How to be a stoic

From the New Yorker, Elif Batuman wrote a short piece on how she discovered stoicism:

When a cabdriver lied about a route, or a shopkeeper shortchanged me, I felt that it was my fault, for speaking Turkish with an accent, or for being part of an élite. And, if I pretended not to notice these slights, wasn’t I proving that I really was a disengaged, privileged oppressor? Epictetus shook me from these thoughts with this simple exercise: “Starting with things of little value—a bit of spilled oil, a little stolen wine—repeat to yourself: ‘For such a small price, I buy tranquillity.’ ”

My mind tends to go to images of monks in brown robes standing in the rain when I think of stoicism, but I think this is a really, really helpful frame of mind. It's complementary to the strategy of remembering what you have control over right now.

Linkfest March 15, 2017

Watch a professional cyclist's carbon wheel melt before your very eyes:

Some people think going gluten-free may be risky for diabetes. Hmmm. Gluten-free diets are, for the most part, a waste of time and effort unless you have celiac disease. And whole grain intake is generally associated with a decreased risk of diabetes, which is consistent with the alleged findings of this study. And this paper (not yet published) comes from Harvard, which gives it a certain cachet, but I'm always skeptical of big, splashy pronouncements like this when they're made ahead of publication. Too many of these studies end up having fatal flaws.

Bikes now officially outnumber cars in Copenhagen. "When Copenhagen first began manually counting cars and bikes in 1970, there were 351,133 cars and 100,071 bikes on the roads—a ratio of about 3.5 to 1. That's important, because it means not only are more people riding—about 150 percent more over 46 years—but also, fewer people are driving."

How the world's heaviest man lost it all. "The only thing that gave him comfort in life was food. It was a drug of abuse, freely available, heavily marketed."

Is loneliness the biggest threat to middle-aged men? Well, Vivek Murthy is definitely qualified to say so, and I think we're self-isolating ourselves with suburban homes and gadgets, but "biggest" is a stretch when we still have tobacco and obesity/diabetes to contend with...

Big pharma is very nervous about possible Trump FDA deregulation. This one cuts both ways. On one hand, I'm afraid that ineffective drugs are going to start coming to market if deregulation goes too far. On the other hand, any deregulation that is opposed by big pharma is inherently attractive.

The ADA 2017 Standards of Care in Diabetes are out. "To help providers identify those patients who would benefit from prevention efforts, new text was added emphasizing the importance of screening for prediabetes using an assessment tool or informal assessment of risk factors and performing a diagnostic test when appropriate." It's a start.

You can't use drugs to "prevent" diabetes

Big, big disclosure here: I am a paid consultant for a CDC grant that aims in part to increase use of the Diabetes Prevention Program. So there. Read on.

Good to see you again, Mrs. D. You mind if I call you Mrs. D? Thanks. Reminds me of "Mrs. C" on Happy Days. You know, she was the only one with the cojones to call the Fonz "Arthur." So you can see the resemblance.

I'm glad you asked about the recent study that showed a medicine called "liraglutide" (brand names Victoza or Saxenda) "prevented" diabetes. You're a smart person, so you read some of the fine print in the study, and you know that ~2200 patients, most of them obese, were randomly given a daily shot of placebo or a daily shot of liraglutide, a chemical that mimics a gut hormone to trick the pancreas into producing more insulin. Liraglutide has the side effect of making people feel fuller sooner after eating. Doctors call this "early satiety." The tricky vocabulary's how we make so much money.

All of the patients had elevated blood sugars, but not so elevated that they could be labeled "diabetic." They were "pre-diabetic" in the current nomenclature, just like you. It means the same thing as "impaired fasting glucose" or "impaired glucose tolerance." The study set out to prove that liraglutide could "prevent" the onset of diabetes. Now you're probably wondering: If I'm taking a diabetes drug, what's the point of having "prevented" diabetes?

And you're on to something, Mrs. D. This is an absurd question at face value, but it keeps getting tested, mostly by drug companies. Not surprisingly, in most cases people getting the diabetes drug were less likely than those getting a placebo pill or shot to have their blood sugars rise high enough to be diagnosed with diabetes.

I'm about to get really, really snarky, Mrs. D, but before I do, it's important that I make this point: the prevention of diabetes is actually a HUGE deal, and not only because diabetes remains the number one cause of blindness, kidney dialysis, and foot amputation in the United States. It is astonishingly expensive. Of the $3.2 trillion (!) that Americans spend on health care annually, diabetes directly accounts for $101.4 billion, making it officially the most expensive disease in America. If you can prevent people from advancing from the just-a-little-abnormal-sugars "pre-diabetes" to old-fashioned diabetes, you save about $12,000 per year in expenses. Now, that's insurance company money, but we all pay for it in premiums.

This is where your insurance premiums are going.

And as I've pointed out before, a big chunk of that extra spending isn't insurance money at all; it's coming out of your pocket in the form of co-pays and whatnot. And it's not much better for the Medicare crowd, who we all pay for in taxes:

So let's perform a quick thought experiment. You came to see me because you weren't feeling your best, and I checked a blood sugar on a hunch, and it's slightly elevated at 106 mg/dl. That's in that pre-diabetic range I've been talking about.

Bummer.

Now, we've got some options here. But let's say I tell you that the best way to keep yourself from becoming diabetic is to inject yourself with 10 units of insulin every night before bed. That way, your blood sugars will go back to normal, and we can both wash our hands of the whole issue. Great, right? We've prevented a case of diabetes! Your blood sugars are normal, after all.

BUT YOU'RE ON A DIABETES DRUG NOW!

Of course we haven't prevented a case of diabetes! We've just put you on a diabetes drug that has (predictably) lowered your blood glucose levels. The entire assertion that we've prevented anything is as laughable as the assertion that we could "prevent" a diagnosis of hypertension by putting you on blood pressure medications.

To make the situation even more ridiculous with liraglutide, it costs a fortune: over $3,000 a month for the 3 mg dose! If you wanna know where that extra $12k a year is going, I think we're hot on the trail. Think what else we could do with that amount of money. And if you for some reason think the idea of "preventing" diabetes by taking a diabetes drug isn't patently absurd, it works only modestly better than metformin, a drug that can easily be obtained for $3-4 per month.

But the final insult, Mrs. D, is that liraglutide worked barely better in its study than a program called the "Diabetes Prevention Program," or "DPP." In the liraglutide study, roughly 2% of people receiving the drug went on to have blood sugars high enough to be diabetic in three years, versus 6% of people getting placebo, for what we call an 80% "relative risk reduction." (Drug companies love using relative risk because it makes the numbers sound so much more impressive) In the original version of the Diabetes Prevention Program, 4.8% of people getting counseling on diet and lifestyle by a coach went on to be diabetic, versus 11% getting placebo, for a 58% relative risk reduction. The numbers for both groups in the DPP were higher, which I blame on an older participant population.

The cost of the Diabetes Prevention Program? $429 per year. So you might not be surprised to know that in 2016, when CMS was debating whether to allow Medicare to cover the DPP, the Pharmaceutical Research and Manufacturers of America (PhRMA) fought against it, saying that twenty years of evidence was only "preliminary." They do. Not. Care. About your health or the seemingly inevitable transformation of America into a single, enormous insurance company that also happens to field a Navy. And we should all remember that back when insulin was discovered, the University of Toronto held the patent for insulin to keep any single company from exploiting the drug for unreasonable profit. How times have changed.

Okay. Deep, cleansing breaths. I'm calming down. Liraglutide is a good medicine for diabetes. It helps keep sugars down, it helps with weight loss, and it may even help prevent heart attacks. In diabetics, that is. But you're not diabetic, and you don't have to become diabetic, and all drugs come with a cost, financially and otherwise. I think we can agree that diabetes is expensive enough; we shouldn't use drugs to "prevent" it that are even more expensive than the disease itself.

So, Mrs. D. You'd be a great candidate for the DPP. But even if you weren't, do you know what the DPP asks of its participants? 150 minutes a week of physical activity and some dietary modifications to allow you to lose around 7% of your body weight. Let's think about what that might look like. The average bike commute in this country is around 19 minutes one-way. Do that five days a week, and you're at 190 minutes already! And that doesn't even count trips to the grocery store! And if you stop drinking insect bait and cut out the foods that aren't really foods:

If you cut those out from your diet and start eating most of your food from the produce aisle or from the canned fruits and vegetables aisle, don't you think that 7% weight loss sounds pretty modest? I bet you'd blow it out of the water. 

And besides, do you really want to cross that grim threshold from "person" to "patient?" Because the first time you put the needle of that Saxenda pen into your skin, that's what you'll have done. You'll have moved the wrong direction on the Double Arrow Metabolism Wellness Index. You'll have gone from a person with agency, someone who takes medicines to feel better or live longer, to someone who has yielded control to a chemical--a $30,000 a year chemical--to do something you could have done better yourself. You'll have succumbed to a philosophy of better living through chemistry.

Maybe Du Pont doesn't deserve this.

Or do you want to be the person who SAVES thousands of dollars per year by ditching the fancy gas-powered wheelchair so you can propel yourself through space with your own legs and feet and by eating real foods you made with your own hands and eating them when you want, the way you want, and in the quantities you want? Do you want to live by a philosophy of self-determination, where you know that every healthy, happy day you live from now on was of your own making? 

If that life is what you want, then don't try to prevent diabetes with drugs. It can't be done. 

Link-o-rama - March 10, 2017

"Someone in Kansas Created a Protected Bike Lane Using Toilet Plungers—and It's Amazing"

"The true paleo diet is eating whatever’s out there in the environment." Based on DNA in dental plaque, it looks like Neanderthals ate whatever they could get their hands on, not just organic, grass-fed beef and free-range chicken. Huh.

Florence Williams on the Outside Podcast talking about her new book "The Nature Fix," which I'm reading right. this. minute.

The bacterium Akkermansia muciniphila appears to protect against obesity and diabetes in mice. Google is already crawling with ways to buy it, natch. *shakes head*

What's with all the arrows?

You’re back! I guess the random link dumps and talk about what a tightrope we're all on health-wise didn't scare you off. Where to start today's post, then? Let’s start with the name. Why “Double Arrow Metabolism?”

I grew up on a farm in south central Kansas. Our farm raised cattle, at least until I was 13-14 years old or so. According to WikiPedia, branding, in the form of burning a pattern into animals’ hair and skin, has been performed since at least ancient Egyptian times to identify cattle. The Wild West of the 1970s and '80s hadn't changed the practice. Our farm’s brand was the double arrow, two vertical arrows arranged in parallel, each with an arrowhead on each end. You can see it splattered all over this site:

Everything in Kansas leans to the right.

Now, this may be simple coincidence, but as you may recall from post #2, I’m an endocrinologist, a hormone and metabolism specialist. And if there’s a medical specialty that loves arrows, it’s endocrinology:

There was a time when I could draw this from memory. Then I decided that God gave us Google images for a reason. Now that space is taken up by happier memories.

Wow! Converting cholesterol to hormones takes a lot of arrows. And chicken wire. Maybe now you can see how, when my world shifted from the windy, sun-drenched agrarian plains of southern Kansas to the fluorescent, air-conditioned, mint-scented hallways of medical academia, sometimes my studies reminded me of home. And not to get sentimental, but that two-headed arrow has always looked like it wanted to move. It reminds me of freedom of movement back and forth between phases or choices. Or, in my case, over the last couple of years, movement away from those fluorescent-lit hallways back to the outdoors and back in contact with people, not just patients.

So: Double Arrow Metabolism.

It’s not particularly catchy. It doesn’t follow the craze of single-word names out there (Spruce) or baby noises (Hulu) or left-out vowels (Scribd, Flickr) or any of the other internet weirdness. It hasn't been tested for SEO or "optimized" (I hate that word) through Google Ad Words. It hasn't been A/B tested.

But it’s honest. And since I’m looking to connect with people and not necessarily just to optimize search engine results, I like the homage to my past. Plus, metabolism is a cheap way to sound smart without using a word people can’t pronounce (if I'm looking to throw out unpronounceable words, I think I've covered that with the diagram above).

I promise that I’ll get back to discussing the path toward medical, financial, and health independence soon. But first a couple of observations: you shouldn't let the process of getting yourself healthier intimidate you. Just as not every new business name has to follow the naming conventions of Silicon Valley, not every healthy person has to be an athletic coastal hipster foodie or a lycra-covered sex kitten. I mean, if that’s what you are, then great. Magazines apparently can’t shoot enough pictures of you:

Backstreet's back, alright!

But you can just as easily be a middle-aged, slightly frumpy guy like me who decided to paddle himself out of the vortex we talked about in post #1. And you can be as happy as that guy is at how it feels to have your feet planted on dry land.

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Link dump - March 8, 2017

Fewer and fewer Americans report trying to lose weight. We may be settling into our role as the one of the fattest countries on earth (we're coming for you, Tonga...). I can't help but think this is because of the many, many, many shitty options that people have had pushed on them that didn't work. Now they've given up. *sigh*

The search for the perfect artificial sweetener continues: 

"Let us pause here to acknowledge the sugar-frosted codependent embrace of Big Food and the American consumer. You could rightly fault consumers for their insistence on an oxymoronic product. But who has been indulging their fantasies for decades now, promising sweet, satisfying taste and no calories? Big Food, of course. Now customers are upping the stakes—and it’s not at all clear that companies can pass the test."

In what seems like a just reversal of a law that had the unintended consequence of highlighting the law of unintended consequences, after 60 years, street hockey will once again be legal in Hamilton, Ontario, under the following conditions:

• The roadway has a speed limit of 40 km/h or less and is a local road.
• Play happens in a place that is "safe and suitable."
• People play no earlier than 9 a.m. and no later than 8 p.m.
• No one plays during periods of limited visibility from fog, snow or rain.
• Play is stopped for any vehicles. ("Car!")

Having robot minions control the lights for them may be turning kids into a bunch of lazy, entitled monsters.

No one can get you to take your medicines but you. Three reminder devices to take your medications were no better than no notification or device in a randomized controlled trial. 

Go. To. Bed. People who get out of bed in the morning tend to eat better and earlier in the day than night owls. Original paper here.

"We found that night owls had postponed timing of food intake, and less favorable eating patterns with higher intakes of sucrose, fat and saturated fat in the evening hours than early birds," said Maukonen, a doctoral candidate in the department of public health solutions. 

Things you can control right now

There are a lot of things you can't control: the weather, the stock market, your neighbor's loud music. But many, many things are under your control, as pointed out by Lori Deschene. And how well you do at seizing control makes a huge difference in your health and happiness:

Right now, you can control:

1. How many times you smile today.

7. When you pull out your wallet for luxuries.

11. How often you notice and appreciate small acts of kindness.

17. The type of food you eat.

21. How much exercise you get.

22. How many times you swear in traffic. [I'd amend this to say that you can control how often you're in traffic at all. If you're swearing at traffic, chances are you are the traffic.]

27. The attention you give to your loved ones when you see them.

28. How much you enjoy the things you have right now.

41. Whether you formulate a new plan or act on your existing one. [this is my favorite]

44. Whether you smoke or drink. [unless you’re an alcoholic, in which case you are in control of whether or not you seek help from a qualified practitioner]

50. How much rest you get at night.

40 minutes

Who is the maniac posting here the last few days? 

What the hell is Double Arrow Metabolism? Doctors always think they know everything. And I don't like the looks of this guy. He was probably born skinny, and here he is trying to judge the rest of us for driving cars, smoking, eating processed foods, spending our money on whatever we want, and spending our free time on social media. Sure, maybe you can be healthy if you've got a good set of genes and luck into a doctor who's not a quack. But it's a roll of the dice. Life is hard, and this guy acts like we can all just "choose" to be healthy. Some of us have obligations! Kids at home, a mortgage to pay. So we get a little stressed out and watch some TV and maybe have a beer or two. Live a little for a change. So what? 

Yet some people live happily and healthily into their 90s, while the overall life expectancy is going down. Is it all just genetics, or is there something we can do to live longer and happier? Let's examine the thin grey line between being healthy and happy and being sick and depressed.

How thin is the line? How about 40 minutes a day?

Let's say you are holding your own, health-wise. On the Double Arrow Metabolism Wellness Index, you're a solid two or three. Then you decide that lying on your side for thirty minutes in bed each night flipping through your Facebook feed is more important to you than moving through space like you were designed to do. All the light from the screen blasting into your retinas throws off your sleep cycle, so you wake up in the middle of every night for ten minutes and raid the fridge to the tune of 200 highly-processed calories.

Then, since you couldn't sleep the night before, you wake up twenty minutes late and decide that you don't have time to make a sensible, non-cake-based breakfast at home.

Let's assume that you commute less than five miles to work, as a solid plurality of
Americans do. You're in a hurry and instead of biking, walking, or busing to work, you swing your fancy gas-powered wheelchair through McDonald’s on your way there and spend $5 on a meal that should have cost you less than $2. Let's be generous and say that this breakfast was no better and no worse than what you would've had at home (a generous assumption indeed). Say this routine (self-inflicted bad sleep, sedentary commuting, breakfast of processed crap, repeat) becomes a habit.

So that 40 minutes a day: 30 minutes of Gay French King scrolling Twitter or Facebook, then 10 minutes of late-night insomnia binging, all at the sacrifice of a more meaningful breakfast and commute, leads to this: 1400 extra highly-processed calories a week in food intake, 1148 fewer calories per week burned by missing your average 19.2 minute one-way cycling commute, $21 a week spent on food you didn't need and shouldn't have bought, and, at the current Federal rate of $0.52 per mile, $30 a week from gas-powered wheelchair driving. And, for the sake of being fair, let's say your fancy gas-powered wheelchair is a sensible car and not a gas-guzzling adult Tonka Toy:

Goodbye, one year's salary. I'll miss you.

If that's what you drive, these numbers would be far, far worse.

End result? One year later, if you started out at 150 lbs, you're now almost 60 pounds heavier. The extra $1440 you spent on your habit in that year, had you just put it in an indexed fund, would now be worth $1541.

And ten years later, if you really fell into a rut, that 40 minutes would have cost you $10,791! Your weight would eventually level out--we all hit our genetic max for obesity at some point--but you'd almost certainly have complications, like diabetes, heart disease, or sleep apnea.

And all this assumes you didn't even take on any credit card debt to pay for this, and assumes that the bad sleep you were getting didn't make your metabolic issues worse, and doesn't even take into account the $1184/year that your new diagnosis of diabetes cost you.

40 minutes a day to stay out of this swirling vortex. 40 minutes.

Link dump - March 3, 2017

People who cook real food and eat it at the table like human beings instead of eating processed garbage in front of a screen like drooling automatons have a lower risk of obesity. Good to know.

Wichita roads are friendlier to cyclists. I've experienced this myself, and I've meant to write a letter to the Eagle thanking the city and its drivers for not killing me, but now it's taken care of. *washes hands*

Obese people who "self stigmatize" may be at higher metabolic risk. This is an interesting hypothesis. Intuitively, I believe it; there's so much undeserved self-hatred out there among people who weigh more than they want to. But the sample size of this paper makes me suspicious. It has the smell of p-value hunting.

Aggressive treatment of subclinical hypothyroidism with levothyroxine in pregnancy probably doesn't result in smarter kids. This is disappointing.

Taxing sugared drinks makes people drink less insect bait. Go figure.

Have a good weekend

What the hell is water?

There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, "Morning, boys. How's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, "What the hell is water?"

-David Foster Wallace

I don't know exactly what the late, great DFW meant by this. Tragically, he's not around to tell us. But what I think he meant is that the most important realities are often the ones that are the hardest to detect. And to continue to borrow DFW's analogy, most of us paddle forward as best we can without ever feeling the flow of water against us, pushing us back, keeping us from reaching our potential. That rush of water consists of a lot of things, but most of them are visible if you look closely.

I’m a physician, as you might have deduced by the initials after my name. And physicians by training are supposed to notice the things that others don't. But most of us don't, and I've been more guilty of this than anyone in the past. See, I'm an endocrinologist. That’s a specialist in metabolic and hormonal disorders (think disorders of the pituitary, thyroid, and adrenal glands; and osteoporosis and diabetes and whatnot). You’d think that an endocrinologist is a person particularly well-trained to help patients escape the vortex of fancy motorized wheelchairs, faux-food, time-sucking devices, and all the other things pulling us under.

But that’s not at all what I was trained to do. In fact, I found during my career as an academic endocrinologist that instead of getting people safely to shore, I was often quickening or deepening the vortex that my patients were swimming in. In 15-minute office visits, I’d prescribe drugs that cost thousands of dollars and have trite, brief (in case the 15-minute visit didn’t give it away) conversations about what they could do with their weight, or their fatigue, or their sadness. The visits cost me 15 minutes, that is. They cost my patients a lot more. A lot more.

I was doing my best, obsessing over the things I could measure or manipulate, like blood sugars, cholesterol, blood pressure, and weight. All those are important. Don’t let anything you read here convince you otherwise. But I was swimming in the vortex myself. I simply paddled forward in the water I was trained to swim in, comfortably moving myself from today into tomorrow, spending the loads of money I made on things that didn’t make me happy and working extra hours to pay them off. I drove like a maniac between two clinics and four hospitals, often putting almost 100 miles a day on my car. The vortex deepened. The extra hours ate into time that I should have spent doing things I loved, like chasing my kids or riding my bike, so I weighed thirty pounds more than I wanted to. The water sped up. And then my blood sugars--one of those things I prided myself on controlling--started going up. And then I started getting really unhappy and resentful at work. I was swimming as hard as I could, but spiraling. What I couldn’t detect was that I and my patients needed to become people again.

What’s that? My patients weren’t people? What am I, a veterinarian?

P. henrylawsoni can out-wrestle A. woodhousii any day of the week.

What I mean is, that once a person crosses that gauzy threshold from the waiting room to the exam room, he experiences a transition from personhood to patienthood. And patients are bad swimmers. Let me illustrate. Most of us, whether we’ve thought about it or not, exist somewhere on this spectrum:

1. I feel great. I’m as healthy as I can be, and I’m intentionally doing things daily to improve my health.

2. I’m healthy, but mostly by accident.

3. I’m not sick, but I don’t feel good. I’m always stressed out.

4. I have one or two health problems that I manage pretty well, but I’m broke.

5. I have a few health problems that I struggle to manage, I’m broke, and I’m working a second job to pay medical expenses.

6. I have been hospitalized one or more times in the last year for chronic health problems, and I can’t work.

7. I’m in a nursing home or assisted living because I can’t take care of myself anymore.

8. I am dying.

The thing about this spectrum is that the strategy for moving up on it depends on where you start, and it’s never a straight line. If you’re one of the unfortunates at #7 or #8 that our system most definitely calls patients, my thoughts are with you. If you are at #5 or #6, your strategy for moving up may involve a lot of pharmaceutical help. I have opinions, at least metabolically speaking, on what that help might look like. But if you’re at #4 or above, and you’re working on getting to #1, the path to get there may meander through the local pharmacy for a bit, but most of the path is outside in the sunshine and fresh air. The path most definitely does not intersect with your couch.

So by reading this blog, if you’ll bear with me, you’re going to learn to feel the water around you, and you're going to get the skills to map out your own path out of the evil vortex. I intend to be completely honest and transparent about what I know and what I’m not so sure about. There’ll be philosophical stuff, like what a good partner in health ought to offer. There may even be diversions into seemingly unrelated topics, like pop culture, the weather, or my favorite, cycling. If I haven’t scared you off yet, come back for the next post.

Freedom from the vortex

Maybe you’re sick. Not throwing up or coughing up blood or having a fever, at least not most of the time, but you’re on a few medications, probably for diabetes or blood pressure issues or cholesterol, and your doctor picks on you to change your diet or be more active whenever you see her. Your medications cost a couple hundred dollars per month, and every second or third time you visit the doctor she adds another one, or replaces an old, cheap medication with a newer, more expensive one.

And maybe you weigh a few pounds (or many pounds) more than you want to. You’ve tried a few diets, mostly Atkins-type stuff, or low-fat, or calorie counting, and you’ve lost weight a few times, but each time the weight eventually came back.

Maybe you’re tired all the time. You feel bad when you get up in the morning, you are fatigued and achy all day, and you don’t sleep well at night. Your doctor thinks you might be depressed, and you’ve tried a couple medications for it, but they don’t seem to help.

And maybe you worry about money. You spend a lot of it on medications, and you go through the drive-through a few times a month even though you promise yourself that you won’t, and you end up working longer hours than you want to because you need to make sure the bills get paid.

Maybe you worry about the environment. You worry that our habits are putting your kids’ futures at risk, and you worry about it, but you aren’t sure what to do. A couple of times you’ve clicked the button to buy carbon offsets when you flew somewhere, but mostly you just try to ignore the problem.

And maybe it hasn’t occurred to you that these are all different manifestations of the same problem. You read that right. There is a very good chance that your diabetes is just another manifestation of the same set of problems as your weight and your fatigue and your money issues and even climate change.

We’re gonna talk about how. This blog is about your health, but not in the way that you’re used to talking about it with your doctor. It's not about the “blood pressure, blood sugar, cholesterol,” kind of health that makes you feel like a gadget someone is tinkering with. It’s more about the “What do I look forward to when I get out of bed in the morning?” kind of health. Or the “What can I do today to make sure I’m happier tomorrow than I was yesterday?” kind of health. Health as freedom: freedom from false choices, freedom from medications (not all of them, but some of them), freedom from the, *ahem*, Bravo Sierra that passes for medical advice from celebrities and celebrity doctors. I’m talking to you, Dr. Oz.

You’re not going to see click-baity posts on this blog about some new supplement or cellulite-destroying cream. You’re going to see posts on how you can take control of your life back. I’m not talking about a life jacket to protect you from the evil, swirling vortex of drug companies, subsidized faux-food, and carbon-spewing cars and factories. I’m talking about the freedom of learning how to swim your way out of that vortex altogether, put your feet on dry land, and walk away. All those people wrapped in spandex and padding away on a commercial gym’s treadmill under creepy fluorescent lights: do you think they’re free? They sure don’t look like it to me. You, with dry feet, having sprung once and for all from the vortex and now walking one foot in front of the other toward a happier, healthier life: that’s what freedom looks like.

I intend to be your guide along this path to medical freedom. I want to teach you a new way to think about your health; a way that allows you to make decisions that are your own and that will get you out of the vortex. You know the last time you had a bad cold, and you felt guilty for taking all the healthy days you had before that for granted, and you wondered when you would finally feel normal again? Remember how you said to yourself that you’d never take a healthy day for granted again? Once you claw your way out of the vortex, you won’t. And it will be because you MADE that next healthy day. You will have made it yourself, with your own hands and feet and decisions. If you believe me, I’ll see you at the next post.