Why do I get so much gas with my "healthy diet?"

The Standard American Diet (SAD) is high in processed food.  Quick meals, microwave meals, drive thru meals or meals heavy with government subsided fructose corn syrup (yeah.....the "first bail out" of the food industry that quietly continues to fatten our future adults while coming out of our weekly paychecks......causing people to claim disability and require expensive medication that again comes out of our weekly paychecks)  I digress.....when the 36 foot digestive tract of a human is used to taking in low residual, processed meals, it sustains it's job of "melting down" food 3x daily and extracting daily requirements of energy needed by our bodies.  The small intestine and colon house about 100 trillion "friendly" bacteria to help breakdown solid material we eat into the building blocks of protein fats and carbohydrates.  Think of them as microscopic maggots.  The bacteria that coexist in our gut are made up of a variety of species that usually cause no harm.  Our first inoculation of the bacteria comes from the birth canal and breast feeding.  Continued "inoculations" of bacteria continue while we age and originate from our water, our siblings/partners and our food (like yogurt).  Most of these are friendly, every once and a while there will be non friendly inoculations like undercooked chicken, unfiltered drinking water, filthy bathroom faucets or the food handler who just coughed into her hand and proceeded to box your meal.  When our gut gets invaded by a bad species of bacteria....it can usually produce white blood cells to kill the species that means to kill us.  Occasionally the doctor prescribes antibiotics to "nuke" our bodies and destroy bad invaders....unfortunately the WMD will also destroy good bacteria.  (This is why you get diarrhea you get after taking a course of antibiotics.....there is suddenly mass death to the good bacteria and the gut can't break down nutrition into protein, fats and carbs-so the food goes right through) 

A similar scene occurs when a change is introduced to our daily regime of eat, breakdown, extract and poop.  When the 100 trillion good guys are used to break down the SAD and suddenly get a high fiber plant source (tofu, fruits and veggies, whole food....)  some of the bacteria will take the high residue fiber and create a byproduct of methane gas.  It is these few species out of the 100 trillion that can also produce gas bubbles in pond scum, bad smelling air in a meat container or shoes that have been worn for 12 hours by a barefoot kid.  The colon is just a transit tube of muscle that moves solid material from mouth to anus.  It has a "usual" diameter of 2-3 inches but if the irritated species of bacteria is making extra gas, the colon inflates to maximum diameter- (goes from garden hose size to fire truck hose width accounting for your big belly and muscle cramps of IBS)  All that gas has to go somewhere and it is usually noted in a car (nasty Monday car pool buddy), under the sheets (dutch oven) or when your relative making a healthy change helps you carry furniture and lets one loose "by accident". 

There are ways to introduce a healthy lifestyle change without the bloating and room clearing gas problem: 
-Introduce the whole food, mostly plant based diet in slow increments over a scheduled calendar (the benefit of getting help from a registered dietitian!)
-Rev up your digestive power by taking digestive enzymes with new introduction or difficult to digest meals (note that not all enzymes are needed and can cause irritation as well so please consider help from a naturopathic doctor!)
-Smother your digestive tract with 300 billion bacteria in a bottle.  Probiotics are a great source of stable, non methane producing bacterial species that will "crowd out" the few guys in your gut that cause problems with high fiber nutrition.  (I don't like yogurt due to it's dairy base and it only contains a fraction of what you can get in a capsul/bottle)

Think of the probiotic this way, there are 20 apartments for rent and everyone that lives in the building goes to sleep early. The realtor brings in college kids and suddenly the harmony of the complex is destroyed by noise and trash until the tenant leaves.  The neighbors avoid another noisy renter by flooding the realtor's office with older quiet people seeking a new place to stay.  Harmony is reestablished.  (please click here to see my DrRic Tutorial on Probiotic Use)

So you spouses who have to deal with inhaling the byproducts of healthy living....go out to your local Whole Foods Market or Fruitful Yield and ask which probiotics are the most affordable and popular for maintaining a stable marriage.  For use with antibiotics, I suggest add the probiotic for 30 days at least.  For introduction of a new diet, I suggest adding a probiotic and considering a digestive enzyme until the 4th month of your change (a harvest).  For IBS sufferers, pre-biotics first then probiotics for life (and don't forget the crucial relaxation therapy).  As always with any change I create a template for, you must  introduce relaxation thinking and activity involving movement - your gut functions way better when emotions are stable and the heart is fine tuned to push blood and white blood cells to the organs that need it most.  (click here to see my discussion on DrRic's Antiinflammatory Lifestyle)

DrRic's Antiinflammatory Lifestyle?

A guru of mine popularized the phrase "antiinflammatory diet".  Essentially a whole food mostly plant based diet.  It goes with the concept that in the millennium, most disease has at its roots a form of inflammation.  I contend that there is more to inflammation than just bad nutrition.  I teach my patients that to get back to the "wholeness" of living disease free.  In my treatment plans and lectures, I write prescriptions of changes to cosider in solidifying your ability to withstand the challenges that face every decade. 

Thinking                 T
Eating             =      E
Activity                  A



You can have good TEA and increase the chances of living until 90-100years old with very little medicines and disease.
You can have bad TEA and allow every bad gene known to the human species to express itself.  It doesn't matter that everyone in you family tree has been without illness or early death.  Living a full catastrophic life (as John Kabat-Zinn refers to) without remorse will only screw up the brilliant actions found in your DNA to live/fix/avoid danger. 

Good TEA consists of;
1-allowing the brain to let go of unnecessary reactions to our environment.  When I have patients come to my office for the first time, 50% will have an elevated blood pressure and state they don't like doctors.  This is probably an evolutionary reaction trained from when you grew up and expected every visit to end in a shot.  Rational thinking should help you figure as an adult you can say you don't want a shot-but subconscious fear is a learned behavior hard to break.  Furthermore, if sitting in a small office, waiting for a stranger and having someone know your "insides" makes the fight or flight/sympathetic system turn on and manifest a fast pulse and high blood pressure......imaging what being late for work, forgetting your lunch, getting billed improperly, having someone tail gait you at highway speed, or just getting bullied or intimidated.... does for your pressure.  It is well documented that most heart attacks in the world occur on Monday morning.  This would be where "thinking" part of TEA is involved but it's more of developing a way to let go of analyzing every millisecond of every encounter and possible outcome.  Doesn't mean live like a hippy from the 60's in a commune but it does mean you have to invest in changing that "teenager-like" reaction of thinking irrationally and letting emotional tornadoes blossom from every stress event.  (I remember someone with anxiety pushing me to come up with a treatment plan for them but "they didn't want pills, didn't believe in psycho therapy and don't have time to practice mind relaxing......this dude needs a referral to Dr Bob Marley)
2-giving every cell in the body the basic building blocks of what they need to perform duties of existing.  Those of you who remember science can picture a cell and its center called the nucleus.  Within the this center, DNA does its magic of replicating for 90 years, cutting out bad genes that look like cancer, conducting the orchestra that takes place to chemically breakdown any toxin that you happen to ingest, recognize and kill any invading virus or bacteria that isn't helpful and keeping you moving/feeling/thinking happy and loved.  Eating crappy food/alcohol/overindulging will tip the scale from "living till 90" to "just getting by" at 20, 40, 60 years and usually when the "Ferrari" is given low quality gas, it's engine will run but performance will be worse than a "Yugo" and it's engine will soon fail. 
3-movement, outdoors, laughter, breath/heart stimulation are all so embraced by your body.  Everyone feels good when they are maintaining some form of activity...even the infants.  If basic brain of a newborn feels joy in kicking feet and moving fingers....what more do we need to prove that stagnation is a bad thing.  I remember watching this kid in the airport waiting for a flight-zoned into his computer.  Didn't move a muscle including his eyeballs for hours......yet there was expression of movement with his left ankle/foot.  It was nervously moving like it alone was on 5 red bulls. (The tell tale sign a police officer looks for in the admission of guilt via body language-this kids' leg was "hiding something")  It was fascinating that his eyes and ears were getting stimulation but his body was trying to express its need for activity..... and he was ignoring it to continue pleasuring his eyes and ears.  This 3rd leg of "DrRic's Antinflammatory Lifestyle" has it's challenges in that most people think of exercise as that feeble attempt at going to the gym and getting personal training from college years.   "Goin to the Gym" is just one of an infinite form of movement activities.  Instinctual activities that have been in existence since the dawn of man are walk and swim (biking was developed in the last few centuries)  There are well established activities that have been utilized by ancient cultures like tai chi or yoga (and the cool thing is they take care of steps 1 and 3).  Info mercials develop every 6-12 months- a new fitness machine guaranteed to change your life (until the next new fitness machine is purchased to replace the now basement delegated "lifechanging equipment")  I believe it is cheaper to hire a guru/coach who can listen to your wants and needs and use experience to develop a sustainable series of activities you had no idea were out there.  How is a patient with limited experience supposed to teach himself a sustainable method of living to turn around a failing body?....the Internet!!! (yeah right!)   While your at it, teach yourself a degree in medicine and the human psyche so I can start sending you some referrals.  Finding an activity you can embrace forever is possible on your own but takes alot of experimenting and direction that most humans don't have patience for (especially if you are unhealthy to begin with).

Bad TEA consists of the Standard American Dream (work alot of hours, make alot of money , you are #1-everyone else is beneath you!), the Standard American Diet (1 in 3 are obese and dying slowly) and the Standard American Pastime (TV)

Not everyone is ready to adopt this antiinflammatory way of living (click here to see a video describing DrRic's Antiinflammatory Lifestyle).  It takes big commitment to initiate and a strong will to continue.  In my opinion, making a change a little at a time is more difficult than being "all in".  When someone shows me the signs that they are invested in "flipping over" to a better way of living, I give everything I can in planning and give them the best "coaches" to initiate and complete the plan.  If they are being dragged in by a spouse, sitting with arms crossed and no intention to listen I try not to waste my time in preaching to deaf ears.  What I know for sure is that everyone will "flip over" whether now or later at deaths door.  If they aren't ready to "flip" now, it's ok I 'll be around for a while to help when it happens....it will happen.

Why can't I get a hold of my doctor?

 

 

I remember when just starting residency in '91, clinic days were limited to 6-8 patients daily.  The model was to make sure the new guys weren't overwhelmed with learning the process as they developed interview and exam skills.  Most important was to give enough time to take the patient case (all written down on paper) and present it to the overseeing doc/teacher.  By the time 3 years passes, most of us in Family Medicine can see patients every 10-15 minutes.  It seems this was the perfect balance of getting the biggest concern diagnosed (impossible to only have 1 medical concern especially medicare aged patients!) and being able to bill medical insurance and break even.  Most family medicine clinics don't break even with seeing patients.  In fact, over the last 20 years, when a bill goes to insurance, I usually see 3/4 of a reimbursement.  Inflation is about 3% annually and yet medical reimbursement decreases every year.  You see it on TV/Internet....spending cuts across the board for reimbursable medical expense by the government for medicare.   What medicare pays for and denies usually is followed by all the medical insurance companies.  Ultimately, medical office have to be really good with cutting corners and saving money. 

So how do primary care medical clinics survive?  They are usually large groups of several hundred doctors consolidated to save on administration and staff fees....."safety in numbers".  Another popular option for young graduates is to join a hospital group.  Hospitals have deep pockets and can help the neophyte doctor float for 1-3 years with base salary/malpractice coverage while s/he builds up a following.  Hospitals know that if the doc orders tests/therapy or suggests surgery, BINGO.....lottery payment!!!!!  Medical insurance reimbursement is procedure oriented so if you order a procedure it pays much better than keeping a person healthy with health education, lifestyle change and community/family bonding.  It is very rare to see a primary care doc in a solo practice.  There is no time to see patients in clinic, review and make decisions on test results, visit patients in the hospital, maintain a business (gotta pay for the multitude of staff necessary to maintain medical records, phone calls and scheduling/billing).....or answer phone calls personally 6 phone calls daily =1 extra non reimbursed hour in the clinic.  More economical to have the phone staff return the call with a preprinted answer.   Then there is the poison of malpractice insurance increasing every year regardless of excellence of practice......I have been in practice for 20 years with no cases of suit but have to pay the same amount as a high risk-new graduate that has a fraction of my experience.  (Maybe I should practice with abandonment!!!)  Na....its not in my nature.

So now I have a private practice (solo) but it consists of tedious evaluation to identify weakness in the plans my patients have to get old and stay healthy.  My "booked up" day is equal to 6 -8 patients.  I have to laugh......its like watching 6 TV shows or 3 movies regarding comparative time spent-not the entertainment.  The medical decision making is easy, with the training I have been privy to, diagnosis and planning is a breeze!!!  (thanks Andy Weil)  The challenge is making sure the teeny weeny reimbursement I get from medical insurance (remember I get 3/4 of what I charge) pays for the roof/staff/utilities/malpractice and my paycheck.   (yes....my paycheck is exactly the same as what a new graduate gets fresh ....out....of ...residency!)   No ....medical insurance says all docs are the same.

The only way I have found to maintain the balance between giving excellence of care and not going bankrupt.  Working a second job.  Here is the irony I was contemplating on the way to an interview 2 days ago.....I give excellent care with a knowledge base I have painfully paid for out of my own pocket to make people successful with healthy lifestyle change.   I also am outstanding in time management when I run the immediate care centers I work for to supplement a "just barely getting by" private practice.   (patting myself on the back) - I can run circles around the younger guys that are complaining "why are the patients in the waiting room and not in the exam rooms" (yet the neophytes are just sitting there not helping the front desk/triage folks!!!)  Primadona pansy-grab a chart and do some work!!!

 Yes....this means to be efficient at my second job.....I have to see patients for one diagnosis and get them out of the room in 10 minutes!!!!   I have to be the doctor (in immediate care clinic) adding to the burden of society illness that I (in private practice) am trying to fix.  What a polar opposite life I lead!!!   I feel it is going in one direction though.  You would think if I healed the world and made everyone successful at lifestyle change.....no one would be sick and the immediate care clinics would go out of business.  Ain't gonna happen.....not everyone is ready for change and too many millions that are leading an unhealthy life.

Like scooping water out of the hole you dug at the seashore......the ocean is too large to bail out of your little hole.   I will be "scooping out" for a long time so who can answer phone calls?!?!

Should I get a check up?...I hate going to the doctor!!

 

“Your office makes no money but continue referring patients for tests and procedures….”

“Every patient you see should walk out the door with a supplement…”

“You need to be seeing more of these coughs and colds per hour, oh btw this guy just has a possible brain bleed so just give him an antibiotic….”

“She only had double vision, a swollen face, blood shot eyes, and couldn’t stop crying, why didn’t you send her back to work….”

“We want you to encourage major lifestyle changes in chronic disease sufferers but can you do it in 15 minutes……”

Doctor Innanoutinfive is paid per patient diagnosis.  An insurance company decides how much the diagnosis will be reimbursed.   Doctor speeds up visit by writing a drug solution that has been found to “reverse” the diagnosis and ignores patients other complaints.  Drug company pays for studies that say their new drug can be used with less side effects than their previous drug that just ran out of its patent.  FDA gets ½ of its expenses paid for by drug companies and approves drug by a fast track before human trials.  Doctors sued by patient's surviving family given wrong diagnosis, delay in referring to specialist, wrongful harm from prescribing "aggressive" new medicine.  Malpractice premium increased to cover “bad” doctor.  Doctor has to see more patients to pay for higher malpractice. 

Lady doesn’t like doctors so refuses to go.  Lady cooks the way mom taught her all daily meals on a budget from local ethnic grocery.   Lady works 1-2 jobs but maintains marriage and raises kids through state school.  Lady attends funeral for kids that died from chronic disease before age 70 diagnosed and treated by Dr Innanoutinfive.   Lady lives to 90 years, natural causes, never takes any medicines.

 

Doctors are prescribing "snake oils" that dont get you healthier, cost the government alot of money and avoid addressing the real cause of disease........this is true quackery!!!