The Good Gut

Taking Control of Your Weight, Your Mood, and Your Long-Term Health

I have spent 30+ years in the practice of internal medicine attempting different strategies to change behavior when bad habits happen to good people.  Too often, lifestyle epiphanies occur after major shake-ups such as the diagnoses of diabetes or other serious conditions.  I particularly like the ‘bibliotherapy’ approach, and I’m always on the lookout for good self-help book recommendations to add to my short list of those that truly effect change.

I am pleased to report here that “The Good Gut” is just such a book, well-written in a way that makes it one of those notable non-fiction works that you’ll read cover to cover, not losing interest or comprehension somewhere between a paragraph’s start and finish (no flipping ahead to see how much longer this chapter!).  The Drs. Sonnenburg do not tediously repeat and overstate the standard health caveats to avoid sugar, lose weight, and exercise, but rather expand on their primary point, namely the importance, care, and feeding of our fellow life bacterial travelers. 

As a regular reader of the latest medical literature, much of the content herein was not news to me.  The presentation, however, in everyday layperson language, was personally compelling in ways that the New England Journal of Medicine is not.  A recent search on the NEJM web-site for ‘gut microbiota’ returned 28 articles, not one of which with a title so compelling as to change my diet for life.  Oh right, I’ve already done that, changing out breakfast foods long before the Sonnenburgs’ book and the rest of menu as a result of this read.

I will be recommending this book to my patients, and I also commend it to you.  This book will be released 4/21/15.

End stage renal disease and EGFR

Well who really gives their kidneys a thought? Patients all worry about cancer, and rightly so, and everyone is finally heeding the call to worry about their hearts. But headline news at medpagetoday.com alerts us that baby boomers are entering the age of end-stage kidney disease.

This coincident with the addition of a new lab value on routine lab printouts--EGFR. This stands for estimated glomerular filtration rate which is a fairly accurate estimate of the efficiency of kidney function. The National Kidney Foundation encourages that all persons "know their GFR number," so now we've got another number to add to our blood pressure, blood sugar, and serum cholesterol statistics. If you know your creatinine (a measure of waste in the blood included on most standard lab panels), you can know your GFR with this handy tool: EGFR calculator.

My discussions with patients about their routine lab work has, therefore, acquired a new level of complexity. The lowered thresholds for fasting blood sugar and optimal cholesterol already require extra time to interpret, but no way to explain EGFR and its implications in a sentence or two.

Results of this screening test are divided into normal (>60), and low. The things that make GFR drop are prevalent in an aging American population, and include hypertension, obesity, diabetes or even prediabetes, and the overuse of analgesics such as Tylenol and Advil. Regular use of diuretics can also contribute to diminished kidney function.

There is information that routinely passes right over the heads of most of my patients (extra weight is bad for you) and some results that finally cause them to sit up and take notice (you have diabetes). Unfortunately, 'you ought to lose weight,' when ignored for years, result in 'you have diabetes.' 'Your kidney function is low' is turning out to be an eye-opening phrase and is one best heeded while lifestyle changes can turn the trend around.

Your momma is so tired...

she couldn't even climb up the Iowa Fatigue Scale. Actually, my momma is so tired she can't even turn on the computer.

If you are dragging your sorry back end through this summer and wondering if it's more than just the heat, check out The Iowa Fatigue Scale and see if you pass or fail. Life's too short to be so tired.