First Do No Harm: Ketogenic Diet :Non Alcoholic Fatty Liver Disease & Epilepsy!

Ketogenic Diet: over 100 years of history and first used in very young children.

Dr. David Unwin was worried about the abnormal liver function of a lady patient he referred her to some specialists in the Hospital and she was seen by a hepatologist and two gastroenterologists (I did wonder why!). 

They all thought that she was drinking too much and the poor lady was very upset because she really really never touch any alcohol all her life and yet she was being told off by the specialists as they all assumed that her abnormal liver function tests were due simply to alcohol! 

Then when she eventually gave up sugar and carbs, the liver function improved dramatically. It was such a relief for her and for Dr. Unwin who reckoned that the specialists had something to learn because all they did was to worry and humiliate her when the treatment could be so simple. A high percent of adults in Britain and other western countries suffered from such Non  Alcoholic Fatty Liver Syndrome.

Link: https://www.youtube.com/watch?v=TEYtRiPKBVA&t=10s

Many are worried about Ketogenic Diet and yet it has over a hundred years of history for the treatment of Epilepsy in very young children that did not respond to a multitude of established medications. Dr. Unwin's experience with T2 Diabetes and now NAFLD is simply carrying on the first principle of medicine: Do No Harm.

Dr. David Urwin:

Dr. David Unwin is GP based in Southport in the United Kingdom. After 25 years of attempting to treat diabetes by conventional methods, Dr. Unwin was introduced to low carb nutrition through one of his patients and the website www.diabetes.co.uk

From this revelation, Dr. Unwin now ignores official advice (NHS:

• eat a healthy diet – try to have a balanced diet high in fruits, vegetables, protein and carbohydrates, but low in fat, sugar and salt; eating smaller portions of food can help....Link: Non-alcoholic fatty liver disease (NAFLD) - NHS ) and treats his patients with a low-carbohydrate diet. Since adopting the approach, his practice now spends £50,000 less each year on drugs for diabetes than is average for his area.

Dr. Unwin is the RCGP National Champion for Collaborative Care and Support Planning in Obesity & Diabetes, as well as a Clinical Expert in diabetes. In 2015 he won the North West NHS ‘Innovator of the Year Award’ and in 2016 he won the National NHS 'Innovator of the Year Award' for his work in treating diabetes with a low carbohydrate approach.

More from Dr. Unwin:

“It’s not just about diabetes; belly fat matters.”

Up to 20% of the developed world now has a condition described as Fatty Liver Disease. This is split into alcoholic and Non-alcoholic Steatotic Hepatitis (NASH). The latter is in large part obesity related. In this way I worry that excess sugar and starchy carbs are leading to the three great modern epidemics; diabetes, obesity, and fatty liver disease. In 2008 The World Health Organization concluded there was convincing evidence that central obesity (defined as waist greater than 80 cms in women or 94 cms in men) was associated with significantly increased risk of cardiovascular disease, hypertension, colorectal and breast cancer and overall mortality.

The good news is that I have often seen a low carb approach help not just Type 2 Diabetes but also liver function, blood pressure, lipid profiles (particularly triglyceride and HDL cholesterol levels), and central obesity.

Link: https://www.lowcarbtogether.com/science/who-benefits-from-a-low-carb-lifestyle/

History: https://www.lchf-rd.com/2021/02/18/a-ketogenic-diet-was-used-first-in-diabetes-then-epilepsy/

On July 27, 1921, the Mayo Clinic’s Russell Wilder, M.D., first uses the term “ketogenic diet” to describe and propose a nutritional treatment for epilepsy that tricks the body into believing it is fasting. With 70%–90% of calories from fat and very limited amounts of carbohydrates and protein, the body becomes deprived of glucose and begins breaking down fat cells for energy. Wilder believes the diet could be just as effective as fasting in treating epilepsy. His colleagues at the Mayo Clinic test the theory on both children and adults with epilepsy and find it works. The keto diet is widely used after that by other institutions, including Johns Hopkins.

Charlie and his family seek care at Johns Hopkins

Charlie Abrahams, a 20-month-old patient with epilepsy and the son of noted film writer/producer/director Jim Abrahams (Airplane!, Top Secret! and The Naked Gun series), is admitted to Johns Hopkins Children’s Center after many epilepsy treatments and surgeries tried on him had failed. Within days of going on ketogenic diet therapy, his seizures completely stop. The Charlie Foundation for Ketogenic Therapies is founded by his parents to raise public and clinician awareness, promote scientific studies and provide research funding for the treatment. 

First Do No Harm is a 1997 American made-for-television drama film directed by Jim Abrahams about a boy whose severe epilepsy, unresponsive to medications with terrible side effects, is controlled by the ketogenic diet. Aspects of the story mirror Abrahams' own experience with his son Charlie.

Cockroach Catcher-Seven Minute Cure

Link: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/keto-diet-timeline.html

From Nanjing to Hiroshima

 Nanjing

88 years ago, the people of Nanking, China's ancient capital city, were in the midst of one of the worst atrocities in history, the infamous Rape of Nanking. The truth of what actually happened is at the center of a bitter dispute between China and Japan that continues to play out in present-day relations. Many Chinese see Japan's election last month of ultraconservative nationalist Shinzo Abe as prime minister as just the latest in a string of insults. And it was recently reported that Japan is considering rolling back its 1993 apology regarding "comfort women," the thousands of women the Japanese army sexually enslaved during World War II.

In 1937, the Japanese Imperial Army, captured Nanking on Dec. 13. No one knows the exact toll the Japanese soldiers exacted on its citizens, but a postwar Allied investigation put the numbers at more than 200,000 killed and at least 20,000 women and girls raped in the six weeks after the city fell.

It was the mass rapes in Nanking and the brutalization of an entire populace that eventually convinced Japanese military leaders that they needed to contain the chaos. Japanese soldiers began rounding up women and forcing them to serve as sex slaves in so-called comfort stations.

This is what most historians believe. But not in Japan, where a large faction of conservatives, led by Abe, denies that the Japanese military forced women into sexual slavery. They maintain that any suggestion to the contrary is simply anti-Japanese propaganda and probably spread by China. At the furthest end of the spectrum, the minimizing turns to flat-out denial; one professor we interviewed at a top Japanese university adamantly insisted there were no killings or rapes in Nanking.

Not surprisingly, all this minimizing and denial enrages the Chinese and others in Asia. But this is a familiar pattern.

Nanking Poster: THINKFilm

On July 2, 1996, the anniversary of Ernest Hemingway’s own suicide, Margaux Louise Hemingway, his grand daughter was found dead in her studio apartment in Santa Monica, California at age 41.

On November 9, 2004, Iris Chang (張純如), who was propelled into the limelight by her 1997 best-selling account of the Nanking Massacre “The Rape of Nanking: The Forgotten Holocaust of World War II”, committed suicide. Earlier she had a nervous breakdown and was said to be at the risk of developing Bipolar illness. She was on the mood stabilizer divalproex and Risperidone, an antipsychotic drug commonly used to control mania. There was a detailed report in San Francisco Chronicle.

Now back to the Japanese atrocities in the Nanking Massacre in 1937, one of history’s worst but relegated to obscurity. The impact of Iris’ book and her tragic death was such on Ted Leonsis, Vice Chairman of AOL, that he went on to produce a film on the subject. The film, Nanking, premiered in Sundance Festival last year, was shortlisted in the documentary feature category of the Academy Awards, and won the Humanitarian award for documentary in the Hong Kong International Film Festival.

Mariel Hemingway, younger sister of Margaux, read the words of Minnie Vautrin in the film. Minnie Vautrin was an American missionary renowned for saving the lives of many women at the Ginling Girls College in Nanking, China during the Nanjing Massacre. In 1941, Minnie Vautrin committed suicide.

In July, 2007 the film premiered in Beijing. The BBC said:

“It is doubtful, though, it will ever be shown in Japan, where historians claim the massacre has been exaggerated.”

Experts estimate the Japanese killed 150,000 to 200,000 people and raped more than 20,000 women and children, but a group of MPs from Japan's governing party recently said no more than 20,000 were killed.

Doctor Atomic

Batter my heart, three-person'd God ; for you
As yet but knock ; breathe, shine, and seek to mend ;
That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.
I, like an usurp'd town, to another due,
Labour to admit you, but O, to no end.
Reason, your viceroy in me, me should defend,
But is captived, and proves weak or untrue.
Yet dearly I love you, and would be loved fain,
But am betroth'd unto your enemy ;
Divorce me, untie, or break that knot again,
Take me to you, imprison me, for I,
Except you enthrall me, never shall be free,
Nor ever chaste, except you ravish me.
HOLY SONNETS. XIV John Donne (1572-1631)

Doctor Atomic Metropolitan Opera House

At the end of Act 1 of Dr Atomic (premiere at the Metropolitan Opera House, New York this season - composer: John Adams), Oppenheimer, the father of the Atomic bomb, faces his own personal crisis alone in the desert, recalling this sonnet by John Donne.

Gerald Finley as J. Robert Oppenheimer in "Doctor Atomic." Terrence McCarthy

This opera was first performed in San Francisco in 2005. You can read about that here.

The Cockroach Catcher and his wife were at the Met’s performance on the 13th of November 2008, a review of which you can read here.

I am not here to discuss the rights and wrongs of the Atomic bomb and its derivatives. There are now 50,000 such weapons worldwide. What is clear is that it has always been humans who hold the key to mass destruction. In Nanking. the Japanese grew bamboo through living Chinese as a means of destruction. It did not take an Einstein to work that one out nor an Oppenheimer to execute it.

In Dr Atomic, at the high point of the final countdown to the test firing of the bomb, there was a tape recorded voice of a Japanese woman repeatedly asking for a glass of water. 

5:29:45 am Mountain War Time on July 16, 1945 Los Alamos National Laboratory

What would the effect have been if images of Japanese atrocities in Nanking or in Hong Kong were projected on stage at the same time? Or perhaps Pearl Harbour, for an American audience?

After all there have been recent attempts by Japan to change their history textbooks. Guilt must in the end find its proper home.

That I may rise, and stand, o'erthrow me, and bend
Your force, to break, blow, burn, and make me new.

 On a Monday in August 1945, Little Boy was dropped on Hiroshima by the crew of an American B-29 bomber Enola Gay.

AMAZON-UK    The Cockroach Catcher II: Attempted Living

Cockroach Catcher-Seven Minute Cure

Cockroach Catcher: Who is the real patient?

 

       Catherine, aged fourteen, had not attended school for some time and all attempts by the school authority and educational psychologist failed to get her back to school. This was a pity as Catherine was really university material.

       She had eleven older brothers and sisters. Two older sisters were married.  One of them had a little baby of ten months. The other had two children at school. The youngest of the brothers attended a public school (i.e. an English private school) on a scholarship, and with financial assistance from the older siblings.

       After an initial visit by the social worker, the team decided to approach the case in a family therapy sort of way – big family therapy in every sense of the word.

       At that time, family therapy was a relatively new development and had probably grown out of some group therapy principles. One of the first courses was established at the Group Therapy Institute in London when I was still at the Tavistock. Little did I know then that it was history in the making. Of the people I was with then, either teachers or co-trainees, many have become prominent practitioners in the field.

       Even the rather adventurous social worker was feeling a bit dubious.  “Do you belong to the school that insists on everybody in the family attending?”  She asked, hoping I would be a bit eclectic about it.

       “Let’s try and get everybody at least for the first session.”

       “I will do my best,” she promised.

       Good old Miss Kimble. She always got things done.

       As some of the family were working, the session had to be organised for the evening.   There is so much mystique attached to our kind of work that families often oblige without asking too many questions, at least at the early stage.

       One of the older unmarried sisters took it upon herself to organise the meeting. The main one that caused some problem was the oldest brother who was a long distance lorry driver going all over Europe.  The meeting needed to be on one of those nights when he was back from his delivery tour. The brother at the public school had a cricket match and he was apparently one of their best bowlers. One of the other brothers agreed to go to the match and bring him to the meeting as soon as the match was over.  The sister with the baby would have to bring the little one but the older children would look after her at the meeting.

       I told them that they could all join in.

       Luckily with so many children the family had a reasonable sized council house and the family room was fairly long.  They moved the dining chairs through to provide seating for everybody.

       The scene was set. We just had to deliver the goods.

       “We have come this far.  We just have to do it,” I told Miss Kimble.  She probably had more faith in me than I had in myself.

       Father looked after the parks and gardens for the council and had been with them since leaving school. Mother had not worked outside of home since the first child was born. She used to work in the Council Offices and that was where she met her husband.

       All the unmarried children who had left school had jobs except for the one who organised the meeting. She was in fact the eldest sister. All hope was on the boy and Catherine, except now Catherine was not going to school and had not been for nearly a year.  Two of the sisters worked in an insurance company, which was a very important local employer. Three boys worked for the Parks and Gardens department. One girl was a life guard at the local public Sports Complex that just opened and one boy looked after the gymnasium. The parents had done well and you could see that it was a very close knit and caring family.

       Only the truck driver was absent. We chatted and waited. The baby in the meantime was crawling in the middle with the two older children fussing over her. Catherine sat close to mother and now and again would hold her hand. I was not too sure who was comforting whom but then family therapy was about observing the family interactions.

       Cricket boy was busy devouring a plate of food mum left for him as he missed his school dinner.

       Others were exchanging various gossips about boyfriends and girlfriends.

       I thought that this was fun but there was also a lot to take in. The traditional approach would have allowed one to be more focused but it would probably have taken a long time to get to where we wanted to get to quickly.

       When I heard air brakes, I knew that big brother had arrived. Everybody else knew as well. Swiftly Catherine let go of mum’s hand and went to the door.  One of the other sisters had the plate that had been kept warm in the oven set in a tray complete with a big can of beer.  I declined the offer of beer as I was working.

       Big brother was quite a big fellow but was friendly enough as he shook hands with me. After a few bites and some gulps of beer he turned to me and said, “We are all here now. What is this about?”

       To this challenge, I explained in a very simple fashion why I wanted to see the whole family. I went on to use what I had since described to my juniors as a journalistic approach to history taking, as distinct from the traditional topic-by-topic approach. With the journalistic mantra – Who?  What?  When? Where?  Why? How? – the patient or the family would just enter the conversation barely aware that you were taking a history. To keep focused, you do need to have clearly in your own mind the information you are seeking.

       If you are not experienced, you can follow a printed questionnaire and take three hours of history but you will just end up with loads of seemingly unrelated information.

       With my favoured journalistic approach you follow leads.  The whole session becomes more integrated and it is easier for patients and families as you are not likely to appear to be jumping from one thing to another. It also comes across as more professional.

       One thing led to another and my break came when one of the boys let slip that he remembered mother going into hospital after Catherine was born and big sister gave up a good job at the insurance company to stay home to look after the rest of them.

       Mother was in the local mental hospital a

nd had electrical shock treatment.

       Mother started crying and big brother was rather upset and asked me what relevance this had except to upset mum.

       At this point, the little baby who had been crawling around stopped in her track and crawled to Grandma and started touching one of her slippers. She started crying too.

       I have my own theory that even before acquiring language, babies are able to retain emotional memory of early experiences. Later on in life it becomes difficult to grasp the source of the upset as there are no words to describe such emotional experiences. Traumas in early life have diffused effects; those happening later on in life are more focused and perhaps easier to deal with.

       One famous psychiatrist once talked about his own experience of his mother’s depression. He talked about having images of a wooden arm and it was through years of psychoanalysis that he reconstructed the whole image of his very depressed mother who had a rather catatonic posture in the deepest depth of her depression. He could remember himself as a toddler running into the house after play to be met with the wooden arm, sharply quietening down and then backing off. It was a rather moving seminar he gave at one of the conferences and a rare occasion when a British psychiatrist talked about psychoanalysis.

       Back with the big family – all went rather quiet. A couple of the girls were sobbing. Catherine tried to comfort mum who said she knew it was all her fault. The eldest brother thanked me for making things clear for him.

       All were relieved to hear that I would not be forcing Catherine back to school and that mother would not be prosecuted.

       All agreed that Catherine would be wasting her brains if she did not have some form of education and I explained that I would be looking into alternatives.

       Miss Kimble told me later that I was lucky to have that break and that it was a good job the baby was there.

       It was uncanny that in my thirty plus years of experience, over half of the children who had problems attending school in a big way had mothers who had serious puerperal (post-natal) depression.  Was the school refusal a clinical manifestation of genetically transmitted depression, or was it the psychological effect of living with a depressed mother? I really do not know.

       Catherine never managed to return to “proper” school but with a fair bit of individual therapy we managed to get her to attend a tutorial unit. This we achieved by getting mother to find some part time work. Big sister too started working part time.

       It was daunting for me to think that a single family session brought about so much change, but then I was reminded that the strength was with the family – we just tried to tap it.

       Catherine had good exam results on the limited subjects she could sit but was immediately offered a trainee post at the insurance company.

       Years later I bumped into one of the older sisters at the Sports Centre.  She thanked me again for what I did for the family and told me that everybody was fine.

       I told her I was scared by the lot of them especially her big brother. She told me I did all right. Catherine was his favourite sister.

       I cannot remember seeing another big family since and with the disintegration of families it became increasingly difficult to do that type of family work.

The Cockroach Catcher II: Attempted Living

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Cockroach Catcher-Seven Minute Cure

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