Mastering Nutrition

You absolutely cannot trust frozen veggies as a source of folate. Remarkably, though, folate is stunningly stable in liver during frozen storage, and even cooking. Access the show notes, transcript, and comments here.

Episode 39 is a panel discussion between me and three panel members who are either finishing medical school now or are recent graduates of medical school. We discuss the current state of nutrition in medical school, whether and how it should change, what doctors and future doctors should do to obtain a deep understanding of nutrition, and what patients should do to obtain high-quality, nutritionally focused medical care. The panel: Clayton Dalton received his MD from Columbia Medical School and is now a resident physician in emergency medicine at Massachusetts General Hospital in Boston. Leland Stillman received his MD from the University of Virginia and will complete his residency in internal medicine at Maine Medical Center in July of 2017. Rob Abbot is a 4th-year medical student at University of Virginia and will be starting a family medicine residency with Virginia Commonwealth University in June of 2017. This episode is brought to you by US Wellness Meats. Head to grasslandbeef.com and enter "Chris" at checkout to get 15% off your order as long as the final price is over $75 and you order fewer than 40 pounds of meat. You can use "Chris" to get the same discount twice. In this episode, you will find all of the following and more: 00:38 I introduce the panel to you in my own words. 07:39 The panel members introduce themselves to you in their words and tell you how they got interested in nutrition. 14:35 Everything in our body is made from our food. So is there a difference between learning “nutrition” and learning how everything in the body works? Does the biochemistry, physiology, and molecular biology learned in medical school count as learning nutrition? 17:13 Triage theory: you can learn every pathway, but if you don’t learn how they’re prioritized in suboptimal nutrient status, you haven’t learned useful nutrition. 24:34 The deficiency of clinical relevance and connections between clinical and basic science material. 26:58 Is teaching less the key to teaching deeper? 30:50 Is the purpose of the medical prerequisites and curricula to sort people rather than teach useful information? 32:12 It’s just harder to teach in a way that connects the dots. 36:03 My upcoming class on energy metabolism. 37:23 Are rare metabolic diseases (inborn errors of metabolism) really irrelevant?  39:29 Is the medical diagnostic paradigm too binary? Should we be looking at disease and health on a continuum instead?  47:56 Wildly misaligned economic incentives take the focus off nutrition. 53:15 In order to avoid burdening patients with unnecessary worry, we often withhold information. But this often hurts our collective pool of knowledge by hampering critical research and impairs our ability to help people. 1:06:38 Nutrition in medical school is abysmal, but do we need more and better nutrition education in medical school, a separate type of medical degree for primary care that focuses on nutrition, or more collaboration between physicians and others (for example, dietitians) who specialize in nutrition? 1:14:57 Empowering patients with mobile apps and other digital technology, providing real-time information in the context of a backlogged medical system. 1:24:14 What should a medical doctor, medical student, or future medical student do now to gain a practically useful understanding of nutrition?  1:34:08 Disciplines are fragmented and isolated, and desperately need to be connected. 1:38:36 Social media will be the next game-changer in medical education. 1:42:00 How to think about a patient’s nutritional status. 1:44:22 Selenium as an example of where testing can help you navigate equal probabilities of help and harm with supplementation. 1:45:03 Testing nutritional status is valuable because knowledge that a choice is necessary makes the choice more sustainable. 1:48:02 What should patients be doing to get good nutritionally focused medical care? 2:02:05 How you can find the panel members. Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/039-nutrition-in-medical-school-do

If you feel better when you eat refined grains or when you take a multivitamin or B complex with synthetic folic acid, this video is for you. Access the show notes, transcript, and comments here.

Spend eight minutes to know whether you need to manage your iron status and how to do it by watching this video. There’s a 30% chance it could make a big difference in your health, and a 3% chance it could be life-changing. Access the show notes, transcript, and comments here.

If you're concerned about your cholesterol, or confused about what to do, this episode is for you. In this episode, I list the four key factors that control blood cholesterol levels and outline the simplest dietary or lifestyle changes we can make to have the biggest impact. This episode is brought to you by US Wellness Meats. Head to grasslandbeef.com and enter "Chris" at checkout to get 15% off your order as long as the final price is over $75 and you order fewer than 40 pounds of meat. You can use "Chris" to get the same discount twice. In this episode, you will find all of the following and more:  00:33 Cliff notes; 09:22 Targeting the low-hanging fruit; 11:50  The total-to-HDL-C ratio as a fingerprint of low LDL receptor activity; 13:20  Other markers such as particle size, particle count, and ApoB as fingerprints of low LDL receptor activity; 16:30  The four factors that control the LDL receptor; 18:50  Intracellular free cholesterol (effects of dietary fiber, cholestyramine, statins, and polyunsaturated fatty acids or PUFAs); 20:37  Thyroid hormone (effects of micornutrients, body fat, and carbohydrate intake); 23:50  Insulin (via PCSK9, effects of the fasting-feeding cycle and carbohydrate intake); 27:00  Inflammation (via PCSK9, effects of acute infection and chronic inflammation); 29:15  Practical approaches to maximizing LDL receptor activity; 29:22  Nutrient-dense whole food diets; 34:00  Thyroid disorder; 37:15   Adrenal stress, circadian stress, inflammatory stress; 39:05  Insulin resistance, body composition, and fatty liver disease; 42:00  Weight loss will improve insulin sensitivity, and for many a low-carb diet is a tool to achieve that, but in an insulin-sensitive person, carbohydrate stimulation of insulin has a powerful beneficial effect on LDL receptor activity; 46:20  Inflammation and PCSK9; 47:00  C-Reactive Protein levels, body composition, diet quality, and exercise; 49:25  Replacing fat with carbohydrate. Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/038-what-to-do-about-high-cholesterol

This is a really important update to the video I put out on Tuesday about millet. There are millets on the market that can wreck your thyroid gland and others that are harmless. It’s important to know the difference. Access the show notes, transcript, and comments here.

If you eat millet or eat gluten-free bread, you should watch this video, because you could be hurting your thyroid. Access the show notes, transcript, and comments here.

In this episode, I explain how to come up with a good question, obtain the background information you need, find research, obtain full texts, organize them, read the different sections of a paper to get the right kind of value out of it, and critically analyze the study design. If you're a beginner, this is really designed for you. If you're more advanced, you'll enjoy the specific examples I give of problems interpreting research studies. This episode is brought to you by US Wellness Meats. Head to grasslandbeef.com and enter "Chris" at checkout to get 15% off your order as long as the final price is over $75 and you order fewer than 40 pounds of meat. You can use "Chris" to get the same discount twice. In this episode, you will find all of the following and more: 0:06:15  How to develop a good question; 0:09:30  How to use pubmed and Google Scholar; 0:11:50  Why and how to use MeSH terms (medical subject headings); 0:16:50  5 ways to get full-texts for free that are totally legal; 0:24:35  How Sci-Hub will facilitate the technological evolution of research distribution and the Spotify-ication of the science publication industry; 0:32:45  How to organize science papers to prevent wasted time and frustration later; 0:34:40  Reference management software; 0:36:35  The anatomy of a science paper; how you should approach each section and what you can learn from it; 0:46:45  Peer review makes discussions within papers more objective; how a scathing peer review from six years ago continues to influence how I teach hormesis today; 0:55:30  Acquiring background information with textbooks; 0:57:35  Specific textbook recommendations; 1:05:15  What you need to do before developing your own point of view; 1:10:30  Strengths and limitations of different study designs; 1:13:47  Observational versus experimental studies and the tradeoffs of context, size, and duration with strength of cause-and-effect inferences; 1:16:50  The central role of randomization in experimental studies; 1:19:20  Randomization needs a high sample size to be effective; 1:21:07  Example: Finnish Mental Hospital Study; 1:22:50  Example: LA Veterans Administration Hospital Study; 1:25:50  Regression to the mean; how a study can show something to be true when it’s completely false; change-from-baseline data versus differences-between-groups data; 1:35:45  The need for a control group: Atkins and methylglyoxal study as an example 1:37:35  Compared to what? Picking the right control group; 1:41:50  The generalizability tradeoff: in vitro and in vivo, animal and human, sex, race, and other population differences; 1:46:47  Contextual patterns determine outcome 1:47:50  Thailand zinc/vitamin A study as an example of nutrient interactions; 1:56:20  Do your homework, assume good faith, ask questions. Access the show notes, transcript, and comments here: https://chrismasterjohnphd.substack.com/p/037-how-to-read-a-science-paper

Last time we talked about supporting zinc nutritional status. Today we talk about how to kill a cold with zinc. Believe it or not, the principles are completely different. Your oysters can help you get sick lest often. But knowing how to find the right zinc lozenge and use it correctly is your secret weapon to stop a cold dead in its tracks when it eventually comes. Access the show notes, transcript, and comments here.

Here’s 5 rules you need to follow to get enough zinc. Access the show notes, transcript, and comments here.