Got a medical question? Let me stretch my brain.
 

As many of you probably know....I am a physician type. Family medicine more specifically. Military to be even more specific.

Well, I am involved in a constant effort to keep my clinical knowledge up to date, and less rusty. I read/listen to many sources, developing/maintaining my skills to stay at the level of a "competent generalist". In the military its a bit tough though because my patient base is just too healthy until they get blown up, then its mostly meat and bone carpentry and then shuttle quickly to the surgeon.

So, I help my friends (thats all of you) alot (probably more than most other physicians). A) it helps my skills, B) it hopefully helps out my friends, C) because of my situation (doc starving for the challenge in the face of healthy patients) it helps me feel better about myself. D) I am an attention whore.

Thus, I thought it might be good to open up a thread where you, my BOTLs/SOTLs, can throw out some concerns and I can see what I can do.

Disclaimers:
1) I can't promise you specialist knowledge. Depending on the question I may throw down what I already know and leave it at that. Or, maybe I will research it to a level I am happy with and then throw down what I have learned. Or, maybe I won't have much to put down about it and that is what you will have to settling with.

2) Anything I throw down here is to be taken for what it is....someone you don't really know (for all many of you know I am a 12 year old pretending to be a doc), fielding questions I may not be qualified to answer. NEVER take what you read here as gospel. If its serious, if its important, you should still see your doctor.

3) I am not always available. I get shipped around alot, spend long times without internet access. I am also orchestrating a big career change in the next 7-8 months (releasing from military, developing a civi practice, renovating a house, parenting children, being a good spouse, selling/buying a house, moving, prepping for the new practice). If I am not responding, maybe I never will.

4) This thread is an experiment. If life gets out of hand or things get too crazy in this thread I may abandon it. I will probably make that known though before it happens.

5) Once again...this thread should not count as your only medical consultation. I cannot refer you to specialists, I cannot determine the "all important" aspects of the situtation without actually being present with you. You probably don't realize how much of medicine is about the intuitive aspects of this situation. Body language, physical traits, they way things get said in a face-to-face encounter have HUGE importance in the evaluation of the situation. I could easily miss major important elements simply by not being in the same room with you, watching you as you describe your issue. Certainly physical exam is impossible, as would diagnostic testing. Finally, I can't start treatments, or even guarantee I will discribe the treatments best suited; once again, intuitive reasoning goes a long way here.

6) This is an advice column. Most advice columns are full of BS. Don't expect more. While I try to stay current and "evidence based", medicine is too big for everything to be based on well-worked out science. As a generalist I try to keep up, but its all too much, so my evidence based knowledge is going to be pathetic in orthopedics compared to an orthopedic surgeon. Its always possible that I may spout out "establish wisdom" in a sub-field of medicine that has already been proven wrong 10 years ago.

Scared you away yet?

And, with that, shoot out your questions and I will see what I can do. Ultimately this is probably going to take the form of a banter thread (in certain ways).

Cheers

Cy

PS: three out or every two people don't know how to handle statistics. Even worse, five out of four people misquote their statistics. I am no different. But, I take stats with a grain of salt. Telling you that condoms are 97-99% effective means that I don't really have the number memorized and that I don't really see the need to more accurate than that anyway....it means condoms are good (unless you are trying to stop herpes, which case they are only 30% effective)

Re: Got a medical question? Let me stretch my bra
 

Why does it hurt when I press *here*?


Sorry, had to do it.

Re: Got a medical question? Let me stretch my bra
 

I think it might be the pointy tips of the asterisks. That's probably why it hurts. :)

Re: Got a medical question? Let me stretch my bra
 

Well, we know you;re not a 12 yo. If you were, you'd tYpE lIkE tHiS and talk about boobies and comic books...:r

Re: Got a medical question? Let me stretch my bra
 

If that's a qualifier I think a lot of us are in trouble. :)

Re: Got a medical question? Let me stretch my bra
 

I'll give ya a whirl Cyanide.

My right knee has no ACL or medial meniscus. I don't have any trouble with the stability of my knee. It has never "popped" again, and it doesn't limit my ability to be active when I want to. I can play squash, hike, climb, etc. I didn't get ACL replacement as I felt it unnecessary.

However, I have noticed over the last year or so that it takes greater effort to get up from a crouching position and my knee aches a little more than usual. It's not a big deal, but I'm not getting any younger.

Would the ACL replacement surgery help with this?

Re: Got a medical question? Let me stretch my bra
 

Thanks for offering to help us out!

Re: Got a medical question? Let me stretch my bra
 

Thanks for the offer. Maybe a little off the traditional medicine question, but a general practitioner is going to get a number of questions pertaining to non-traditional medicine. So here goes:

Can you tell me whether or not you think turmeric/curcumin is an effective anti-inflammatory spice.

Re: Got a medical question? Let me stretch my bra
 

hey I like boobies and comic books. :D

Re: Got a medical question? Let me stretch my bra
 

This is a long shot, but any ideas will be greatly appreciated.

Every once in a while my wife has crippling lower back spasms that are triggered by simple things like bending over or getting out of a chair. They aren't frequent, but when they happen she has pain to the point where she can barely move. It usually takes a full day of rest and heat on her back before she can get out of bed. And ibuprofen. Lots of it. She has taken muscle relaxants for this but they don't seem to work any better than Advil. X-rays show she has narrowing discs, but her doc isn't sure that is the problem. She tried chiropractic for several months but it hasn't been effective in the long term.

That's the background. My question is this: she had a spasm yesterday (just getting off the couch) and afterward she had numbness and tingling in her legs and in her arms from the elbow to the fingers. This was new and it went away after a few hours, so we're not too worried about it, but I'm wondering if it gives us any new ideas as far as diagnosing the cause of her back spasms. Maybe it was just a reaction to the pain?

Thanks for any suggestions, Doc! Great idea for a thread! :tu

Re: Got a medical question? Let me stretch my bra
 

I sprained my ankle pretty bad in PT almost a month ago and it is still a little bit swollen. It doesn't really hurt that much any more but the fact its still swollen has me wondering if it is just because I am constantly on it doing vigorous activities and don't have a chance to rest it, or could it be something more serious?

Re: Got a medical question? Let me stretch my bra
 

You are not alone.:r

Re: Got a medical question? Let me stretch my bra
 

how do you cure scalp feliculitis, noting that a 10% panoxyl soap bar has gotten you no where?

Re: Got a medical question? Let me stretch my bra
 

I'll let the Dr. give you an official answer, but it could definitely be a sprain and still hurt for months. Some sprains even need surgery, but it doesn't sound like yours is as bad as some I've heard about if you can still run on it or even walk without turning your ankle. Swelling can take months to completely go down as well.

Re: Got a medical question? Let me stretch my bra
 

Ian.....it's called Old Age!:r

Re: Got a medical question? Let me stretch my bra
 

Yeah, I know. But I'm not even 40 yet.:bh

I want to still be able to walk a bit when I hit 50.

Re: Got a medical question? Let me stretch my bra
 

I have a similar problem with my left knee. When I'm good about taking my glucosamine, condroitin, msm (all in one tablet), I have almost no problems. Without it, I can tell when there is a low pressure zone within 200 miles.

Might be worth a try.

Re: Got a medical question? Let me stretch my bra
 

Why does Tom's butt itch? :)

Re: Got a medical question? Let me stretch my bra
 

Re: Got a medical question? Let me stretch my bra
 

Wow, this is going to be fun. I am going to tackle this one first, then once I am done baseboards in the bathroom I might tackle some of the orthopedic questions.

OK, checking through pubmed rather quickly I noticed a review of all available data regarding this directly. Curcumin, which is believed to be the "active component" of Turmeric does seem to have some ability to alter gene expression in animal chondroblasts (cartilage progenerator cells) and is seemingly believed to have some anti-inflammatory effect. Some caveats though would be that, as a supplement, having to go up against the GI system and then the liver before it gets into the blood, its unlikely to show any objective anti-inflammatory benefit systemically. The review article does note that further, properly designed studies need to be conducted before it should be advocated for treatment of inflammatory conditions (this usually means that the available data consists of small crappy studies [SCS] that are not statistically powerful enough to prove anything; to see into the truth, bigger studies with rigid controls are needed). As an aside, osteoarthritis is no longer believed to be a true inflammatory condition and so, this is probably why we aren't seeing much benefit from anti-inflammatories in general (it seems to be more of an analgesic effect we are getting from the drugs).

So, bottom line....in cell cultures it might be beneficial, but the delivery method is probably going to get in the way of experiencing any "real" benefit to the person. That being said, if you believe it helps, and it isn't itself causing you any harm....then its reasonable to give it a shot. Just don't take too much of it, as any ill effects in the face of unlikely benefit is a net decrease in quality of life.

Cheers

John

Re: Got a medical question? Let me stretch my bra
 

You're such a douchebag. :D

Re: Got a medical question? Let me stretch my bra
 

Hey Ian;

The knee is kind of funny, in that there are a number of conditions that can look identical in symptomology. And further, they respond equally well to conservative therapies. But, once they start not conforming to said therapies, then you have to get specific in order to approach the surgical options. That's where MRIs come in.

But, it was reasonable to not repair the ACL, and it may be reasonable to now re-examine the issue to see if things should be approached differently now.

All that said, in the military I find many a soldier with your exact story. Heck, my knee is almost identical in story as well. What it probably boils down to in this case is something called Patellofemoral Pain Syndrome, also known as Chondromalacia Patellae. This is where the knee-cap doesn't track through the groove at the end of the femur (upper leg bone), and as a result gets torn up pretty bad. It leads to stiffness and pain after long periods of sitting (this is called the "moviegoers sign"). What is causing this mis-tracking is a mis-alignment of the tibia (lower leg bone) in relation to the knee. This in turn is commonly cause by fallen arches (either obvious; or "dynamic" where you only see the collapsing inwards when you shift from non-weight baring to weight baring). As the foot collapses inwards, the tibia is slightly angled inwards, meeting the femur at the knee at a slight angle. Now the kneecap tries to jump-rail when the leg is straightened.

I commonly see this in knees where some of the other structures are damaged. This decreases your "physiologic reserve" to compensate for the fallen arches (by simply pulling everything into place through brute strength) and the mal-alignments are allowed to unveil themselves.

So, what do you do?

1) Increase that physiologic reserve by a) strengthening all the muscles groups or b) repairing that ACL (but you can't repair the meniscus)

2) grab some good sturdy orthotics (I find generic, off the shelf ones are best because they are relatively cheap which makes it easy to replace when they wear out, roughly at the same rate as a pair of running shoes), and have a look at how old the soles of your shoes are. People find their knees start to hurt more as their shoes age.

When you get back to Edmonton here I will have a look.

Cheers

John

Re: Got a medical question? Let me stretch my bra
 

I will tackle Fumes' next. But in the meantime, do a search on my posts and you will see that I put in some fairly lengthy posts into a back-pain thread about a month or two ago. It would be good background reading. I will re-read it myself and may just post a link to it if I think it covers the info well enough.

But for now....

Back to painting (baseboards are done)

Re: Got a medical question? Let me stretch my bra
 

Thanks for the info John. :tu

I appreciate the help.

Re: Got a medical question? Let me stretch my bra
 

What studies are showing us is that we really don't have a strong grip on the cause of many cases of chronic (or in this case, recurrent) back pain. Reasonable clinicians are starting to dismiss the discs as the cause of all back-pain (and really limitting it to the rare occassions where the discs are actually pressing on nerves).

But, that doesn't leave us with many convincing stories to tell. And, it leaves it up to us to create a compelling fiction to fill the gaps. I just so happen to have one of those "compelling fictions", good enough that I have even convinced myself that it may have validity.

Many back injuries will result in some muscle damage, either from the actual trauma or from the huge muscle contraction you exherted to try to avoid the trauma, pulling the muscle. When the muscle heals, well it heals with scar tissue instead of regenerated muscle fibres (muscle-building is a different process)

Scar tissue has a number of characteristics:

1) its never stronger than 70% the tissue architecture it replaced
2) It has no contractive function, its not a muscle
3) It shrinks over time. Look at any scar on your skin, if its large enough it will have a puckered edge, it shrank (you could easily find exceptions to this)
4) It is heavily innervated with pain nerve fibres.

So, what this leads to is a case where, the moment a scarred muscle starts to fatigue too much through heavy strain (twisting while carrying something) or through prolonged use (like sleeping in a bad position), it lengthens under load, surpassing the length of the scar, the weak scar starts to tear, sends off massive numbers of pain signals to the central nervous system. In a reflex loop, signals short circuit back to the muscles to tell them to go into a massive contraction to protect themselves under load and then this loop just keeps cycling on itself.....resulting in muscle spasm.

Finally, imagine all the other nerves that have to traverse from the spine to the periphery. They have to pass around and through all the structures in between point A and point B. Scars love to entangle anything near them as they develop. Its not unreasonable to think that some of these nerves could get caught up in the scar tissue, and thus get tethered down to nearby muscles. As the muscles go into spasm, they wrench on everything attached to them, including the nerves. Nerves don't work well under mechanical tension and thus the numbness would occur. You wouldn't feel the nerve geing stretched. But you would feel odd sensations/pain in the area of the body the nerve served. The brain doesn't know anything about where the nerve travels, only what regions it innervates.

Hope this is helpful..

Cheers

John

Re: Got a medical question? Let me stretch my bra
 

Its not unreasonable for this thing to continue to swell for a while. I could speculate an anatomic cause, but it would be largely a fable involving healing tissue being leaky and repetative strain making it more pronounced. The key though is that it doesn't continue to hurt without (even gradual) improvement. It may get tight and uncomfortable because of the swelling, but if that "OMG something bad just happened" flash of pain, you are probably OK. All that said, I certainly wouldn't train at 100% until things were 100%...I don't know, keep it down to 75-85% effort :)

And stretch it out before/after. That story about scar tissue above, that would apply here as well....so the more limber the ankle is while it is healing (within reason of course) then the more likely the scar tissue won't shrink to a performance-hindering "shortness"

Re: Got a medical question? Let me stretch my bra
 

thanks for the info doc

Re: Got a medical question? Let me stretch my bra
 

What I should add to this would be to wrap the ankle before PT if at all possible. Since you are using the term PT, I assume you have access to a base pharmacy and MIR. Pick up some Coban. Its really great stuff; self-adherent, thin tensor bandages stuff.

The wrap will prevent the swelling.

PRICE works great for most soft tissue injuries. Originally developed for ankles, but pick and choose the rational elements for the injury at hand.

Protection, Painkillers
Rest
Ice
Compress
Elevate

Re: Got a medical question? Let me stretch my bra
 

I haven't seen much scalp folliculitis. It is interesting that it is being treated with a benzyol peroxide solution. If it were a limitted, easy to get to area, I would treat it with something like polysporin or mupirocin (sp?) twice a day for 10 days. If that didn't work or if it were a hard to get to area (like a hair covered scalp) then I would go more for a system (pill) antibiotic like cloxicillin or erythromycin. All that said, I would certainly take a second look at it before concluding its a bacterial infection of the follicles on the scalp. I would be looking for another diagnosis (like pustular seborrheic keratosis) or an underlying cause and treat that.

If it were hard enough to treat I would certainly go ahead and swab it and await lab results to determine if it were anything more problematic than a typical skin-borne bacteria causing it.

Re: Got a medical question? Let me stretch my bra
 

I believe it is because Tom's butt was always meant to itch. Without an itch, one could not define Tom's butt. It's like saying "Why is the sun hot?"

Re: Got a medical question? Let me stretch my bra
 

First of all thanks, a couple months ago I was helping a friend move furniture when I felt what I can only describe as a warming sensation and pain in my shoulder. I immediately lost strength in my shoulder. In fact I wasn't able to put my truck in gear to drive home. My shoulder only hurts when I move it a certain way. And at night in bed it's not a pain like in the muscle, but more of an ache. I can massage it and fell no sore spots, but move it a certain way and PAIN.

Re: Got a medical question? Let me stretch my bra
 

Move it which way? How about holding arm straight down at side with palm facing forward. As you rotate the shoulder up to the side (like a properly on a plane, spinning), and then over the top until you touch the opposite shoulder with your thumb (with elbow over head. Does that hurt? Maybe reaching behind your back to scratch your back with your knuckles. Does that hurt? How about holding elbows tight to side and then rotating forearms outwards. Does that hurt?

I am presuming right off the bat that you may be dealing with a rotator cuff injury. However the differential diagnosis (its the concept of "a list that contains every diagnosis that a particular condition could be"...things only get struck off the list when they can no longer possibly explain the situation) would also include a biceps tendon rupture (but I think you would describe the situation differently).

And by the way....Tom might have worms. That might explain the itch.

Re: Got a medical question? Let me stretch my bra
 

I'll give this a shot. It feels like I have a NASCAR restrictor plate in my adam's apple area. Sometimes it gets constricted and restricts my breathing. Whether it's going up the stairs, running a few miles, riding the bike it feels like I could be fine if I could only get enough air into my lungs past this constriction. BTW, thanks to sleep apnea I have no uvula, tonsils and my sinuses have been reamed out. I also have incredibly active sinuses. Any guesses?

Re: Got a medical question? Let me stretch my bra
 

Ok, I'll play.

When I first moved to Chico they had these weird things called "seasons," yea we don't have those in SoCal. So naturaly the trees lose their leaves and polonate rather more dramaticly than down south. Sortly after the move I had the worst sore thoat of my life, so bad that it would wake me up at night, it lasted for a couple weeks with verying degrees of intensity. During that time I also suffered from swollen tonsils, pink eye (first time in my life) and plugged ears. My insurence didn't work up here so I went to the schools med place and she said it was allergies intensified by a nasty cold that had been going around of some sort and just gave me a script for sudifed. Well it helped but I was still displeased and drinking three cups of hot lemon tea and honey a day was rather old at this point so i went to the health clinic. There the doc said that I had a sinus infection at was looking pretty brutal and that he felt that was the cause off all of this, saying as it would max out one area it would move to another. He gave me Leviquin. It helped, but I still wasn't top notch for a week or so after the pills were gone.

Anyway regardless to this day I have wat look like little bumps on the soft tissue above my dangley ball thing in my throat. My family doctor has looked at this and asked promptly if I drink a lot of hot liquids, "why yes, about a whole pot of coffee daily." Do you drink alcohol, "well its safe to say there wont be any breweries closing while I'm around." Do you smoke, "5 cigars a week." then he says that its just an irritant because of all of these things. Now I may just not have paid that much attention to the inner dynamics of my mouth before this ordeal, but I feel fairly confident the little bumps came with that. They don't bug, no irritation, just there hanging out, rather small, about like a pin poke size.

What do you think doc?

Re: Got a medical question? Let me stretch my bra
 

Stop hanging around Darrell :r


;s

Re: Got a medical question? Let me stretch my bra
 

:(

Re: Got a medical question? Let me stretch my bra
 

My grandfather died from a pulmonary embolism. He actually had what they said was a saddle pulmonary embolism and several clots in his left leg. One of the left leg clots actually ripped the artery as it traveled and there was nothing that could be done.
Last spring my mother survived a saddle pulmonary embolism and four clots in her left leg.
A couple of months ago one of my brothers (8 years my junior) wasn't feeling good and drove himself to the hospital. He collapsed in the hospital parking lot. He also had several clots in his left leg and a saddle pulmonary embolism.

So - can this be something hereditary. I'm nervous for my other younger brother and sister. Is there something they should be doing? Check ups or screening of any kind?

Having three family members with the same thing kinda puts you on edge.

Thanks,

Ron

Re: Got a medical question? Let me stretch my bra
 

I will answer this one next, then later see if I can handle a couple of the others.

MOST CERTAINLY, there are about a dozen genetic/heritable conditions that could lead to this sort of story. With so many people having similar stories in your family I would definitely get them all lined up to do the testing.

Depending on what the genetic distribution of the specific condition is, you may be looking at 50% of your siblings having it. If you do not have it, then your children would not be able to have it. But, different conditions distribute in different ways....thus everyone should still get tested.

Re: Got a medical question? Let me stretch my bra
 

I haven't a foggiest regarding what that is. We don't have any real NASCAR in Canada so I don't even recognize the reference.

That being said, it sounds like you have something obstructing the area. Well, that wasn't all that helpful right? This could either be because of anatomical masses (but seeing you have had an ENT-ream-out-job, then I doubt that), or it could be due to secretions (sinus related). Another potential might be due to a cyst of some sort, maybe a thyroid cyst (or enlarged thyroid), or possibly a pharyngeal branchial cyst (remnant of a gill slit...believe it or not).

A simple physical exam (maybe with some simple blood work) might give you some answers.

Re: Got a medical question? Let me stretch my bra
 

Interesting as I am turmeric crazy in my cooking. I put it in just about everything. I know it is common to mix tumeric in milk when giving to children (in India).

Re: Got a medical question? Let me stretch my bra
 

When you say "on the soft itssue above my [uvula]", I presume you mean the soft-palate (soft part of the roof of the mouth, posterior to the hard-palate).

Well, you had me on this one, so I did a little research. At this time I will plug a little more info for the layperson (I intend on slipping this stuff in all over the place). A particularly good website for researching information for yourselves is the patient section of uptodate . com. The doctor end of this website is becoming the world leader in condensed medical information. Its my first source (then I go through many other sources as needed). Both ends are written by world experts on the topics they write.

In this case, the research didn't change what my approach would be regarding this one (it confirmed that some fears were warranted, and that no easy "better diagnosis" was immediately obvious to the specialists).

This is a case where having eyes-on is very important. Its what determines is on the differential diagnosis and what is not. But, let me tell you, when a medical student comes to me with this sentence:

"My patient is a daily cigar smoker who occassionally drinks alcohol and has noticed persistent non-painful papules to his soft-palate over [insert timeframe here...months? years?]" then the first thing that should come to my mind is cancer. In fact it is what we call a an UPO diagnosis (until proven otherwise). Now, don't freak out to much. Its probably not cancer. But, I would want to be 100% comfortable with being able to say "its not cancer" before I would be so bold. Maybe in your case having a brief look at it would make a physician comfortable that, indeed, it is not. Otherwise, a biopsy would be in order.

Keep in mind, that the majority of mouth mucosal cancers start out as "pre-cancer" lesions and stay like that for a very LONG time. Only if ignored long enough, combined with a large amount of bad-luck do they transform into cancer. A biopsy would tell you if it were pre-cancer or not, and give plenty of time to cut it all out and aim for cure.

Finally, many of these mouth/throat cancers are conditions of chronic exposure over LONG periods of time. I assume you may be fairly young (sounded like you were talking about university life, so likely you are fairly young). If that is the case, then the invincibility of youth is on your side (in that you probably haven't been exposed to daily cigar smoke for 20 years), providing you take the steps to rule it out.

Re: Got a medical question? Let me stretch my bra
 

Thanks for the tip. I'm 23 I've only been smoking for barely two years and didn't drink till I was 21. That was my fear when I went to the doc but he assured me not to worry just figured I'd see what you thought on the whole thing.

Re: Got a medical question? Let me stretch my bra
 

There are 5 crucial questions to ask when you are playing with thoughts of oral cancers:

Bleeds? (mouth, nasal)
Skin changes? (in the mouth, around the mouth)
Throat/ear pain?
Obstructions?
Voice changes?
Enlarged lymph nodes?

Well that's six, but really two of them fit together in my mind. And of course, answering yes to these doesn't mean cancer (a sinus infection could have you answering yes to 5 of them), but it does sharpen your focus.

Re: Got a medical question? Let me stretch my bra
 

Thank you John for providing information.

Re: Got a medical question? Let me stretch my bra
 

Yes thank you!

Something I neglected to mention is that they are almost unnoticable anymore and the thing my doc said he would attribute them to most likely is my horendous allergies. But I must tell you, everything you have said are the samethings my doc and I talked about. Just wanted to see what another doctor had to say. :) hope I gave your noddle the jog you were looking for, and I will deffinatly keep an eye on it :tu

Re: Got a medical question? Let me stretch my bra
 

Glad you caught it the way I pitched it. I was feeling a little anxious cutting you the straight deal over an online forum like this. The C word is not one I like to throw out there and leave festering on its own.

Re: Got a medical question? Let me stretch my bra
 

Nope, no worries. It'd be different had I not already had it checked out.

Re: Got a medical question? Let me stretch my bra
 

Hmm...very interesting. Mrs. Fumes is a grad student and has been spending an inordinate amount of time sitting on a very worn out couch with her laptop and several large stacks of papers. I suggested that she get up and stretch occasionally, but oh no, there's too much work to do and no time. I would expect that sitting in an ergonomically inappropriate position for extended periods of time might be a trigger for back spasms.

This was quite enlightening! Thanks for taking the time, John.

Re: Got a medical question? Let me stretch my bra
 

I read and hear alot about the hunter gatherer diet, and how with the agricultural revolution we started consuming high amounts of grains and carbs that threw off our bodies.

What is your opinion on this?

Re: Got a medical question? Let me stretch my bra
 

Well, I had never formally heard of "the hunter-gatherer diet" AKA "paleolithic diet" until you mentioned it here.

And, I can't say that 15 minutes later I am an expert on the topic.

But, it seems to push a high meat content, followed by wild grains, foraged plant materials etc. The big push regarding this diet is the proposed lack of signs/symptoms of cardiovascular disease, with some bandwagoning in "diabetes, ... cancer, auto-immune diseases, obesity".

From what I see so far there isn't any smoking gun. Unfortunately, some of the websites I have perused do seem to take on a fervor that makes me concerned for what lays beyond.

The claims regarding ridding yourself of these disease really does not have much foundation on which to stand. I would doubt that the studies could really control for enough variables to determine what the causation was. Hunter-gathering leads traditionally to expending lots of energy to obtain the food and probably not gathering an abundance of food. Its the agriculture evolution that probably was one of the first steps to allowing humans to start advancing in population and technology, as food became easy. I think the evidence is really pooling in that a calorie restricted diet may be one of the most effective ways to live as long as possible, at least in animal models. But that leads to emaciation, lethargy and generally a "not fun" life. Your metabolism probably slows down so much that you live longer, wishing you were having fun. Animals don't mind much as they are really just worried about surviving one second to the next. So, lack of food availability probably takes care of obesity, diabetes and by extension cardiovascular disease. I was not able to find any relavent sources, but I do imagine the life expectancy was pretty low in hunter-gatherer eras. Trauma, starvation, infection probably killed most humans then. Only once food was easy to get did we live long enough to die from cancers. Auto-immune diseases? I think that is a red herring. While they are interesting and shocking, they are relatively rare. Including them would only be for the shock value and probably a complete fiction.

I don't think that grains and carbs are the route of dietary evil. I do think that they are cheap and easy to produce and thus are highly utilized in food products. Combine that with overeating and you are almost guaranteed to be eating too many carbs. But that will probably be true for fats as well, not so much protein. For some reason protein doesn't factor high into a poor (which commonly coincides with cheap) diet.

I like to stay active, otherwise I would seriously consider the calorie-restriction thing (isn't the Bernstein diet like this?). But, then, a week in, I would probably hunt down a kid in my neighbourhood and eat them. So, reasonable diet is for me.

If one wanted to be a full thinker in designing a diet, they would first start with what their calorie requirement is. I think mine is about 2400 a day just to live (I am a big guy) then add my exercise expenditures (probably 1200-1500 a day, 10km+ a day). If I wanted to loose weight I would come in under that sum. Otherwise, aim for that sum.

Then decide what the required protein is. I believe the researched requirement per day is approx 0.76 gram/kg body weight for grams of protein a day. Alot of people round that up to 1gram/kg. This is the type of numbers when the dieticians calculate out diets for hospital patients with dietary components to their treatments. It is based on various rigorous studies that I trust (but don't have references to anymore). Then subtract out the calories from that protein (4 cal/gram protein approx). Then calculate the fat. I think its 30% calories from fat, no more than 30% of your fat being saturateds. Fat is 9cal/gram. Then the rest can be carbs. Include at least 30gram fibre into your carbs every day.

Include an exercise program that involves 40 minutes cardio/aerobic (pace that leaves you breathless if you try to converse while doing it) 3 times a week. With that, you are probably sitting on about as healthy a diet as need be.

All the micro-nutrients (vitamins/minerals) will probably be easily satisfied with any balanced food sources you choose (BALANCED, no excluding groups) and you won't have to worry about deficiencies (despite the absolute non-truths spread onto the public) except maybe vitamin D if you don't get enough sun, folate for fertile females, iron for females with heavy cycles.

No nutritional therapies will "boost the immunity" (unless you are actually correcting a true vitamin deficiency). You cannot boost the immunity. The only thing that "boosts the immunity" is inflammation and infection....and that's more a case of stimulating the immune system you already had. You may develop immunity from a particular pathogen that attacked you, but you will not have a "stronger/more potent" immune system. The only diseases that can realistically be treated with dietary therapies are those that involve dietary abnormalities (obesity, diabetes, cholesterol). Cancer will laugh at your dietary changes. If anything, better nutrition will strengthen a cancer, by strengthening you maybe, and thus freeing up more resources the cancer can use up. That being said, don't kill a cancer by killing the host.

I have kind of gone all over the place with this post, and in turn, only touched very briefly on many topics. Hopefully I have hit some of the important ones at a useful level of detail.

Cheers

John