent of other covariates, including lipids, blood pressure and blood sugar.13 Considering that refined sugar, even when compared with starch, has been found to raise serum insulin levels,14 15 this provides compelling evidence that overconsuming added sugars (sucrose or high-fructose corn syrup) may lead to an increased risk of CHD through raised insulin levels.

The evidence incriminating insulin and carbohydrate in atherogenesis is strong, and that this scheme would link atherosclerosis with diabetes, obesity, hyperlipaemia, lack of physical exercise, and, possibly, hypertension.16 (Stout and Vallance-Owen)

It has been known for over 50 years that people with hypercholesterolaemia and hyperlipaemia generally have abnormal carbohydrate metabolism, with an elevated insulin level often driving their hyperlipidaemia.17 Indeed, insulin has been found to increase lipogenesis18 and stimulate smooth muscle cell proliferation.19–21 Hyperinsulinaemia is also an independent risk factor for CHD,10 11 and insulin resistance predicts future cardiovascular risk.22 23 Increased levels of insulin are found in multiple disease states, including obesity, coronary artery disease, hypertension, peripheral vascular disease and those with hypertriglyceridaemia.24 Thus, any dietary factor that worsens glucose tolerance or promotes insulin resistance will also likely increase the risk of acute MI, CHD and CHD mortality. Considering that a diet high in added sugars (particularly the fructose component) leads to insulin resistance,25–28 the overconsumption of added sugars is undoubtedly a contributing factor to CHD and CVD mortality. Indeed, compared with a diet that contains less than 10% of calories from added sugars, a diet containing 25% or more calories from added sugars nearly triples the risk for CVD mortality.29

Data from animal and human studies have noted that the isocaloric replacement of starch, glucose or a combination of both, with sucrose or fructose, increases fasting insulin levels,14 15 reduces insulin sensitivity,25–27 increases fasting glucose concentrations,30 increases glucose and insulin responses to a sucrose load14 15 and reduces cellular insulin binding.25 In other words, calorie for calorie, consuming added sugars is more harmful than starch or glucose regarding worsening of insulin sensitivity and glucose tolerance. Additionally, feeding rats sucrose leads to impaired glucose tolerance31 and adipose tissue that is less sensitive to the effects of insulin.32 33 Thus, data from animals and humans indicate that overconsuming added sugars drives insulin resistance and hyperinsulinaemia.

During an acute MI, the heart switches from primarily using fatty acids as energy to using glucose. As insulin facilitates glucose uptake into cells, patients with insulin resistance during an acute MI will have a worse prognosis. Indeed, the degree of insulin resistance is related to the severity of an MI,34 and after an MI diabetics are more likely to die compared with non-diabetics.35 A diet high in added sugars promotes insulin resistance and diabetes,14 15 28 36 37 and thus may lead to larger MIs and increase the risk of CHD mortality.

It is well known that those with diabetes have a higher risk of mortality and MI versus those without diabetes,38 which is independent of smoking status, cholesterol levels, blood pressure and body fat distribution. Additionally, patients diagnosed as being newly diabetic also have an increased risk of MI. Diabetics also have more coronary atherosclerosis than non-diabetics,39 40 particularly a higher frequency of severe narrowing of the left main coronary artery and healed transmural ventricular scars.41 The Framingham study showed that those with diabetes have an approximate threefold increased risk of dying from CVD versus the general population as well as an increased risk of stroke, CHD and peripheral arterial disease.42 Higher blood pressure or higher lipoproteins did not account entirely for the increased incidence of CHD among diabetics.13

A diet high in added sugars has been shown to increase the prevalence of diabetes, whereas a lower intake has the opposite effect.43–46 Thus, added sugars promote an increased risk of CHD by increasing the risk of diabetes, which has been shown in both ecological analyses as well as clinical trial data. Considering that added sugars also promote insulin resistance, and those who experience an acute MI are more likely to be insulin resistant, the overconsumption of added sugars drives CHD.25 27

A raised cholesterol level is not the only risk factor in those with CHD. Indeed, many other abnormalities commonly occur such as elevated glucose, insulin, triglycerides, uric acid and lower levels of high-density lipoprotein cholesterol.47 Additionally, impaired glucose tolerance, insulin resistance and altered platelet function are commonly found in patients with CHD or those with risk factors for CHD.48–51 All of these CHD abnormalities are induced or worsened in humans and animals when given a diet high in sugar,52–55 which can be reversed when reverting back to a diet low in sugar.14 55 This provides compelling evidence that the overconsumption of added sugars is a principal driver of CHD.

Administration of a diet high in sugar for just a few weeks leads to approximately one-third of men experiencing numerous changes seen in CHD and peripheral vascular disease.53 54 These suggest that the overconsumption of sugar and the subsequent insulin resistance and/or hyperinsulinaemia drive CHD as well as other diseases such as hypertension, diabetes, obesity and gout.56 57 Interestingly, smoking, which is a risk factor for heart disease, has been found to induce hyperinsulinism,58 suggesting that both the overconsumption of added sugars and smoking predispose to heart disease in a similar manner (via hyperinsulinaemia; although both also induce inflammation, oxidative stress and increased platelet adhesiveness).59–61

Over the past 200 years, the average intake of added sugars has increased from 4 to 120 lb/year.62 Sugar is even more rewarding than cocaine in animal studies, and in humans added sugar is arguably the most widely consumed addictive substance around the world.63 The fact that diabetics have an increased risk of occlusive arterial disease,24 and that non-diabetic patients with vascular disease have raised insulin levels,24 suggests that insulin resistance is at the centre of heart disease. Considering a diet high in added sugars can induce insulin resistance and hyperinsulinaemia in humans, and a reduction in added sugars can improve these metabolic derangements, there is compelling evidence that the overconsumption of added sugars (high-fructose corn syrup and sucrose) is a principal driver of CHD. Indeed, refined sugar, as compared with fat, starch, glucose, or a combination of starch and glucose, promotes greater detriments on glucose and insulin levels in humans.14 15 28 36 37

Currently, the main dietary culprit thought to lead to CHD is saturated fat. However, the overconsumption of added sugars (sucrose or table sugar and high-fructose corn syrup) has also been associated with an increased risk of CVD and mortality from cardiovascular causes. A diet high in added sugars for just a few weeks has been found to produce numerous abnormalities found in patients with CHD including elevated insulin levels and insulin resistance. More importantly, a diet low in added sugars and refined carbohydrates has been found to reverse all of these metabolic defects. The evidence indicates that added sugars are a likely dietary culprit leading to CHD.

What I Ate for Lunch

As I counsel patients about how their nutrition directly affects their health, I’m often asked questions about specific challenges.  One of the most common questions is what to eat when dining out.  I’ve decided to share some of the meals I’ve found at local restaurants that fit the low carb paradigm taught at Trinity in the hopes that it will show patients that there really are some good options when eating out.

Yesterday, I was out with my wife and son running errands and we stopped in at the Parkside Grill for a late lunch.  I had the Grilled Cilantro-Lime Chicken which comes with a rice pilaf and broccoli. I substituted the rice for green beans. It was an excellent meal; very flavorful and filling for $9.99.  Additionally, I had unsweetened ice tea, skipped the bread basket, and asked for extra butter.

I’m sure few patients are shocked that grilled chicken and green vegetables are a recommendation from their doctor in order to stick to a healthy eating plan.  However, in the midst of all the other options, even tempting salads with candied nuts, this meal was delicious, simple, and inexpensive.

The nutrient break down is listed below showing a net carb intake of 9.5 grams.

Fat 22.1g 41.9%
Saturated Fat 11.6g
Cholesterol 209.3mg
Sodium 486.9mg
Carbohydrates 15.9g 13.4%
Fiber 6.4g
Sugars 6.1g
Protein 53.1g 44.8%

Article: Evidence surrounding the use of low carbohydrate, high fat diets for the prevention and treatment of CVD, type 2 diabetes, and obesity is accumulating.

Here’s a great article by Drs. Demasi, Lustiq, and Malhotra on the association concerning low carb high fat diets (like the one taught by Trinity and VitalSigns) and their ability to reverse (ie, cure) insulin resistance, type 2 diabetes, and obesity.  The purported risk of increased cardiovascular disease is shown to be not fully understood.

Clinically, I see dramatic improvements in the health of my patients when they adopt the low carb diet I teach.  They lose dramatic weight (my patient record is 200lbs) and reduce their dependency on medication.  Functionality and vitality return to their lives.  It is amazing to walk with patients through this process.

If you’d like to see what this program can do for you, contact us about the Direct Primary Care program where there is no charge for office visits, phone calls, or emails and most labs we need to manage your nutrition and health are included in the cost of membership.  Patients can join today with memberships starting at less than $1 per day!

Click here to join.


The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance | Insight | Pharmaceutical Journal

What to drink?

What to Drink? 

​Besides water, it sometimes seems like there is nothing truly safe to drink. Let’s start with the most obvious problems – sweetened drinks. Unfortunately this includes most of our favorites,such as sweet tea, Mountain Dew, Dr. Pepper, Coke, Pepsi, Gatorade, Powerade, Red Bull and many more. As a major source of empty calories and carbs, these are seen as the number one dietary cause of obesity. What’s more, they are major contributors to diabetes. As this liquid sugar is consumed it hammers the pancreas into putting out a big bunch of insulin to deal with it. Over time the body gets less and less responsive to this insulin, which then leads to diabetes. Eventually the pancreas usually wears out in its ability to secrete adequate insulin.

​Ok, so how about diet drinks? Many of these, unfortunately, have their own problems. This is currently a growing area of research. Some recent studies showed that consuming a diet soda daily was associated with a higher stroke and dementia risk. It looks like some of this may have been due to other factors rather than a direct result of the diet soda consumption. Still, it certainly gives one pause. Similarly, another study showed that routine diet soda drinkers had higher levels of certain hormones that stimulate transport of glucose (sugar) into fat cells. Likewise, switching to diet soda consumption doesn’t routinely encourage weight loss. This may have be due to the just-mentioned hormone effect, or perhaps drinking diet sodas keeps the taste and desire for sweet things in our brain so that we seek them out.  

​Even juices don’t get a pass. Like sweetened drinks juices are rather packed with calories and carbs. On the plus side, at least they provide some nutrition and vitamins in the mix. But in general it is better to eat the whole fruit rather than just the juice.

​Milk? Many folks have lactose intolerance and get gastrointestinal symptoms if they drink milk. Others worry about the calories in milk. Still, if you tolerate milk, drinking it in moderation (perhaps an 8 ounce glass or so per day) at least gives some protein, calcium, vitamin D and other nutrition in exchange for the calories.

​Well, what about unsweetened coffee or tea? Here the findings are mostly positive. Of course if you have problems with anxiety, heart palpitations, or acid reflux, caffeinated beverages may not be for you. On the other, if you don’t struggle with these issues, unsweetened tea and coffee may be a reasonable options. Several coffee studies have indicated positive benefits such as lower incidence of type 2 diabetes, diminished Parkinson’s disease, decrease in certain cancers, and sharper mental focus.  

​Naturally, alcohol also has its challenges. Some simply don’t like it or have been impacted by alcoholism in a loved one. If a person has no objection to drinking alcohol and can limit themselves to no more than two drinks daily (if they are males) or one drink daily (if they are females) then alcohol in careful moderation may be ok. Of course it will still often have empty calories and carbs.

​So finally that brings us to water. Here is still the best source for quenching our thirst and hydrating. There is no scientifically based right amount of daily water intake for everyone. But keeping well hydrated and thirst-quenched is certainly a good start. Yet even water has a couple of cautions. Drinking it unfiltered from local streams can lead to catching parasites such as Giardia. Even the plastic bottles that bottled water comes in have come under suspicion in recent years. Some studies have suggested that a chemical called PBA leaches from the bottles into the water, or other liquids, that they contain. It has been suggested that this may have negative effects such as lowering testosterone in men. The findings are still early, but they are enough to promote concern.

​So, what to drink seems to boil down to plenty of water from safe sources with options for unsweetened tea and coffee, and smaller amounts of juice and milk, and even smaller amounts of alcohol. There do seem to be a few non-sweetened seltzer type drinks that are likely not harmful as well. So when somebody asks, “What’ll you have to drink?” it’s a bit more complicated than it used to be… or on second thought, maybe the known healthy choices are getting fewer and simpler. One way or the other, find a way to keep healthy and hydrated in these hot summer months in Tennessee.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835