This is an article I wrote for a hand surgery newsletter. It will be published soon, I think?
Carpal tunnel syndrome is one of the most common conditions that is seen by hand surgeon, and the general consensus is that definitive treatment involves surgery. Certainly, this is the case for a large majority of patients are evaluated for this condition. And surgery, which involves surgical decompression of the median nerve at the wrist, by a endoscopic or open method is safe and highly effective, producing reliable results that reduce both pain and numbness.
However, there is a subcategory of patients that I have seen in my practice ? that in fact, most hand surgeon see in their practice ? who do not respond well to treatment. These patients are either prediabetic (aka metabolic syndrome) or diabetic, and because of persistently high blood glucose levels,? and/or high circulating levels of insulin (in the case of type II diabetics), often sustain damage to the median nerve which is not addressed effectively by surgery.
This often places the hand surgeon in a conundrum. The patient often has hand pain that is intractable to conservative therapies, which keeps them up at night, and makes it difficult for them to function effectively during the day, but if surgery is performed, often the pain will either not be mitigated, or worse yet, because of the damage sustained to the nerve because of their metabolic condition, surgery will result in increased pain.
I have seen many of these patients in my practice, and I find it both frustrating and unfulfilling to perform surgery, as it doesn?t provide the typical results that carpal tunnel surgery should. Ordinarily, the success rate of carpal tunnel surgery is very high (as high as 95-99%), and as a result, for most hand surgeons, it is one of their favorite procedures to perform because patients are generally both happy and thankful to have their hands back and pain-free. But in the case of the prediabetic, or the diabetic, surgery presents much more of a challenge. So I began thinking: was there another way to treat these patients? And the answer that I found has to do with my own passion for health, wellness, and nutrition.
In my own quest to find the road to lasting health, I became an strong advocate for both evolutionary medicine and the Paleolithic diet. In my own personal life, I have lost over 40 pounds that I gained during a long and stressful residency to become both a plastic & hand surgeon. Initially, I was not successful at losing weight because I thought, like most people, that weight loss was a simple formula of eating less and exercising more. Even though I found myself losing 15 to 20 pounds rather easily, I would generally stall at that point and when winter set in, with all the holidays, eating, and spending time indoors, I found myself each spring gaining all the weight back, with a few extra pounds. But being an avid reader with a particular interest in evolution and biology (I have always been fascinated, in particular, with the evolution of the hand) I came across the Paleolithic diet.
Recently, the Paleolithic diet has become popularized in the media. It goes by several names including the Caveman diet or the Stone Age diet, and because of this, it has been marginalized as another fad or gimmick diet. I certainly thought of it as such initially. I am sure many of you who are reading this have an image of the caveman in the Geico commercials. I certainly did when I heard about the diet. ?But I was lucky to read some very good resources about this and similar diets from well-respected researchers who spent their careers studying the lives and habits of modern-day hunter gatherers. These groups of people, who have avoided the process of modernization and industrialization, provide a window into how people lived and survived for millions of years before the advent of the agricultural and industrial revolution, and they are, for the most part,? virtually free of any of the diseases that we see on a daily basis and modern medicine like diabetes as well as cancer, heart disease, hypertension, and depression in spite of the lacking access to many of the advances of modern medicine.**
Noting this along with my particular interest in evolutionary biology, I saw right away that there was something to this diet that was very different than other diets with fancy names and promises of rapid weight loss and quick fixes for complex health problems. It was clear to me both as a physician and as a person who had become obese via a stressful life and a stressful job, that modern life is not at all like the life of our ancestors.
In fact, modern life presents a number of features that are discordant to the way that our bodies were created to function through evolution. Food today is highly processed, it is filled with sugar and grains, people live highly sedentary lives that are full of chronic stress, they don?t get enough sleep, and they don?t have meaningful interactions with other human beings. It is a recipe for disaster in terms of our health, and you don?t need to look much farther than the halls of a modern hospital to see what happens when people do the exact opposite of what their bodies were designed to do.? And I certainly saw this in my practice as well, especially in the case of carpal tunnel syndrome in patients who were prediabetic and diabetic.
One of the great strengths of the Paleolithic diet is that once the principles of the diet are applied in the daily life of a person who is afflicted with one of the many chronic illnesses that are running rampant in our modern society like diabetes, not only does the person tend to lose an enormous amount of weight while gaining lean body mass, the diseases that the person was suffering (which often require multiple, expensive medications) tend to either improve or are cured. That is, not only does a person look better on the outside, they actually are much better on the inside.
I know countless stories were people who were taking medications for diabetes stop taking those medications. People with sleep apnea? who relied on a CPAP mask to get enough oxygen while they slept put those cumbersome masks and machines in the closet forever. And so I wondered, would my patients with carpal tunnel syndrome improve in a similar fashion?
I decided then whenever I saw a? patient in my office who presented for the treatment of carpal tunnel syndrome prediabetes, metabolic syndrome, or diabetes that instead of simply going through the standard protocol of conservative therapy followed by carpal tunnel surgery, I would experiment and discuss nutrition, specifically the Paleolithic diet, and encourage my patients to take control of their health if they wanted to have the best possible result from treatment. Surprisingly, many of the patients were very receptive to my suggestions, and decided to experiment with the Paleolithic diet, and many saw improvement of their symptoms as a result, not only with carpal tunnel syndrome, but with other joint pains they had been suffering from, as well as other illnesses ? including diabetes. What exactly did I tell them to do?
- Remove all sugars and grains from their diet
- Remove all wheat products from their diet
- Remove all processed vegetable oils and hydrogenated oils from their diet
- Encourage the consumption of high quality animal products such as fish and grass fed beef
- For those who were lactose tolerant, I recommended high-fat dairy as well as fermented dairy such as yogurt and kefir
- Eat a wide variety of colorful vegetables
- Eat an equally wide variety of leafy green vegetables
- Eat fruits according to their natural seasonal availability (ie berries and peaches in summer)
- Supplement with Omega 3 fatty acids, coenzyme Q 10, Magnesium, and a very high quality multivitamin (which includes a balanced mix of minerals and antioxidants)
- Get plenty of rest and sleep
- Make sure in addition to exercising a few times a week, that they found time to walk, especially with someone.
With these simple and straightforward suggestions, most people said they felt less pain in their hands as a result of carpal tunnel syndrome. They also lost weight, and felt better about themselves. I can?t say that all avoided carpal tunnel surgery. Some still had pain and decided to go ahead with the surgery, and the majority of these patients had excellent results. They also reported better health, many saying they had not felt this good in years.
I have found that this is the power of the Paleolithic diet. It produces very profound changes with very simple and intuitive steps, and you don?t have to be a caveman to do it. In fact, living like a modern-day hunter gatherer is not a feasible goal for the vast majority of people.? The goal is to try to tap into our ancestral milieu, in order to achieve health and vitality, and it seems this can be done without actually being a caveman per se.
I believe that the ultimate success of 21st century medicine will not depend? on the level of technology that is available to provide patients care or the amount of money that is spent on that technology. We live in an information age, and as a result, I believe that it will be the quality of the information that is transmitted from doctor to patient that will serve as the bedrock to quality (and cost effective) care. The majority of that information will be on how to prevent diseases before they occur, and manage them through noninvasive and nonpharmacological methods such as nutrition, exercise, and supplementation once they do occur.
Will this resign the hand surgeon obsolete? I personally do not think that will be the case. There will always be the need for doctors, but saying this reminds me of watching an old Star Trek movie where the crew travels back in time to the 1980s and visits a hospital.
I will never forget Bones observing what was going on there and calling treatments like dialysis barbaric. It makes me laugh a little bit as I write this, because what I am suggesting is that we move forward by looking backwards. That may sound funny or even absurd to many or most people reading this, but with the current medical system making very little impact to combat the rampant rise of chronic illness in our society coupled with the skyrocketing cost of medical care, I question whether the path that supposedly leading us forward is actually leading us backwards.
**It is also interesting to note that these hunter gatherer groups do not develop arthritis and the typical age related skin changes in the same manner that people in the industrialized world do. One of the arguments commonly used to explain the rise in chronic illness in the Western world is simply the fact that people, on the average,? live much longer than hunter gatherer groups do. That is, the average lifespan for the majority of humans that have ever existed is probably, at best, about 35 to 40 years, whereas the majority of the population in the industrialized world enjoys an average lifespan of about 75 to 80 years. As a result, our skeletal structure and our skin is not well adapted to being used for so long and as a result, ?it breaks down.? However, careful study these various modern-day hunter gatherers reveals that, apart from gray hair, the elders of these groups are much healthier than their Western counterparts. In fact, all you need to do is drive down a busy intersection in any major city and really start looking at people from a physician?s perspective, and you will see that these people on the whole, do not look anything like hunter gatherers in terms of their physical structure. Place one of the members from the Masai tribes or a native from Papua New Guinea, and the fact is, you will see a major difference between them and the average American in terms of being lean, fit, and muscular , unless of course that American happens to be a Navy seal, an Army Ranger or a fitness professional.
Source: http://www.midwestprs.com/non-surgical-treatment-of-carpal-tunnel-syndrome-the-paleolithic-diet-and-the-challenges-of-21st-century-medicine
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