Miscellaneous Clinical Precepts II (#1 was just for nurses)

1)                      Our appetite mechanism was not designed to take care of diabetes. The presence of ample glucose in certain cells in the hypothalamus (just above the pituitary gland) results in satiety of the appetite.  In diabetes mellitus, both type I and type II,  blood glucose cannot enter any cells in the absence of sufficient insulin, So the appetite remains strong even with blood glucose levels much higher than would occur normally--as if further elevation of blood glucose would get it into the cells.  Insulin therapy corrects this situation promptly.  In milder type II diabetes attempts at prompt dietary control without insulin injections may almost require protective custody because of the persisting abnormally enormous appetite.  This type of abnormal hunger is probably more severe than any hunger experienced by the rest of humanity.

2)                      Iron absorption from the intestines is suppressed in the absence of anemia, but enhanced in the presence of anemia regardless of the cause of the anemia.  This results in appropriate regulation of absorption of dietary or medicinal iron only in normal people and in people with blood loss anemia.  Iron medication in the case of anemia from all causes other than iron deficiency risks iron storage disease.  Transfusion therapy for anemia other than blood loss is especially risky in this regard.

3)                      Similar to iron excess, vitamin A is also quite toxic.  In the presence of adequate vitamin A stores already present in the body, vitamin A precursors such as β carotene are not converted to the active vitamin. A normal diet from natural sources could result in vitamin A toxicity if all these precursors were converted to the active vitamin after absorption.  Very large amounts of β carotene, enough to cause a yellow complexion, can accumulate without harm. However, truly enormous quantities as supplements might overwhelm this natural protective mechanism. 

4)                      To feel satisfied the stomach responds to distension.  It is only a reservoir to meter food into the small intestines no faster than they can process it.  Almost all digestion takes place there, and when the intestines begin to feel overwhelmed by the tasks it is facing, all appetite ceases.  Remember how much more full we feel about 20 minutes after Thanksgiving dinner.  The intestines are coming to grips with the rich dessert and truly remonstrate.  To cash in on the knowledge of this phenomenon start your meals with some hearty food, then kill time with salad.  Thus your intestines will feel busy and your stomach will be distended as if storing a second helping of the hearty food.  Simultaneous satisfaction will emanate from both organs.  Salad first is for healthy people trying to get their money’s worth at a smorgasbord.

5)                      The following will help to overcome extreme prejudice against gay people: Homosexuality is an example of a genetic paradox.  Homosexuality would seem likely to die out of a population because of reproductive failure.  Yet comparative primatologists have studied chimpanzees and other primates and determined that homosexuality motivates non-dominant males to stick around their natal groups enhancing the survival of their nephews and nieces against the hazards of the jungle including tribal territorial warfare by other troops of chimpanzees—a pre-human biological basis for acceptance of “gays in the military” if you will.  Bonobos, a distinct species formerly called pigmy chimpanzees, have a matriarchal social organization.  They actually have lesbian rituals to diffuse conflict among their leaders.  Sexual activity has been used for social purposes other than reproduction for a very long time.


      John A. Frantz, M.D. 

      October 5, 2004