Using emotionally charged language to personally attack others

They are also important for electrical signaling and cell transfer. Boiled down to its most basic level, the ketogenic diet is very simple�eat fewer than 50 grams of carbohydrates daily, eat 1. 2 to 1. 5 grams of protein per kilogram of body weight, and fill in the rest with fat. If you do that, after a few days your body will start relying on fat oxidation and ketone bodies for fuel. Of course, as with all things nutrition, the nuts and bolts are a little more complicated than that. For optimal health, there are considerations other than macronutrient composition. Because of the late Dr Robert Atkins and his diet revolution that was originally popularized in the early to mid-1970s, the ketogenic diet often comes to mind as the type of short-term diet used for weight-loss purposes. Inpatient medicine, in contrast, with its endless rounds and stream of patients with progressive, chronic conditions cycling in and out of the hospital, struck them as hopelessly ungratifying. Outpatient medicine, with its worried well, would be a waste of time or more of the same. I recall thinking that it was difficult to argue with them. Only years later have I come to appreciate the fallacy. First, surgery doesn�t necessarily fix things. What it does is slice someone open, with the potential to do irreversible harm. Tens of thousands of people have had their backs or their prostates operated on with no gain, or with devastating consequences. Some have benefited greatly. So, the premise that a career in surgery will spare the physician the messy uncertainties of trying to help people whose bodies are still largely a mystery to the medical profession is false. It reflects a desire to cling to an expectation of perfection that characterizes many who want to become doctors and who are able to make it into and through medical school. It's not that we come together in electric recognition and pure understanding, then fall away from that through conflict, difference, and the reassertion of selfish needs. Rather, we come together in a rush of passion, then we achieve love through the ongoing conversation we're able to create, one body to another body, one mind to another mind, one heart to another heart.

The conversation by which we engage each other is love. MARILOU WAS SIXTY-EIGHT and had recently been diagnosed with breast cancer. Her husband, Ned, sixty-seven, had retired from running a local articlestore, which he'd heroically sustained until it was cannibalized by the internet. With his grizzled white beard and work clothes, he looked entirely at home puttering in their junk-festooned bungalow. Marilou had a down-to-earth, no-frills energy, close-cropped gray hair, and a raspy voice. Looking ahead to her treatments, and back at their thirty-five-year marriage, they were feeling renewed love and attraction for each other. When we were younger and had troubles, we'd fly apart, said Marilou. At our lowest point, we both had sex with other people. Although this is not what Dr Atkins intended or advocated for, it is still the net result of his promotion of the ketogenic diet. While a ketogenic diet will almost certainly result in weight loss relatively quickly, it has the potential to be much more than a means to a temporary weight-loss end. I say temporary because if you use the ketogenic diet for weight loss but immediately return to a high-carbohydrate diet, you will most likely gain back any weight you lost as your body again has to deal with the excessive amount of glucose it receives. The benefits of a ketogenic diet extend beyond weight loss. For example, the medical community has used the ketogenic diet to effectively control epilepsy since the 1920s, when the diet was developed as an alternative to fasting. There are several theories regarding how the ketogenic diet is able to prevent epileptic seizures but there is not currently a consensus. Most likely it has to do with the brain�s fuel shift from glucose to fatty acids and ketones. Recently there has been an explosion of interest in the ketogenic diet�s potential uses beyond weight loss and the control of medicinally intractable epilepsy. The ketogenic diet looks to have promising applications for the treatment of a variety of neurological disorders including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Alzheimer�s disease, dementia, Parkinson�s disease, chronic migraines, and even stroke recovery. It makes perfect sense that the ketogenic diet could provide relief for individuals with these conditions because one of the primary effects of ketosis is a shift in neurologic fuel source, as the common thread between many neurological disorders is some form of glucose metabolism malfunction. Second, caring for patients with chronic conditions, or simply the vagaries of old age, isn�t just about ordering lab tests, CT scans, and pills while watching them slowly recede toward death. It�s about helping people cope with and adapt to what�s happening to their bodies as they live their lives.

But to serve patients in that way requires emotional and cognitive capabilities that aren�t discussed in medical school and are rarely modeled by faculty. With that piece missing, the perception of those heading into surgery that medicine is a Sisyphean task isn�t far off the mark. Internal medicine and primary care really are demoralizing if you think of patients as walking checklists of tasks to complete each time you see them. What I�ve observed is that surgeons run from human engagement but can�t hide from it, whereas medicine doctors are drawn to it but are unprepared for what comes their way. These are generalizations, of course, that apply to many but certainly not to all. Among all types of physicians are those who do in fact openly and fully engage. To those who wonder where they fall, I pose the following question: Do you find interactions with your patients nourishing, and leading over time to a sense of attachment? That�s what engagement feels like. Who knows why? Hurt, anger, revenge. Drinking, of course. But, it turns out, you can't get rid of love by having sex with other people. She laughed. It's still there, as mysterious as ever. We're not a match made in heaven, but at some point, you learn to respect love. You're not always happy, but belonging to each other means more than anything else. When things were rough, what helped us more than anything was our friends, said Ned. We called themthe tribe. What Is the Ketogenic Diet? The ketogenic diet is awesome.

OK, more in depth: The ketogenic diet is a dietary pattern that shifts your metabolism from relying on glucose as its primary fuel source to relying on fat. This shift is likely an evolutionary trick that humans developed to account for periods in which quick energy was not available and we needed to rely on fat storage to prevent starvation. Almost all of the cells in the body can oxidize, or break down, fat and utilize ketone bodies for fuel instead of the typically preferred glucose. The few cells that do require glucose, including red blood cells (RBC) and certain portions of the brain, can have their needs met by the conversion of protein to glucose. Even in very lean individuals, the body has a greater capacity to store fat than carbohydrates. The adaptation to burn fat as fuel would have allowed our ancestors to survive the periods in which food was harder to come by. Typically, your body can store about 2,000 calories of carbohydrate at any given time. Those calories are then converted and stored as about 400 grams of glycogen, which is the stored form of glucose, in skeletal muscle. Those who answer yes are fortunate to have a personally and professionally rewarding career, and their patients�whether they appreciate it or not�are cared for by a healer. While healers appreciate being appreciated, it�s not what makes their work fulfilling, and its absence doesn�t diminish their sense of fulfillment. The problem is that too few physicians find patient interactions nourishing, likely because they have been unable to retain the curiosity and openness to engage that they exhibited in their early lives. As discussed, there are many pressures to become less open and accessible to others, and to prioritize conforming over questioning as we grow up. The consequences for physicians and their patients are mutually adverse. Many physicians slog on, unfulfilled in their work, in the same manner that many people accommodate unfulfilling marriages. The connections are not there. Patients may or may not know what they�re missing. They often expect surprisingly little from their doctors other than technical competence and amicability. But, unfortunately, this often means settling for less than they need. ' They could see good in both of us, even when we couldn't. They helped us not let our grudges swamp the good.

With my first wife, there was always a crisis. I tried to take care of them all. I wore myself out. It killed me to think of leaving, but it was killing me to stay. I found a therapist and she saved my life. I started to learn what a healthy relationship felt like. When I met Marilou, she had her crises. But she didn't act like they were all my fault. Muscle glycogen cannot be used by other parts of the body; 100 grams of glycogen stored in the liver can be distributed throughout the body; and 25 grams of glucose circulate in the bloodstream. By contrast, energy stored as fat can easily exceed 10,000 calories, even in lean individuals, and would obviously be of much greater use in those with excess body fat. Simple arithmetic shows us why a body utilizing fat for its fuel source would be able to keep going much longer than one relying on glucose and glycogen stores. It is for this long-term fuel adaptation that more and more endurance athletes, like ultra-marathon runners and long-distance cyclists, are turning to the ketogenic diet to give them a competitive edge over those that rely on carbohydrate metabolism and must refuel several times during a race. What Does the Ketogenic Diet Do to the Body? The ketogenic diet has many physiological effects of great importance. The most obvious effect of the ketogenic diet is in its name�it initiates the production of ketones. Ketones, or ketone bodies, are molecules that are produced during the breakdown of fat that can be used for energy. There is relatively little in medicine that is so cut and dried that a lack of engagement isn�t consequential. It is a paradox that we are prone to pass on to the next generation the destructive behaviors of those who hurt us.