On Master Cleanse (or, is CT Lin crazy?)

image from Garciniacambogiacoloncleanse.com

Thanks to @ToddMeier, one of my IT colleagues at UCHealth.  He explained to me the benefits of periodic modified fasting.  This discussion put me on to watching a documentary about the Science of Fasting on YouTube, and then of course reading the book “Master Cleanser“.

Of course, I do not subscribe to non-medical claims about cayenne pepper boosting the blood circulation or “the only thing you lose during this, is mucus and clogged lymphatics”. But, look past all that.

If you know me and my writing, I like trying new things.  This certainly falls into the category of “something new.”  Perhaps the most powerful vision from my reading, is the idea that our Mastodon-hunting ancestors would have enormous protein meals and then perhaps not eat for weeks while the tribe looked for additional prey.  Fasting and starvation are a normal, expected physiology for our human bodies. We know that the human body can go weeks without nutrition.  Modern life, with 3 meals per day, and easy access to sugar and fat, and our tendency for overeating based on stress, eliminated the possibility of activating our fasting metabolism.  Various reports of improved energy, cognition, reduced inflammation and joint pain, and perhaps a resetting of our sugar cravings, were all attractive aspects of trying this. My colleague at University of Colorado has written extensively on this (The Fat Switch and The Sugar Fix).

This sounds somewhat reminiscent of the Paleo diet and perhaps pseudo-scientific hocus-pocus.  Nevertheless, with my underlying gout, and this desire to try something new, I broke through several weeks of ambivalence and decided to prepare the lemon drink proposed by this “master cleanse.”

The drink comprises half of a squeezed lemon, 2 tablespoons of pure maple syrup (200 cal), and a pinch of cayenne pepper.  This is added to an 8 ounce cup of water, and preferably consumed hot.  It is surprisingly tasty for what I considered a “deprivation” diet.

I am now on day 3 of my master cleanse and feeling good.  I am experiencing no hunger, I went to my usual 90 minute karate workout, I did 4 hours of yard work, cutting down innumerable branches to appease my home-owners association “warning letter”, and now I have done a couple 5-mile bike-to-work rides.

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Despite my wife’s misgivings, I did not “bonk” or hit the wall on my rides. Maybe my ketogenic diet was actually promoting my fat cells to convert stored fat into ketone bodies for nutrition (the normal non-glucose pathway, I vaguely recall, as I clear the cobwebs from my medical school physiology days). My sustenance has been about 3-4 cups of master cleanse lemonade. I could not convince my wife to smell me to check if my breath was actually fruity (as patients with diabetes who are in severe ketoacidosis exhibit).

Some observations:

Within about 2 or 3 minutes of consuming a master cleanse glass, the hunger disappears rapidly. Hunger is suppressed for 4-6 hours.  Then taking another glass rapidly suppresses appetite again.  I find no decrease in energy.  I find that the hour spent preparing for a regular meal, eating the meal, and cleaning up from the meal becomes just 2 minutes of drinking my lemonade and cleaning a glass (… and then an hour writing a blog about it).  I no longer experience post-meal fatigue and drowsiness.  I think that my mental clarity is actually better throughout the day, and I am forgetting to drink tea as an energy boost because I find I do not need it.

Unlike my perception that fasting would be a miserable starvation experience, this method, that does provide 200 cal in maple syrup 3-4 times per day, is a comfortable, minimal impact to my day.  I am finding that it does not impair my exercise or activity at all.  In fact I am somewhat motivated to stay physically active to prevent any muscle breakdown during this “cleanse.”

It is unclear to me how many days I will persist in this trial.  Each day I find there are challenges as I either smell my wife’s aromatic cooking or observe various family members crunching their way through a delicious meal.  I find interesting moments when I crave a bagel or a piece of cheese, or some takeout Chinese food.

One time, I did consume a ginger candy midway through this cleanse and about 30 minutes after felt somewhat drowsy.  I am wondering if this is a burst of insulin in response to an oral glucose load, causing post-meal sleepiness (see: Post-prandial somnolence on Wikipedia).  Hard to say if it was a coincidence.

Last night in a moment of weakness I rationalized having a bowl of miso soup from a concentrate that I bought at a local Japanese store.  Reading the label carefully, I find that it is only an additional 30 cal of protein and a little bit of carbohydrate.  This was perhaps the most delicious bowl of miso I have ever had in my life.  There is no umami flavor in lemonade.  https://en.wikipedia.org/wiki/Umami

UPDATE end of day 4. Having braved 4 days of “cleanse”, my cravings betrayed me at last: chips, salsa, miso soup and some cheese and crackers. Oh well, not the end of the world. After four days of consuming only 600-800 calories by way of lemon drink, I figure that’s about 1200 calories net negative each day. My scale did show a drop of 5 pounds over this period of time, with really very little effort. Not sure I noticed any difference in my knee pain (probably a non-inflammatory degenerative arthritis anyway), and my gout is so stable, can’t tell the difference. I did my usual activities, sipped 3-4 glasses of “cleanser” each day, found a surprisingly peaceful, evenly-balanced energy day, felt clear-headed and at least somewhat virtuous. If I was a data geek (ok, I am) I would ask my doc for some lab tests on my uric acid (breakdown product from muscle) and a serum creatinine and electrolytes, to see what is going on inside. Maybe another time, if I end up doing a more extended version someday.

Surprisingly, I found that the first meal after 4 days of a liquid-only diet was an incredible sensory experience.  The luxury of just CHEWING and using my tongue and tasting flavors is a surprising joy when it is no longer a routine.  Maybe that is one good reason to do a periodic fast, the ability to re-discover such simple joys. Oh, the crunch, the flavor, the aroma…

CMIO’s take?  A little bit of fasting may do you good.
Have you fasted before? Let me know!

Patient Knowledge and Experience is the largest untapped resource in healthcare

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Yes, I firmly believe this. We are starting to mine our EHR data. We can begin to see prescribing patterns, and how they affect patient vital signs (blood pressures, heart rates, pulse ox). We can look at aspirin prescriptions in patients with coronary disease. We can look at steroid inhaler prescriptions in patients with persistent asthma.

But what about patient experience? Those who have conducted Group Visits can begin to see patients educating each other, in ways that physicians, staff, educators don’t understand. “How do you manage your insulin dose when you work swing shifts or night shifts?” “When you catch yet another cold, how does that affect your liquids intake and medications for heart failure?”

Companies like “PatientsLikeMe” are beginning to look at this information as well. It is about time that our EHR vendors (or maybe startup companies) start helping us unlock the knowledge inside our own medical records for the benefit of other patients.

FOR EXAMPLE, in the screenshot above, in a presentation that I give, consider a 55 year old man with worsening knee arthritis. How hard would it be for us to find “patients like me” treated in the past few years with similar symptoms, similar age/sex/activity level/health status, who were faced with a similar decision about choosing an orthopedic operation and physical therapy?

We could say several really interesting things:
-See how many chose each option
-Compare the 3, 6 and 12 month outcomes of each choice, for pain and function
-Evaluate PROMIS (patient reported outcomes) of each option for: overall health, anxiety, depression, functional status.

Who would NOT want such information? Local, recent experience of other people like me, facing a similar challenging decision.

CMIO’s take? Time to disrupt ourselves.

Book review: The Better Angels of our Nature

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Whoo. Four stars. OK, 5 stars for philosophical arguments and hard science content, 3 stars because it is hard to listen to for hours on end.

This is an important book, and one that argues that over the time scale of humanity (decades, centuries and millennia), instead of at our puny scale of 24-hour news cycle CNN or short term memory of the last few days or weeks, violence as consistently declined. Pinker argues with compelling evidence that the background violence that used to be taken for granted (murder, rape, robbery, war) is much less prevalent as time goes on. Because our brains don’t carry the long view unless someone assembles the data and points it out, we are inclined to see what our nightly TV and news cycles bring us: episodes of violence across the globe.

Pinker argues that global communication technologies (the Gutenburg press and thus books, then radio, TV, internet) both enhance our ability to understand the other AND ALSO over-emphasizes the individual acts of violence, as those salacious details are “what sells” and what our hind-brains, wired for risk-assessment, remember most easily.

And yet the statistics speak loudly that the “truthiness” of what our gut tells us, is not true. In chapter after chapter, example after example, Pinker deconstructs our presumptions and shows us we are wrong. This is the best, least violent era yet for humanity.

CMIO’s take: Maybe it is less newsworthy, but voices like Pinker are sorely needed.

Gladwell writes about autonomous cars and digital music (must read!)

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from https://thebestschools.org/features/defending-malcolm-gladwell-intellectuals/ 

https://www.caranddriver.com/features/when-autonomous-cars-rule-what-will-happen-to-car-culture-feature

Malcolm Gladwell does it again. I picked up last year’s Car and Driver when at the barber this weekend. C/D created a 31 page spread on Autonomous vehicles, or as they cleverly put it “Auto: No ‘Mo Us.”

Gladwell edited the contributions of about a dozen authors, but his final essay was a stunner: how self-driving cars are to the passionate car lovers, as digital music is to passionate music lovers from the 60’s and 70’s. There is something about the ubiquity of a technology and service that strikes at the heart of what causes people to pursue hard-to-find, counter-culture and memorable music. And this translated, in decades past, to those who created long lasting memories.

CMIO’s take? Automation, convenience and digital tools become the enemy of personal memory and identity? A thoughtful read and critique of our age.