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I recently visited the Galapagos (more posts and pictures coming soon).  During that trip I brushed up on some of my Darwin knowledge- in a lecture on board, with some books in the ship’s library, and reading The Voyage of the Beagle on my Kindle. I just got back from a very different trip (visiting family in the UK), but again I managed to brush up on some Darwin, this time by visiting the place where he lived, worked, and died- Down House.

 

Down House, the home of Charles Robert Darwin (1809-1882) for the last 40 years of his life, is in the village of Downe in Kent.  Here Darwin conducted many experiments, and wrote most of his scientific work (On the Origin of Species by Means of Natural Selection (1859) being the most well known).  I am certainly a Darwin enthusiast (some might say a Darwin stalker…), but I expect that even those who have only a mild interest in Darwin, history, evolution, or science would enjoy a tour around this historic site.

 

Down House is located in the village of Downe (the Darwin’s kept the traditional spelling after an “e” was added to the village to distinguish it from the county Down in Ireland), and it has had a number of renovations since it’s initial construction in the early 1700s.  The Darwin’s acquired Down House in 1842, when Darwin and his wife (and first cousin) Emma (nee Wedgewood) wished to escape the hustle and bustle of London with their growing family (at the time they had two children and were expecting a third).  Darwin, in his characteristically frank style wrote, “It is a good, very ugly house, with 18 acres.”, though I think many today would disagree with this assessment!

 

Down House as it is today, with a very excited tourist.

Down House as it is today, with a very excited tourist.

 

Over the course of his 40 years at the house Darwin enlarged it not only for his growing family (he and Emma had ten children, though only 7 survived to adulthood), but also for the comfort of his servants.  Writing to family he said “It seemed so selfish to make the house so luxurious for ourselves and not comfortable for our servants “. One of Darwin’s many interesting (and noteworthy) traits was his humanism.  He was an avid abolitionist (a disagreement with Captain Fitzroy on this subject almost got him kicked off the Beagle), a kind “master” to his house staff, a loving and involved father (an anomaly in Victoria times), and supporter of the humane treatment of animals.

 

Today the name Charles Darwin calls up images of a great scientist, a deep thinker, and a major contributor to human knowledge.  However, this certainly wasn’t the future his family imagined when Charles was a youth.  As a boy he received a classical education at Shrewsbury School.  This was not an education that paired well with young Charles’ interests of beetle collecting (then a national craze), chemistry, and shooting.  His father, a respected physician, is reported to have said “You care for nothing but shooting, dogs, and rat-catching and you will be a disgrace to yourself and all your family.”.

 

After his mediocre performance at Shrewsbury School, Darwin was sent to Edinburgh to follow in his father’s footprints and become a physician.  Alas (or fortunately, for the future of science), Charles could not stomach the brutality of surgery in the era before anesthesia, and he returned home after less than two years.  He was next sent to Cambridge to earn a degree so that he could enter the clergy (entering the clergy was a common career path for men from good families with a penchant for natural history).

 

While Darwin did complete his degree at Cambridge, he never went on to study for the clergy, as he was recommended by a mentor to accompany Captain Robert Fitzroy on the Beagle. Darwin wasn’t the first young naturalist recommended for the job (he actually wasn’t on the boat as the naturalist, though he did later rise to this position, his “job” on the ship was to act as Fitzroy’s companion- a gentleman that a captain could talk to amongst a ship-full of burly sailors).  While his father did not support this decision he did eventually let young Darwin (he was 22 at the time) depart on this adventure at the recommendation of Charles’ uncle Josiah Wedgewood.

 

The expedition aboard the Beagle was meant to last two years, but it stretched into a five-year endeavor.  Darwin’s observations during this travel were instrumental in shaping his thinking and his future.  It is rather fascinating to realize that Darwin’s 5-year, around-the-world journey aboard the Beagle was the only travel he ever undertook.  He returned to England in October of 1836, married in January of 1838, and in September of 1842 took his growing family from the strictures of London to Down House where he would spend the rest of his life.

 

Once at Down House, Darwin preferred to correspond with friends rather than travel back and forth to London.  He was a prolific letter writer- spending the equivalent of thousands of pounds per year on stationary and postage.  While it does seem that Darwin was a bit of an introvert, this insular life was largely a result of ill health.  Once an active and lively young man with a penchant for exploring and shooting, he was plagued with illness after his return from the journey aboard the Beagle.  His symptoms, which were present in varying degrees for the rest of his life, included a number of GI problems, palpitations, and extreme fatigue.  There have been many theories about this illness, ranging from Chagas disease to Chronic Fatigue, including lactose intolerance, Crohn’s disease, and psychosomatic disorders.  Whatever the cause, this illness debilitated Darwin, and at Down House he developed a schedule around his symptoms- working when he could and resting when he must.

 

The Sandwalk at Down House, also sometimes known as the Thinking Path, was where Darwin would walk three times a day (health permitting).  There is a walk down around the property with a loop in the woods, and Darwin would walk laps on the circuit deep in thought.  He would kick rocks from one side to the other to keep track of his laps, as his mind was usually on matters other than his number of "reps".

The Sandwalk at Down House, also sometimes known as the Thinking Path, was where Darwin would walk three times a day (health permitting). There is a walk down around the property with a loop in the woods, and Darwin would walk laps on the circuit deep in thought. He would kick rocks from one side to the other to keep track of his laps, as his mind was usually on matters other than his number of “reps”.

 

Down house wasn’t only Darwin’s home, but also the place where he conducted many experiments – on pigeons, barnacles, orchids, and weeds- work that was instrumental in supporting his theory of natural selection.  Of course Darwin was not the first person to suggest that species were mutable, but he was the first to convincingly propose a cogent mechanistic theory and support it with various lines of evidence.  Both he and Alfred Russel Wallace appreciated the implication of Thomas Malthus’ commentary on populations- that sooner or later populations were checked by famine and disease- and both men independently came to the same theory of natural selection based upon the pressures exerted by nature.  However, it was Darwin who first wrote about the theory (though he did not publish it) and who collected extensive evidence to support the theory.

 

The Hot House at Down House.  A collection of orchids and carnivorous plants are maintained here.  This is where Darwin hypothesized that the orchid Angraecum sesquipeda was pollinated by moth with a long proboscis.  This was discovered to be true, 21 years after Darwin's death.

The Hot House at Down House. A collection of orchids and carnivorous plants are maintained here. This is where Darwin hypothesized that the orchid Angraecum sesquipeda was pollinated by moth with a long proboscis. This was discovered to be true, 21 years after Darwin’s death.

 

The Kitchen Gardens.  Not much going on this time of year, but in summer these beds are full.  This is where Darwin did experiments on pin-eyed and thrum-eyed primroses.

The Kitchen Gardens. Not much going on this time of year, but in summer these beds are full. This is where Darwin did experiments on pin-eyed and thrum-eyed primroses.

 

The remnants of some of Darwin’s experiments can still be seen at Down House.  His hot houses (heated by composting manure!), where he maintained large numbers of orchids and carnivorous plants, are still maintained, as are the large kitchen gardens where he studied primulas.  A reconstruction of “The Worm Stone” that Darwin and his son Horace used to study the action of worms is in the garden, and English Heritage, who maintains the house, continues to dig experimental weed plots similar to those that Darwin constructed to study the succession of plants.

A reconstruction of "The Wormstone".  I was being optimistic when I took this pic, and hoped that I wasn't actually taking a picture of the septic system...

A reconstruction of “The Wormstone”. I was being optimistic when I took this pic, and hoped that I wasn’t actually taking a picture of the septic system…

 

Throughout my visit to Down House I was overcome with a feeling of awe.  I grew up with a deep respect and affection for Darwin- my father is a huge fan, to the point where my brother’s middle name is Darwin.  Being the second born I received an equally nerdy though significantly less well known middle name- Lyell.

 

Charles Lyell was a geologist (I actually wrote about him briefly in my first blog post!) and a well-respected scientist.  He was a mentor for Darwin, though it took him a while to come around to Darwin’s theory of natural selection.  He eventually did, and it was Charles Lyell and Joseph Hooker who presented Darwin’s and Wallace’s papers On the Tendencies of Species to form Varieties and On the Perpetuation of Varieties and Species by Natural Means of Selection to the Linnean Society in 1858. It was a thrill to see Darwin’s portrait of Lyell in his study, as well as various volumes of Lyell’s books in locations throughout the house.

 

Visiting Down House certainly increased my understanding of this great man, and also increased my respect for him.  He was a humble man, a hard-working man, a loving father, and a great mind.  He was also a troubled man- plagued with illness, profoundly concerned by the implications of his theory, and deeply scarred by the loss of children he loved.

This is a picture of Downe Church (not mine) where Darwin would walk every Sunday.  Darwin lost faith in religion after the death of his first daughter, and while he would walk his family to church on Sunday he would not enter the church.  This is where his wife, Emma, is buried (Darwin is buried in Westminster Abbey).

This is a picture of Downe Church (courtesy of wikicommons) where Darwin would walk every Sunday. Darwin lost faith in religion after the death of his first daughter, and while he would walk his family to church on Sunday he did not enter. This is where his wife, Emma, is buried (Darwin is buried in Westminster Abbey).

 

Darwin’s work on natural selection is a classical example of the scientific method.  As a naturalist, especially during his time aboard the Beagle, he made a number of observations.  These observations led him to a hypothesis (natural selection) that he then researched extensively.  He was not purely a “great thinker”, who came up with a theory, but also a patient and meticulous experimentalist who painstakingly showed that species were mutable through pressures of nature.

 

Sometimes in science, medicine, and certainly in the paleosphere we get stuck on an idea or a theory.  We latch on to something that just “makes sense” or fits in nicely with our current way of thinking, and we start to accept it as fact.  Seeing how hard Darwin worked to build evidence to support a theory, which on an intellectual basis was so obvious, reminds me how important it is to not stand on theory alone, but to work diligently towards better understanding through rigorous science.

 

Though sometimes controversial in the US, Darwin is well loved in the UK.  He had a distinguished funeral at Westminster Abbey and is interred near the monument for Sir Isaac Newton.

Though sometimes controversial in the US, Darwin is well loved in the UK (and is featured on the ten pound note). He had a distinguished funeral at Westminster Abbey and is interred near the monument for Sir Isaac Newton.

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I’ve been fortunate to do some pretty amazing travel in the past, but the journey I just returned from has certainly stolen the show. 

 

As an evolution nerd, a Darwin enthusiast, and a lover of the natural world, a trip to the Galapagos was truly an experience I will never forget.  I’ve wanted to visit the Galapagos for a long time*, and while I had thought about visiting in my 6 months off between med school and residency I only booked the trip about a month ago.  My father (also an evolution nerd, Darwin enthusiast, and naturalist) and I travelled with National Geographic and Lindblad Expeditions on a trip to the Galapagos aboard The National Geographic Endeavour (named in honor of the first vessel that Captain Cook used in his explorations – the one that landed on the eastern coast of Australia; Cook never visited the Galapagos).  I’ll just start by saying the company, the experience, the ship, the crew, the staff, the naturalists, the whole package- were all first rate.  It’s a top of the line option for visiting the Galapagos, and it really shows.

 

In many people’s minds, the Galapagos are inexorably linked with Charles Darwin and his theory of Natural Selection.  Darwin visited the Galapagos, on HMS Beagle, in 1835. Darwin was aboard the Beagle for 5 years, but he only spent 5 weeks in the Galapagos of which only 19 days were on land!  Nonetheless, the observations he made there and the samples he collected were important ingredients for his future theory.

 

Tagus Cove- One evening we stopped in Tagus Cove- an area where Darwin landed.  There is graffiti in this cove, as it was traditional (until recently) to leave the name of your boat on the cliffs (some are amazingly high up).  The earliest inscription we saw was from 1836, the year after Darwin visited.

One evening we stopped in Tagus Cove- an area where Darwin landed. There is graffiti in this cove, as it was traditional (until recently) to leave the name of your boat on the cliffs (some are amazingly high up). The earliest inscription we saw was from 1836, the year after Darwin visited.

 

Most of the walks we took on this cruise were rather relaxed, but this evening’s hike was a change of pace, and we made good speed up a steep trail.  Looking back, we could see the Endeavour and a large pond that Darwin wrote about in The Voyage of the Beagle.  Alas, while he was hoping for a refreshing dip in some fresh water, he was frustrated to find that this pond is brackish.

 

A [disappointingly] brackish pond.

A [disappointingly, at least for Darwin] brackish pond.

I recommend the Galapagos chapter of The Voyage of the Beagle (Chapter 17).  It is a delightful and quick read, and if you have an e-reader you can find it for free online.  The Voyage of the Beagle was a travel journal of sorts, and while Darwin was the naturalist aboard The Beagle (well he was eventually, he didn’t start that way but eventually replaced the original Naturalist) he first became famous as a travel writer (his theory of evolution didn’t make him famous until quite late in life, and strangely his book on Barnacles wasn’t a big seller…).

 

Over the years, the Galapagos became a popular stopping point for ships.  While there is very limited fresh water, it was a good place to replenish food.  Early visitors introduced goats (a species that quickly flourished on the islands, wreaking havoc on endemic creatures) and the Galapagonian tortoises were particularly popular as well.

 

There are a number of species that are uniquely Galapagonian- the tortoise being a prime example.  These giant creatures at one time roamed the islands in great numbers, but their populations were decimated by humans in ~150 years.  The tortoise had two great misfortunes- first, they apparently taste pretty good (Darwin wrote of roasted tortoise breast “Gaucho style” being quite tasty, and was complimentary of tortoise soup (from medium sized animals), though he found nothing remarkable in the rest of the animal).  Perhaps the greater misfortune for these giants is that they can survive for ~2 years without food or water.  In a time before refrigeration, when fresh meat was almost an impossibility on long sea voyages, tortoises could be stashed on boats for ages until they were finally consumed.  I admit to being rather bad about anthropomorphizing animals, but I can only imagine that being kept in the hold of a ship for over a year before being killed and eaten was a rather unpleasant end.

 

A Medium Sized Tortoise- Perhaps this is a good soup-sized tortoise?

A Medium Sized Tortoise- Perhaps this is a good soup-sized tortoise?

 

These giants are believed to live over 200 years, though it is hard to be sure since we haven’t been studying them that long.

These giants are believed to live over 200 years, though it is hard to be sure since we haven’t been studying them that long.

 

The tortoises on different islands are considered different sub-species (though where you draw the line at species vs. subspecies or variety was a common quandary during our tour of the Galapagos) and some have gone extinct due to human harvesting, competition (with things such as introduced goats), and decreased hatching (because of damage to nests due to introduced species).  One of the most famous Galapagos Tortoises was “Lonesome George”, the last of his kind- a subspecies of tortoise that inhabited Pinta Island.  While a number of attempts were made to breed George and “save” his kind, none were successful, and he died- the last of his kind- in 2012.

 

Lonesome George had been living at the Charles Darwin Research Station on Santa Cruz Island since his discovery in 1971, and for many years was the center’s most famous denizen.  We visited Santa Cruz, and the Charles Darwin Research Center, during our cruise, and we got to see the conservation efforts there.

 

The National Park manages 97% of the land of the Galapagos (only 3% is habited). The Charles Darwin Research Center does a lot of research, but only the national park can change policy and initiate change in the park.

The National Park manages 97% of the land of the Galapagos (only 3% is habited). The Charles Darwin Research Station does a lot of research, but only the national park can change policy and initiate change in the park.

 

Eggs from different subspecies are hatched and reared in captivity on Santa Cruz (and there are two other tortoise breeding centers elsewhere in the archipelago).  When they are large enough to be released they are tagged and released.  These efforts have generally been very successful and the tortoise population is recovering nicely.  While they claim the number painted on the babies backs are for identification purposes, I secretly hope there is some illicit tortoise racing going on after hours!

Eggs from different subspecies are hatched and reared in captivity on Santa Cruz (there are two other tortoise breeding centers elsewhere in the archipelago). When they are large enough to be released they are tagged and released. These efforts have generally been very successful and the tortoise population is recovering nicely. While they claim the number painted on the babies backs are for identification purposes, I secretly hope there is some illicit tortoise racing going on after hours!

 

After his death, Lonesome George was sent to NYC where he was preserved by experts at the Natural History Museum.  The current celebrity at the Charles Darwin Research Center is a much happier tale.  When conservation efforts were initiated, there were only 14 tortoises of the Española subspecies- 12 females and 2 males.  While conservationists hoped to build the population from these animals, the females were not interested in the males.  In an attempt to save the subspecies, a global search for a male of their kind was initiated- seeking out giant tortoises in zoos and private collections around the world.  Eventually a male was found in the San Diego zoo, and after some negotiating “Diego” made his way back to the Galapagos.  Now, having fathered over 1000 offspring, Diego is known as “Super Diego”, and the subspecies is doing well!

 

The conservation of the Galapagos Tortoises seems to be on the road to success, which is wonderful.  The Charles Darwin Research Station has also had good success breeding and reintroducing some subspecies of Land Iguanas.  In fact, the breeding program at the research center has now been closed because the efforts were so successful.

 

These cuddly guys (land iguanas) have had a hard time on some islands, but with restoration and conservation efforts they are now dong well.

These cuddly guys (land iguanas) have had a hard time on some islands, but with restoration and conservation efforts they are now dong well.

 

There were slim pickings for the Land Iguanas on North Seymour. These guys like to eat prickly pear cactus, but were taking to the trees to find some greenery in this sparse environment.  One of the naturalists we were with said he had never seen Land Iguanas so high in trees before.

There were slim pickings for the Land Iguanas on North Seymour. These guys like to eat prickly pear cactus, but were taking to the trees to find some greenery in this sparse environment. One of the naturalists we were with said he has never seen Land Iguanas so high in trees before.

 

Lusher pastures for this land iguana near Urvina Bay.

Lusher pastures for this land iguana near Urvina Bay.

 

You may not know it, but about 30,000 people live in the Galapagos.  While 97% of the island is National Park (for which you need a permit and a naturalist to visit- no more than 16 tourists per naturalist), there are a number of inhabited areas.  At the end of our cruise we visited Santa Cruz, where the Darwin Center is, and San Cristobal, from where we flew back to the mainland.  In Santa Cruz we took a walk through town, and it was fun to stop at the fish market and see the catch of the day.  Humans weren’t the only interested customers!

 

Pelicans at the self-serve bar

Pelicans at the self-serve bar

 

A bit more anthropomorphizing... I imagined this Sea lion waiting for his number to be called at the deli counter.

A bit more anthropomorphizing… I imagined this Sea lion waiting for his number to be called at the deli counter.

 

The Sea Lion was given a hunk of fish and the fishmonger kept the pelicans back with a fly swatter so he could enjoy it!

The Sea Lion was given a hunk of fish and the fishwife kept the pelicans back with a fly swatter so he could enjoy it!

 

The Galapagos are part of Ecuador, and until fairly recently were not inhabited.  Initially, colonists were “gifted” land, as encouragement to come and live in the Galapagos, but now there are significant efforts to curb immigration.  When we were in Santa Cruz we headed up into the highlands to see tortoise in the wild (they much prefer to be in the highlands with lush vegetation and more water, but the females come out of the highlands to lay eggs- an unfortunate habit, since the smaller females were more desirable fodder for hungry sailors, and were much closer to the ocean than the large males who stayed in the highlands).

The tortoises in the highlands like to relax in ponds such as this one.  They will drink gallons of water when they visit, but can go years without water in hard times.

The tortoises in the highlands like to relax in ponds such as this one. They will drink gallons of water when they visit, but can go years without water in hard times.

 

At first I was confused by the shrubbery this tortoise had acquired, but after seeing them wallowing in the weed-covered pond all became clear.

At first I was confused by the shrubbery this tortoise had acquired, but after seeing them wallowing in the weed-covered pond all became clear.

 

Unfortunately, this method of hiding didn't save tortoise from hungry sailors.  Darwin writes how sailors would flip these hiding beasts over and carry them off to the ships for storage. Darwin also wrote about his attempts to ride these massive creatures!

Unfortunately, this method of hiding didn’t save tortoise from hungry sailors. Darwin writes how sailors would flip these hiding beasts over and carry them off to the ships for storage. 

 

While we were in the highlands we visited a plantation where a family grows coffee and sugar cane.  Both grow well in the Galapagos, and while we visited we learned how people traditionally processed sugar (into molasses and alcohol) and coffee.

 

Sugar Cane processing- This isn’t how the family processes sugar today, but this is the traditional method.  Sugar cane is fed into the press and juice comes out the bottom.  On this plantation half of the sugar cane juice is made into molasses and half is made into alcohol!

Sugar Cane processing- This isn’t how the family processes sugar today, but this is the traditional method. Sugar cane is fed into the press and juice comes out the bottom. On this plantation half of the sugar cane juice is made into molasses and half is made into alcohol!

 

Diabetic Warbler?- This Yellow Warbler really liked to hang out on the sugar cane press!

Diabetic Warbler?- This Yellow Warbler really liked to hang out on the sugar cane press!

 

Hooch- this was the open vat where the sugar cane juice was fermenting.  The final product, after it was passed through a still, was… rough.  There's a reason people age rum!

Hooch- this was the open vat where the sugar cane juice was fermenting. The final product, after it was passed through a still, was… rough. There’s a reason people age rum!

 

Coffee- Having had an introduction to traditional coffee processing methods in Belize, I got a review in The Galapagos.  Here you can see the unroasted cleaned and uncleaned beans.

Having had an introduction to traditional coffee processing methods in Belize, I got a review in The Galapagos. Here you can see the unroasted uncleaned and cleaned beans.

 

I took a new camera with me on this trip and certainly had some fun with shots like this...

I took a new camera with me on this trip and certainly had some fun with shots like this…

 

We got to try coffee beans, sugar, coffee, sugar juice (delicious with a squeeze of lime), and hooch (ditto).  While I certainly took lots of pictures in the Galapagos thing, the only physical product I’m coming home with is some Galapagonian Coffee.

 

Admission time- Label something “Evolutionary” and I am 27% more likely to purchase it.

Admission time- Label something “Evolutionary” and I am 27% more likely to purchase it.

 

I have a lot more to write about, and many more pictures to share, but this seems like a good stopping point for now.  I’ll get the next post up ASAP, but it may be a bit of a wait since I head to the UK tomorrow for a quick visit with family.

 

Me and my old new-friend. Unlike Darwin, I didn't try and catch a ride (though you can see why he tried!)

Me and my old new-friend. Unlike Darwin, I didn’t try and catch a ride (though you can see why he tried!)

 

*While I have always been keen to visit the Galapagos, I have also been somewhat wary.  There is no doubt that humans have done a lot of damage in the Galapagos.  While the bulk of this damage was done by early visitors who purposefully introduced a number of hardy species, tourists certainly have the potential to damage the environment, spread seeds, and introduce species or disease.  That being said, done correctly, tourism can be an incredible force for good in the Galapagos.  A lot of damage has been done in the past 200 yrs by sailors, settlers, and visitors.  Progress is being made to repair these damages, with money coming largely from tourists.  If humans were to now abandon the Galapagos, the endemic species would be pushed out by species that have already been introduced. Well-regulated tourism, appropriate management of the land, and conservation efforts can help preserve the Galapagos. They are certainly a wonder worth saving.

Yesterday I posted some thoughts and pics from my recent adventures in Belize… Here’s round 2!

 

In yesterday’s post I mentioned going on a photo shoot of the twin cities with NICH (the National institute of Culture and History).  One of the stops on our tour of San Ignacio was the old hospital.  This hospital was closed about 7 or 8 years ago, with a new hospital now operating on the outskirts of town.  The old hospital now sits in disrepair, slowly disintegrating.  Being a medically-minded person, I found this stop on the tour very interesting.

 

The abandoned walk in clinic.

The abandoned walk in clinic.

 

 

Live Birth Registry- A sign of the times.  This explains how you register the birth of a baby delivered at home.

A sign of the times. This explains how you register the birth of a baby delivered at home.

 

 I didn’t take any chemoprophylaxis for malaria (I’ll admit I didn’t even think about it, though I have had Hep A vaccines- something generally recommended for travel in this part of the world).  Interestingly (disturbingly?) the CDC [http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/travel-vaccines-and-malaria-information-by-country/belize#seldyfm533] and NHS [http://www.fitfortravel.nhs.uk/destinations/central-america/belize/belize-malaria-map.aspx] disagree about malaria risks in Belize.  The CDC says Cayo, where I spent most of my time, is an area where chemoprophylaxis is advised, while the NHS says it is a low risk area with no need for prophylaxis. Hmmm….

I didn’t take any chemoprophylaxis for malaria (I’ll admit I didn’t even think about it, though I have had Hep A vaccines- something generally recommended for travel in this part of the world). Interestingly (disturbingly?) the CDC and NHS disagree about malaria risks in Belize. The CDC says Cayo, where I spent most of my time, is an area where chemoprophylaxis is advised, while the NHS says it is a low risk area with no need for prophylaxis. Hmmm….

 

 I spotted this cot in the abandoned hospital, and immediately recognized it as a Cholera Cot.  These are one of the things doctors learn about in med school but will never see in the US.  Cholera causes MASSIVE fluid loss by diarrhea.  Cholera cots are designed with a hole in them so a bucket can be placed under the patient to measure fluid loss. Replacement of fluid and electrolytes with Oral Rehydration Therapy is amazingly effective for this otherwise very deadly disease.

I spotted this cot in the abandoned hospital, and immediately recognized it as a Cholera Cot. These are one of the things doctors learn about in med school but will never see in the US. Cholera causes MASSIVE fluid loss by diarrhea. Cholera cots are designed with a hole in them so a bucket can be placed under the patient to measure fluid loss. Replacement of fluid and electrolytes with Oral Rehydration Therapy is amazingly effective for this otherwise very deadly disease.

Confirming my suspicion, I saw this plaque on the wall in another room.

Confirming my suspicion, I saw this plaque on the wall in another room.

 

 

 

There’s definitely a push to teach kids about healthy living.  I thought this mural on a school wall was much better than the USDA food pyramid, but maybe that’s just me… Unfortunately, I saw kids eating a lot of junk food in Belize- candy, chips, and Coca-cola are ubiquitous in Belize (note- there is no Pepsi in Belize- they were run out years ago. Bowen and Bowen [http://en.wikipedia.org/wiki/Barry_Bowen] dominate the beverage industry in Belize).

There’s definitely a push to teach kids about healthy living. I thought this mural on a school wall was much better than the USDA food pyramid, but maybe that’s just me… Unfortunately, I saw kids eating a lot of junk food in Belize- candy, chips, and Coca-cola are ubiquitous in Belize (note- there is no Pepsi in Belize- they were run out years ago. Bowen and Bowen dominate the beverage industry in Belize).

Despite the abundance of junk food, the children in Belize are very active and generally appear to be thriving.  I joke that Belize is very much a country of free-range chickens (they’re everywhere) and free-range children (they’re everywhere too).  You frequently see young children out playing on their own, babies and small children being cared for by siblings, and small kids walking home alone from school in their uniforms.  They’re an active bunch (perhaps because few, if any, have home computers or smart phones?), and find opportunities to play everywhere.  School yards are generally rather bare, but you’d often see kids playing with old tires and barrels.  I’ll admit that I found their love of play mesmerizing and inspiring.

 

These kids were on break outside their school in San Ignacio.  I watched at another school where kids sprinted outside to take advantage of a ten-minute break between classes.  They spent the time sprinting up a construction embankment (not a “Caution” tape in sight).

These kids were on break outside their school in San Ignacio. I watched at another school where kids sprinted outside to take advantage of a ten-minute break between classes. They spent the time sprinting up a construction embankment (not a “Caution” tape in sight).

 

More “free-range” kids.  These girls kept running up to this painting of Jesus and giving him hugs.  There have been a lot of missionaries in Belize over the years.  Pentecostals, Nazarenes, and Mormons have all tried to make inroads into this culture.  I went through customs behind a group of young Mormon missionaries.

More “free-range” kids. These girls kept running up to this painting of Jesus and giving him hugs. There have been a lot of missionaries in Belize over the years. Pentecostals, Nazarenes, and Mormons have all tried to make inroads into this culture. I went through customs behind a group of young Mormon missionaries.

 

Dogs are also generally left to be “free-range”, often with tragic results.  It’s rather heartbreaking to see the starving, mangy dogs all over the streets.

Dogs are also generally left to be “free-range”, often with tragic results. It’s rather heartbreaking to see the starving, mangy dogs all over the streets.

 

And now for something completely different…

Xunantunich- There are a number of Mayan Sites in Belize.  Xunantunich (sounds like zoo-nan-tune-itch) is just across the river from my friends’ house.  Not only did I visit to see the archeology, but the 1-mile trek up the hill to the entrance became a favorite walk when I had spare time.

 

You have to take a ferry across the river to get to the site.  The ferry is hand-cranked, and carries pedestrians, cars, and horses!

You have to take a ferry across the river to get to the site. The ferry is hand-cranked, and carries pedestrians, cars, and horses!

 

Xunantunich grounds are about 1 square mile, and contain a number of structures.

Xunantunich grounds are about 1 square mile, and contain a number of structures.

 

El Castillo (The Castle) is the tallest structure on the site and the second tallest structure in Belize.

El Castillo (The Castle) is the tallest structure on the site and the second tallest structure in Belize.

 

It’s a great climb to the top of El Castillo.

It’s a great climb to the top of El Castillo.

 

You get beautiful views of Guatemala and Belize on the climb up.

You get beautiful views of Guatemala and Belize on the climb up.

 

From the top of El Castillo you can see how many of the structures line up.  Many Mayan sites are lined up with a north-south and east-west axis.  At Xunantunich, El Castillo is at the center of these two axes.

From the top of El Castillo you can see how  the structures line up. Many Mayan sites are lined up with a north-south and east-west axis. At Xunantunich, El Castillo is at the center of these two axes.

 

Like most of the archeological sites I visited in the Yucatan, Xunantunich has a Ball Court.  It’s interesting to think what games these courts may have been used for [http://en.wikipedia.org/wiki/Mesoamerican_ballgame]…

Like most of the archeological sites I visited in the Yucatan, Xunantunich has a Ball Court. It’s interesting to think what games these courts may have been used for

There are a number of beautiful restored friezes on El Castillo.

There are a number of beautiful restored friezes on El Castillo.

 

There is a significant Belizian Defense Force (BDF) presence at Xunantunich.  It is very close to the Guatemala border, and there have been problems with people illegally coming across, mugging tourists, and then running into the jungles.  On one of my morning walks one of the guards used my scent to practice with his German Shepherd trained for tracking(!!), and you frequently saw soldiers with big guns patrolling the roads and ruins (though initially a bit intimidating with their big guns, a number of them were very chatty when they realized I was a frequent flier on their territory).

 

 

Belize’s wildlife and wonder.

 

My friends took me on a few cool road-trips while I was visiting.

 

I snapped this on our trek from Succotz to Placencia, as we travelled on the Hummingbird Highway- yes, this is a highway!

I snapped this on our trek from Succotz to Placencia, as we travelled on the Hummingbird Highway- yes, this is a highway!

 

 The roads in Belize often leave a lot to be desired.  A good 4X4 vehicle is frequently needed!

The roads in Belize often leave a lot to be desired. A good 4X4 vehicle is frequently needed!

 

I snapped this as we took a walk in the Guanacaste National Park in Belmopan.  Here we saw (and more notably heard!) Howler Monkeys, which I think should more accurately be called Roaring Monkeys!

I snapped this as we took a walk in the Guanacaste National Park in Belmopan. Here we saw (and more notably heard!) Howler Monkeys, which I think should more accurately be called Roaring Monkeys!

 

I spotted Toucans a couple times in my travels around Belize.  I saw this pair on a walk down from Xunantunich.

I spotted Toucans a couple times in my travels around Belize. I saw this pair on a walk down from Xunantunich.

 

I also spotted leaf-cutter ants a few times.  I particularly like the little fellow toting a flower.  It’s impressive that these teeny little ants actually beat a path into the grass as they work.

I also spotted leaf-cutter ants a few times. I particularly like the little fellow toting a flower. It’s impressive that these teeny little ants actually beat a path into the grass as they work.

 

On my first day in Belize we headed into the jungle to walk around the grounds of a herbalist.  We saw a number of medicinal and edible plants there, including this Cassava.

On my first day in Belize we headed into the jungle to walk around the grounds of a herbalist. We saw a number of medicinal and edible plants there, including this Cassava.

 

 

And this Ginger… (I also was excited about the lemon grass, Keffir lime leaves, and the promise of Galangal)

And this Ginger… (I also was excited about the lemon grass, Kaffir lime leaves, and the promise of Galangal)

 

Bananas grow with abundance in Belize (this pic was taken in someone’s yard, but we also drove through miles of a banana plantation on our way to the coast).

Bananas grow with abundance in Belize (this pic was taken in someone’s yard, but we also drove through miles of a banana plantation on our way to the coast).

 

Life is abundant in Belize.  It almost seems as though this Orange Tree has more epiphyte biomass than Orange Tree!

Life is abundant in Belize. It almost seems as though this Orange Tree has more epiphyte biomass than Orange Tree!

 

Speaking of Oranges… Talk about something you probably wouldn’t see in the states.  These workers were catching a ride as this tractor sped down the highway laden with oranges.  This sight was by no means unusual.

Speaking of Oranges… Talk about something you probably wouldn’t see in the states. These workers were catching a ride as this tractor sped down the highway laden with oranges. This sight was by no means unusual.

 

Traffic rules (well, rules in general) are pretty lax in Belize.  There’s no such thing as vehicle inspection, and most of the vehicles would not be deemed road-worthy in the US.  I saw more cars without brake lights than I saw with.  It’s not abnormal to see cars with a paucity of lug nuts.  Shocks are a luxury, and carrying capacity is only limited by your imagination.

 

A pretty typical Belizean vehicle (check out those rear tires!)... It would be fun if the vehicles came with biographies (I think many make it to Belize after being written off in other countries).

A pretty typical Belizean vehicle (check out those rear tires!)… It would be fun if the vehicles came with biographies (I think many make it to Belize after being written off in other countries).

 

The per capita GDP of Belize is 1/5 of the US, and the standard of living is very low.  People live in very crude houses- often just one or two rooms for a rather large family.  While touring San Ignacio with Hector Silva (check out my last post for more on this interesting fellow) we stopped to chat with this woman… Check out the family’s living situation- you can see their feet from the outside (I suppose it makes sweeping easier), and their sink is outside their window, draining directly onto the ground below (warm running water is a rare luxury in Belize).

 

 

WindowSink

Chatting to us over the kitchen sink.

 

Despite the very basic way of life in Belize, people there seem genuinely happy.  There certainly are hardships, but families seem strong and supportive, children well adjusted and happy, and life is generally good.  Animals don’t get the care or attention that most of us have come to expect (I mentioned the dogs above, and horses are frequently very malnourished and scrawny), and I hope that with time and tourism there is greater respect for the environment.

 

I do hope to return to Belize again in the future.  It is a nice treat to visit a warm and sunny place during the depths of winter, and there is a lot to learn and appreciate in Belize.

 

NB- playing in the jungle isn’t without risk.  When I visited the Yucatan as a college student I discovered that I am acutely sensitive to Black Poisonwood, also known as Chechem.  In Mexico I developed blisters on my legs when I unwittingly came in contact with the plant, and despite being very aware of the tree when I visited Belize 8 years ago I still somehow came in contact with some and again got blisters.  On one of my morning walks up to Xunantunich I went off the beaten path and down an overgrown 4X4 trail.  It seems that I again got in contact with Chechem, and developed a chemical burn on my neck (no, it’s not a hickey, I promise!).  The traditional remedy for this is topical application of sap or tea made from the bark of the Gumbo Limbo tree.  While I was in Belize I used this remedy, and it did seem to help, especially on my arms where I got a rash (I believe) from walking under a poisonwood tree while it was raining (as I said, I appear to be acutely sensitive).

 

 

A Chichem induced chemical burn on my neck.

A Chechem induced chemical burn on my neck.

 

There are other notable risks of visiting Belize.  I saw a number of public notices touting that Belize has the highest rate of HIV in central America.  I also saw public notices warning about the prevalence of Chagas disease.  In some areas of Belize, the risk of Leishmaniasis is significant, and a friend of the friends I was staying with recently had a cutaneous lesion.

 
I was sorry to leave Belize (especially because a storm hitting the east coast delayed me in Houston overnight!), but I am excited to be getting ready for my next adventure.  Tomorrow morning I head to Ecuador, and on Saturday I head to the Galapagos! For a Darwin enthusiast, this trip is an opportunity of a lifetime, and I will endeavor, while aboard the National Geographic Endeavor to experience the Galapagos to the fullest (and hopefully share my experience here).

 

 

Mural

The tagline for this blog has always been “Ramblings of an evolutionary-minded future-physician.”  I started this blog thinking that most of these “ramblings” would be verbal, but for the next few months these ramblings are going to get a bit more “real”.

 

In the next few months I plan to write more about my physical ramblings (though I do hope to squeeze in some “academic” posts as well), as I will be traveling rather extensively.  Having finished my medical training in November, and my trek along the residency interview trail (a rambling story for another post), I am now using my “free time” between graduation and the start of my intern year (which kicks off at the end of June) to travel as much as possible.

 

The first stop on my itinerary was Belize.  I visited Belize with my Mum about 8 years ago during Spring Break of my first year of medical school.  On that trip I rode horses through the jungles and mountains, and then headed to Caye Caulker where I relaxed on the beach, did some diving, and studied physiology (Or at least I tried to study a bit… my school had cruelly scheduled an exam for the Monday after our return from break!).

 

I returned to Belize this time at the invitation of friends who moved there about a year ago.  (Let this be a warning- if you invite me to come visit, I’ll probably try and take you up on it! I much prefer travelling to places where I know people so I can get an insiders perspective instead of a tourist experience.) Keen to escape the New Jersey Winter, and keen to experience life in a small Belizean village near the border of Guatemala, I boarded a plane to Belize City two weeks ago and only just returned (after an unexpected overnight stay in Houston thanks to the most recent winter storm to hit the North East).

 

I won’t bore you with all the details of my travel, but I will share some photos, observations, and experiences… I hope you enjoy!!

 

Belize is about the size of my home state of NJ (though with less than 5% of the population). I spent most of my time in the west- near the one (legal) border crossing to Guatemala.  I was fortunate to have some beautiful days (it’s been a very rainy past few months), and I was able to capture some beautiful views.

 

Stunning scenery overlooking the countryside on one my walks up to Xunantunich.

Stunning scenery overlooking the countryside on one my walks up to Xunantunich.

 

Looking out over Benque Viejo from the hilltop in Succotz.

Looking out over Benque Viejo from the hilltop in Succotz.

I also headed to Placencia (on the coast) for a few days.  The Caribbean was beautiful, as was the weather, and I enjoyed time in the water as well as some time stand-up paddling. 

Beautiful water and skies in Placenica.

Beautiful water and skies in Placenica.

 

 

 A great place to go for a paddle. I enjoyed paddling in the open waters, and cruising along next to the mangroves, the roots of which were teeming with small fish.

A great place to go for a paddle. I enjoyed paddling in the open waters, and cruising along next to the mangroves, the roots of which were teeming with small fish.

 

When inland, I spent quite a bit of time in the “twin cities” of San Ignacio and Santa Elena. I was very fortunate to join my friends on a photo shoot of the twin cities for NICH– the National Institute of Culture and History.  We travelled around the city taking pictures of historic sights and getting an amazing history lesson from Hector Silva- a retired politician with an encyclopedic knowledge of Belize.  He is the last living pre-Independence minister (Belize attained independence from the Crown in 1981), and has an impressive political history.  He was first elected to local office at the age of 23 in 1957 (or maybe it was ’58- I’ll admit I didn’t take notes while I was talking to him and was surprised to find that this Belizian legend didn’t have a wikipedia page!), was appointed to the first Belizian cabinet, and has been very involved in Belizian politics up to the present day (though he is retired).  He is a fount of knowledge, and obviously well loved by Belizian people.  It was impressive to see the immense respect for him from passers by as we walked around the streets of the twin cities. “Don” Hector Silva is incredibly passionate about Belize, and about life. Even in his 80s he had more excitement and enthusiasm for life than many people a quarter of his age.  I was incredibly fortunate to not only meet him him, but also to get a tour of the twin cities from him.

 

NICH has collected a number of historic pictures of the twin cities, which Hector Silva took us through.  At one point he showed us a picture of the reservoir and said how he had travelled to London to petition for money for its construction. Prior to its construction people got all their water from the river that separates the twin cities- the Mopan River.

NICH has collected a number of historic pictures of the twin cities, which Hector Silva took us through. At one point he showed us a picture of the reservoir and said how he had travelled to London to petition for money for its construction. Prior to its construction people got all their water from the river that separates the twin cities- the Mopan River.

 

One of our stops on our photo tour of the twin cities was the market place, where Don Hector identified a number of new fruits for me.  Here he is singing the praises of the Sapodilla- the fruit from the tree that produces chicle (the traditional starting ingredient for gum). Belize used to export large amounts of chicle when it was still used in chewing gum. Don Hector likes to joke that Belize is actually a part-owner of Wrigley Field in Chicago.

One of our stops on our photo tour of the twin cities was the market place, where Don Hector identified a number of new fruits for me. Here he is singing the praises of the Sapodilla- the fruit from the tree that produces chicle (the traditional starting ingredient for gum). Belize used to export large amounts of chicle when it was still used in chewing gum. Don Hector likes to joke that Belize is actually a part-owner of Wrigley Field in Chicago.

 

Hector insisted we try a Sapodilla, and it really was delicious (I had another 3 during my stay). It is very sweet, with a texture much like a very ripe pear.

Hector insisted we try a Sapodilla, and it really was delicious (I had another 3 during my stay). It is very sweet, with a texture much like a very ripe pear.

 

This is the Hawkesworth bridge, or "High Bridge", that you cross to go from San Ignacio to Santa Elena.  On the return trip you take the "low" bridge.  In my pic you just see the one small motorcycle crossing the bridge, but I watched 18-wheelers make the crossing as well!  Prior to the construction of bridges and roads connecting the twin cities to Belize city there was a fair amount of river traffic for transportation of goods.

This is the Hawkesworth bridge, or “High Bridge”, that you cross to go from San Ignacio to Santa Elena. On the return trip you take the “low” bridge. In my pic you just see the one small motorcycle crossing the bridge, but I watched 18-wheelers make the crossing as well! Prior to the construction of bridges and roads connecting the twin cities to Belize city there was a fair amount of river traffic for transportation of goods.

 

As an enthusiast of local and traditional foods, I’m a fan of exploring markets when I travel (I wrote about markets in Sharjah when I visited the Middle East last year).  The markets in Belize are full of fantastic fresh fruit and veg.  I first visited the San Ignacio market on Thursday with NICH, when there were a number of fruit stalls open.  On Saturday, Market Day, the market is chock-o-block with stalls selling produce, clothes, herbal remedies, jewelry, and just about anything you can imagine.

 

I was particularly drawn to the produce stalls…

 

A traditional produce stall at the market.

A traditional produce stall at the market.

 

More produce.

More produce.

 

And yet MORE produce…  Interestingly, there is a large Mennonite community in Belize.  They are very involved in agricultural pursuits there.

And yet MORE produce… Interestingly, there is a large Mennonite community in Belize, where they are very involved in agricultural pursuits.

 

No table in Belize is complete without at least 1 bottle of hot sauce, and hot peppers are a staple of the diet (Habaneros in particular).  The love of spice in this part of the world definitely makes me want to learn more about Darwinian gastronomy.

No table in Belize is complete without at least 1 bottle of hot sauce, and hot peppers are a staple of the diet (Habaneros in particular). The love of spice in this part of the world definitely makes me want to learn more about Darwinian gastronomy.

 

Pitaya Juice- Pitaya (AKA Dragon Fruit) Juice, purchased in the San Ignacio market.  It was delicious!

Pitaya Juice- Pitaya (AKA Dragon Fruit) Juice, purchased in the San Ignacio market. It was delicious!

 

I probably went overboard purchasing produce, but it was so fresh and appetizing that I couldn’t contain my enthusiasm.  Also, food in the market is INCREDIBLY cheap (10 bananas for a dollar, 3lbs of cucumbers for a dollar, a beautiful head of lettuce for $2, 8 oranges or 4 grapefruit for a dollar… and these are prices in Belizian dollars! The exchange is $2Bz=$1US- yes, you could get 6lbs of cucumbers or 20 bananas for $1!)

 

My haul- I finally got to try “Apple Bananas”, which I wrote about a year ago, as well as culantro- a herb that tastes like cilantro but looks very different (it is in the bottom left).  Also featured: lettuce, scallions, dill, zucchini, jalapenos, sorrel, star fruit, custard apple, bread fruit, sapodillas, melon, papaya, jicama, beets, carrots, and a pile of citrus! (the pile of green and orange fruits are actually Jamaican limes, while the green fruit in the bottom right corner is a ripe orange!).

My haul- I finally got to try “Apple Bananas”, which I wrote about a year ago, as well as culantro- a herb that tastes like cilantro but looks very different (it is in the bottom left). Also featured: lettuce, scallions, dill, zucchini, jalapenos, sorrel, star fruit, custard apple, bread fruit, sapodillas, melon, papaya, jicama, beets, carrots, and a pile of citrus! (the pile of green and orange fruits are actually Jamaican limes, while the green fruit in the bottom right corner is a ripe orange!).

 

The beauty of staying with friends is that I had access to their kitchen, so I was able to try out some new dishes with my purchases.

 

Fried breadfruit (we parboiled the breadfruit then pan fried the slices in coconut oil).

Fried breadfruit (we parboiled the breadfruit then pan fried the slices in coconut oil).

 

I combined jicama with scallions, culantro, jalapeno, and lime juice to make a really tasty jicama salad.

I combined jicama with scallions, culantro, jalapeno, and lime juice (yes- that orange thing is a lime) to make a really tasty jicama salad.

 

I’ve only had papaya a few times before, and I generally find them to be very “hit or miss”.  This one was certainly a “hit” with me, and I devoured it with a few good squeezes of Jamaican lime juice.

I’ve only had papaya a few times before, and I generally find them to be very “hit or miss”. This one was certainly a “hit” with me, and I devoured it with a few good squeezes of Jamaican lime juice.

 

One of the cool things I did on vacation was help my friend make coconut milk.  With the help of a machete, a scary looking coconut grinder, some brute force, and a food processor, you too can make your own coconut milk!

One of the cool things I did on vacation was help my friend make coconut milk. With the help of a machete, a scary looking coconut grinder, some brute force, and a food processor, you too can make coconut milk!

 

Speaking of coconut… I of course had to check out the selection of cooking fats in a local store.  Lard and coconut oil are both produced locally, but are sadly being pushed out by shortening (made from all kinds of things, including animal fats, palm oil, and hydrogenated vegetable oils) and vegetable oils.

 

It definitely appears as though vegetable oils are beating out traditional fats in Belize...

It definitely appears as though vegetable oils are beating out traditional fats in Belize…

 

Food in restaurants in Belize was generally very good and VERY cheap.  Rice and beans are a popular dish, and while I don’t usually eat them at home, I did partake in Belize. The rice is frequently cooked with coconut.

 

Chimole- a traditional Belizian dish. It is made black by a spice paste that includes charred chilis.

Chimole- a traditional Belizian dish. It is made black by a spice paste that includes charred chilis.

 

This is stewed Gibnut, an animal also known as "the Royal Rat" (because this is what was served to Queen Elizabeth when she visited Belize- incidentally, she hasn’t returned since).  It was very tasty (and quite fatty).  Meats (chicken, beef, or pork) are frequently served stewed with rice and beans (and as with this dish, some plantain).

This is stewed Gibnut, an animal also known as “the Royal Rat” (because this is what was served to Queen Elizabeth when she visited Belize- incidentally, she hasn’t returned since). It was very tasty (and quite fatty). Meats (chicken, beef, or pork) are frequently served stewed with rice and beans (and as with this dish, some plantain).

 

After partaking in quite a bit of street food (the tacos, at 3 for $1bz in the market are a bargain), returning to the US and seeing the plastic wrapped apples in the airport lounge was rather amusing.  There are very few regulations in Belize, and people often cook food in their home and then walk around the streets selling it- I saw this with everything from BBQ chicken dinners to coconut candy.

 

I have a lot more to share, but this seems like a good place to sign off for now… Thank you Damon and Bonnie for being wonderful hosts!! I will try and get more up tomorrow!

I’ve written previously about the role of dietary fats in liver diseaseI’ve spoken on the subject as well.  It’s kind of my “thing”- lipids and liver- so I was kind of excited yesterday when I came across a relatively new paper while browsing PubMed.  I thought it was so interesting, and the final points so salient, that it deserved a post… I hope you think so too!

 

If this is something you're into, I suggest reading on!

If this is something you’re into, I suggest reading on!

 

I’ve written before about “Liver Saving Saturated Fats”.  By “hits” it’s one of my most popular posts to date, and it’s a good primer to this post, so if you haven’t read it I’d suggest you go back and give it a read.  The long and the short of it, however, is that when it comes to alcoholic (and non-alcoholic) fatty liver disease, saturated fat is not the enemy.  On the contrary, dietary saturated fats protect against liver disease while fat sources that are rich in polyunsaturated fatty acids (PUFAs), such as corn oil, soy oil, or just about any industrial “vegetable” oil, are closely associated with the development and progression of liver disease.

 

One of the great papers on this subject (at least in my opinion), was published by Kirpich et al in 2011.  In this paper they showed that diets that contain alcohol and are rich in PUFA lead to increased intestinal permeability, increased circulating endotoxin (from gut bacteria), and increased production of inflammatory cytokines [1]. These pathologies aren’t seen in the absence of alcohol, or in the presence of alcohol in the context of a diet high in saturated fat.  While I am very fond of the Kirpich paper, I was somewhat frustrated by their choice of dietary fat in the saturated fat group: a mixture of beef tallow and medium chain triglyceride (MCT) oil.  The result was a diet that had a high degree of saturation, but consisted of a variety of different kinds of saturated fats.

 

The problem is, not all saturated fats are created equal.  

 

There are a number of important differences between medium chain fatty acids (MCFA) and long chain fatty acids (LCFA).  First is the obvious difference: size. MCFA are between 6 and 12 carbons in length, while LCFA are greater than 12 carbons in length.  Shorter fats are easily absorbed across intestinal epithelial cells, and MCFAs rapidly make it to the liver where they are metabolized. On the other hand, long chain fatty acids are absorbed by a longer route, travelling via the lymphatics and making it to the liver in newly formed chylomicrons.  Once in the liver, MCFAs are short enough to be directly transported into mitochondria to be used for energy, while LCFA must be “shuttled” into mitochondria via a pathway that requires carnitine and various transferases.  These are just some of the basic metabolic differences.  Fatty acids are also used by the body for cell signaling purposes- both as second messengers and through modulation of gene transcription and translation- and they’re incorporated into cell membranes.  Various dietary fats are handled differently by the body, and it can be difficult to tease out the details with mixed dietary sources and in complex biological systems, but scientists persevere!!

 

On to the paper…

 

The paper I came across yesterday is a concerted effort to start to tease apart the difference in the effects of dietary MCFA and LCFA in the context of chronic alcohol consumption[2].  Previous papers (discussed in my previous post) have shown that MCFA and LCFA (or frequently a combination of the two) protect against liver injury associated with chronic alcohol consumption, and some have started to understand the mechanisms by which these dietary fats are “liver saving”, but to date I have not seen a paper that specifically tried to look at the differences between MCFA and LCFA in the context of alcoholic liver disease.

 

The diets:

 

In order to look at the differences between dietary MCFA and LCFA in the context of chronic alcohol consumption, two experimental diets were used in addition to the traditional control and alcohol “pair fed” diets.  The control and traditional alcohol-fed diets relied on corn oil for 30% of calories.  Corn oil is approximately 50% PUFA, predominantly the omega-6 linoleic acid.  The two treatment groups relied on medium chain triglycerides or cocoa butter (yes, the stuff in chocolate) for 30% of calories.  All the fatty acids in MCT have less than 12 carbons (it’s 67% C8:0), while all the fatty acids in cocoa butter have more than 16 carbons (C16:0 and C18:0 are predominant).  By creating “saturated fat” diets that were exclusively medium chain or long chain in nature, the researchers were able to draw conclusions on the importance of saturated-fat chain length in liver pathology.  As with the alcohol-fed corn oil diet, in the MCT and cocoa butter diets 38% of the calories came from alcohol.  All the experiments in this paper were done after 8 weeks of alcohol consumption.

 

First things first- both MCT and cocoa butter (CB) were able to prevent most of the alcohol induced pathology that was seen in the regular (corn oil) alcohol-fed animals.  There was significantly less fat accumulation and none of the inflammatory cell infiltrates that were seen in the corn oil and alcohol-fed animals.  The alcohol-fed animals on the corn oil diet also had more hepatic triglycerides, more hepatic cholesterol, and more hepatic free fatty acids.

 

The liver can be damaged in a number of ways with alcohol consumption, but one significant mechanism relies on the activation of Kuppfer cells (the macrophages of the liver).  In rats fed ethanol and corn oil, there was an increase in the number and size of macrophages. There were also increases in inflammatory cytokines that were prevented with MCT and CB feeding.

 

Previous research has shown that saturated fat consumption prevents an alcohol-induced increase in gut permeability (which allows endotoxin to make it into the circulation where it can lead to the activation of macrophages).  This previous research, however, was with a diet that combined medium chain and long chain fatty acids.  In the current paper, Zhong et al show that the MCT diet maintains the tight junctions between cells, normalizing serum endotoxin in the face of alcohol consumption.  This is not true for the animals fed the CB diet, where there was an increase in circulating endotoxin similar to the alcohol-fed animals on the corn oil diet.  However, the amount of endotoxin in the livers of the CB-fed animals were on par with the control and MCT-fed animals, and as mentioned before the levels of inflammatory cytokines were not elevated.  This appears to be due to an increase in the protein levels of ASS1, which binds endotoxin, inactivates it, and clears it.  Thus it seems that dietary MCTs work in a way that maintains the expression of gut tight junction proteins, preventing endotoxin from making it into the circulation, while long chain saturated fats work in a way that increases endotoxin-binding proteins in the liver.  Both prevent endotoxin-induced damage in the liver, but in very different and distinct ways.

 

So where does this leave us?*

 

This paper again shows that saturated fats are protective against alcohol-induced liver damage.  It digs deeper than past papers, separating out the effects of dietary medium chain fatty acids versus long chain fatty acids.  While both medium chain and short chain fats are protective, they appear to be so in very different ways.  Dietary MCT prevent alcohol-induced downregulation of tight junction genes in the intestinal eptithelium, preventing endotoxemia and hepatic inflammation.  On the other hand, dietary CB normalized hepatic endotoxin concentrations by increasing the amount of an endotoxin-binding protein (ASS1), thus increasing the elimination of endotoxin from the liver and preventing hepatic inflammation.

 

This raises the question (at least to me), of how much MCT is needed to preserve the integrity of the intestinal epithelium?  While preventing inflammatory damage by endotoxin in the liver is an admirable task (well done chocolate!), I’d personally prefer to keep endotoxin out of the circulatory system in the first place. We know from the Kirpich paper that a “saturated fat” diet that is 40% fat using an MCT:beef tallow ratio of 82:18 maintains gut integrity in the face of alcohol consumption and prevents an increase in circulating endotoxin, but how much MCT do you need to maintain gut integrity in the face of an intestinal insult**. This is also important because there are no natural sources of pure (or concentrated) MCTs (at least to my knowledge).  Coconut oil is approximately 50% MCTs, predominantly the C12:0 Lauric Acid.

 

This paper makes good strides in starting to understand how saturated fats of different types protect against the damage done by chronic alcohol consumption.  While it may encourage you to have a coconut chocolate with your next glass of wine (oh twist my arm!), I think this paper is also important because if confirms the destructive nature of diets high in polyunsaturated fatty acids.  Tis the season for overindulging, and this paper shows that it’s better to over indulge on chocolate and coconut (or steak and eggs), and not on anything bathed in vegetable oils!

 

Personally I like to get my fats separate from my booze, but I know some are fans of this seasons saturated fat/alcohol combo!

Personally I like to get my fats separate from my booze (and with less sugar), but I know some are fans of this seasonal saturated fat/alcohol combo!

 

* It’s worth noting that this paper also presents data from metabolite profiles in liver and serum samples from the different groups of animals.  The data is way over my head (they analyzed 220 metabolites from liver samples and 167 metabolites from serum samples), but I did find it interesting that regardless of dietary fat source, the three alcohol-fed groups were quite distinct from the control group.  Additionally, the CB and MCT groups distributed closely, obviously distinct from the alcohol-fed corn oil group.

 

**Interestingly, that paper also showed that the saturated fat diet caused an increase in the mRNA levels of a number of tight junction proteins in comparison to the control (i.e.- not alcohol-fed) corn oil diet.  The current paper showed dietary MCTs capable of maintaining Occludin at control levels, and capable of increasing ZO-1 in comparison to all other groups (control corn oil-fed included).

 

1.            Kirpich, I.A., W. Feng, Y. Wang, Y. Liu, D.F. Barker, S.S. Barve, and C.J. McClain, The type of dietary fat modulates intestinal tight junction integrity, gut permeability, and hepatic toll-like receptor expression in a mouse model of alcoholic liver disease. Alcohol Clin Exp Res, 2012. 36(5): p. 835-46.

2.            Zhong, W., Q. Li, G. Xie, X. Sun, X. Tan, W. Jia, and Z. Zhou, Dietary fat sources differentially modulate intestinal barrier and hepatic inflammation in alcohol-induced liver injury in rats. Am J Physiol Gastrointest Liver Physiol, 2013. 305(12): p. G919-32.

Merry Christmas!

 

Christmas isn’t for everyone, and Christmas as a Christian Holiday vs. an excuse for rampant consumerism seems to be on the decline, but it can be a truly wonderful time of the year.  For my family it’s a time of good music, good food, and spending time with people that matter.  Unlike many who spend the holidays with large gatherings of extended family, it’s just my parents and me in this country, so we don’t have large family gatherings (of our own) to attend.  However over the years we’ve been adopted by friends who include us in their family celebrations.  We’ve now been celebrating Christmas day with these friends for well over a decade!

 

Different things “make it Christmas” for different people.  For some it’s Grandma’s cookies or hanging a special ornament on the Christmas tree.  For others it’s a specific Gospel reading, or a certain Christmas song or carol.  While I’m not sure it’s what “makes it Christmas”, listening to King’s College Choir (Cambridge England) Festival of Lessons and Carols is a wonderful Christmas tradition.

 

Here is the 2010 Festival

 

 

Christmas music is always a reminder to me that natural selection is everywhere.  The Kings College Festival is always a lovely combination of old and new. It starts with “Once in Royal David’s City”, a carol that has been around since the mid 1800s, and includes other traditional pieces as well as some modern compositions.  Some of the modern stuff is great, and will be carried on by future choirs for generations to come, others will disappear into the archives- deemed “not quite good enough” to make it into the hallowed halls of “Christmas Greats”.

 

The old carols that we still sing today have gone through many rounds of natural selection- I am sure there were plenty of carols written in the 1800s that aren’t around today, but the ones that have made it this far are good- they hit a chord with the listener, whether the listener is religious or not.  They fire our neurons in ways that make us want to hear them again, next year, and for generations to come.

 

Natural selection is still ongoing.  It’s the reason “In dulci jubilo” has been around for over 600 years and “Funky, Funky, Christmas” is (hopefully) on it’s way to obscurity (though it will perhaps be immortalized on youtube).

 

 

And now- since I can’t think of any sensible segue from “Funky, Funky Christmas”, I will just make the following bold statement:  I bet Jesus didn’t have asthma.

 

I bet he wasn’t allergic to peanuts either.

 

I’m not here to debate whether Jesus existed, but I do think it’s worth thinking about the fact that anyone who WAS born in a stable is probably on the way to a robust microbiome and an appropriately occupied immune system (i.e.- not over active and causing asthma and allergies).  Since he was a vaginal delivery, lived in an age before antibiotics, and was exclusively breastfed (no formula 2000 years ago!), I expect Jesus had an admirable gut flora indeed!

 

And with that, dear readers, I wish you a happy (and merry) Christmas!  In an effort to reduce the quantity of unnecessary objects in our lives, my family has taken to the philosophy that Christmas gifts should be “Consumable, or the best gift ever”.  As such, I am looking forward to trying a nice new olive oil and balsamic vinegar, an interesting piece of cured meat, some lovely dates from Dubai, and a tasty looking bottle of tequila… Merry Christmas indeed!!

Thanksgiving

There are so many things that are worth writing about on and around Thanksgiving. 

 

For those of us interested in ancestral health and evolutionarily-appropriate eating it’s fun to explore what a pre-pilgrim Thanksgiving feast might have been.  Yesterday I spotted this article on Twitter discussing what a pre-pilgrim dinner would have looked like in Portland (the location of my penultimate residency interview!).  It is well worth a read.

 

My Thanksgiving feast this year is certainly of the ‘more traditional’ pilgrim/post-pilgrim variety, and will consist of a locally raised wild turkey and a Bourbon Red – a heritage breed turkey.  Incidentally, I don’t expect any Wild Turkey Bourbon will be consumed…

 

Thanksgiving is also a great, and thoroughly appropriate, time to talk about what we are each thankful for.  Family, friends, food, shelter, health; even the ‘least fortunate’ amongst us in the developed world are incredibly blessed when we look around the world and see those without access to clean water, basic medical care, or basic freedoms and security.

 

As I reach the end of my med school career, and pathologically over-think my future options, it seems like a very appropriate time to look back and think about what I am most thankful for from this rather lengthy journey.  Without a doubt, the thing I am most grateful for during the last 8.5 (*gulp!*) years is people.

 

As some of you may know, it was never my intention to be a doctor.  Truth be told, I never would have taken the MCATs (Medical College Admission Test) if my summer roommate hadn’t dared me to do it.  Nipa, though you won’t be reading this, Thank you.  On the day that I took the test I met a charming and chatty pre-med while we waited in line.  She thought my light-hearted approach to the MCAT was hilarious and offered me her AIM screen name so we could chat if I decided to apply to med school.  Without Jackie my AMCAS (American Medical College Application Service) application would have been submitted sans-personal statement, an act that certainly would have doomed my efforts.  Incidentally, Jackie and I ended up attending the same medical school, so I’ve had the opportunity (even as recently as a couple of months ago, since she pursued residency training locally) to express my thanks to her.

 

My large university had a “Pre-health” office that assists aspiring health professionals prepare their application for medical school.  When I called to ask if they would help me (only a month or so before applications were due), they told me that they could help me get my application ready… for the next year.  Fortunately the pre-health office at the woman’s college campus was willing to take me on (despite the fact that I wasn’t from her college), making my application to medical school a reality.

 

The day before my first medical school interview my college roommate asked me what I was planning to wear for my interview, telling me “I think people wear suits for med school interviews.”.  I laughed this off, but after a last minute email exchange with my advisor my roommate went shopping with me to help me find an appropriate suit.  I alternate between cringing and chuckling when I think about the response I would have received had I shown up to a med school interview in a tank top and cool Malaysian Sarong, my original plan!  Incidentally, prior to my residency interviews I headed to Long Island to meet up with this same friend for another suit-shopping experience (this suit is much sharper, if I do say so myself!).

 

I applied and interviewed for more PhD programs than I did MD/PhD ones (though since I only interviewed at four PhD programs that’s not saying much!).  I was very tempted by two of the stand-alone PhD programs, and my decision to pursue the combined degree literally came down to the final day.  I remember the day before the decision was due I met with an MD/PhD student who sold me on the virtues of a combined program.  Without Jay, it’s entirely possible I would have opted for a non-clinical route.  Another good friend, who’s opinion I still very much value, had warned me that “No sane person puts herself through the torture of med school unless she’s sure she really want to be a doctor.”.  I’m not saying he’s wrong- I’m sure there’s quite a list of people who have questioned my sanity over the years!

 

Someone who has contributed more to my medical education than he shall ever know is Russell.  I thank “Russell”, though I shall never know his real name.  Russell was a 74-year-old man who died of “coronary artery disease”, at least that’s what his cause of death was listed as.  While I became very familiar with his body, I will never know anything about his life.  From his lean and muscular body (Russell was short for “Russell the muscle”), I imagined him as a fit and active man, but I shall never know.  Books have been written about gross anatomy lab (including one written about the experience at my school- my anatomy teacher is on the cover of this book!), and I’m sure every student has a slightly different experience of this ‘right of passage’.  I feel safe saying that we are all, uniformly, thankful for the gift that our donors gave.

 

I’m not going to go through and thank all the people who helped me survive (I would not call it thrive) in medical school.  Completing my PhD was a particularly stressful time, and I am forever thankful for the many people who supported me through that experience.  Returning to medical school (after 4.5 yrs in the lab) was difficult, but made much easier by classmates who did their best to get me up to speed on the floors.  The three guys I did my first neurology rotation with were particularly kind in helping me hold-it-together while stressing out about how to present a patient to our attending physician for the first time.

 

I would be remiss for not recognizing the role that many of my residents played in my development as a future physician.  Some residents love to teach while others barely tolerate students, but even the grumpiest and most sleep-deprived resident shaped my experience in someway (for better or worse).  Likewise, various attending physicians have been mentors that I struggle to recall while others have truly fashioned some aspect of my clinical or personal development.

 

It takes a village to raise a child, but it takes a hospital to make a doctor.  When you are a medical student or resident-physician, nurses, physician assistants, therapists, and social workers can make or break your day.  The reality is that these people frequently know more than you about what your patient actually needs.  Speaking of patients- they are, of course, an integral part of medical education.  Many are lost in my memory, but others will stay with me throughout my clinical career, for the impact they had on my medical knowledge and the impact they had on me personally.

 

As important as all of these people have been to my development as a clinician and a person, I am most grateful for my friends. I have loved the poem “A Prayer” by Frank Dempster Sherman (1860-1916) since college, and as I travel around the country interviewing for residency programs (and catching up with friends along the way), it has never struck so true.

 

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I have a fantastic network of friends, one that I am truly thankful to have nurtured over the years.  In an era when the word “friend” may conjure up thoughts of a virtual connection on facebook (especially when in the same sentence as the word “network”), it can be easy to lose touch with people that matter or let friendships devolve into a series of “likes” and “pokes”.  On the other hand, online social networks can help make connections that have been lost.

 

When I interviewed in Vermont I met up with a friend I have not seen since High School. On my way home from an interview in New Hampshire I spent the weekend catching up with friends in Boston. Before heading to Colorado for an interview I went to play polocrosse (imagine a combination of polo and lacrosse) for the first time in 2.5 years, in Texas.  There I saw friends that I have literally not seem for years, but who opened their homes and stables to me without hesitation.  With the exception of one upcoming interview, all of my interview travels are combined with a visit with one or more friend.

 

When I entered medical school I was unsure whether I would ever use my clinical degree in practice.  The medical knowledge would be useful for asking relevant research questions and the clinical knowledge would be useful when friends and family needed phone-a-friend medical advice, but I certainly was not sold on the idea of being a clinician when I entered medical school.

 

Now I am sold- I do want to practice clinical medicine (as well as be involved in research and academics), and I am forever grateful to all the people who have helped me find my way along this path.  My desire to be a fount of knowledge for my friends and family is still one of my greatest drivers, and it is certainly a large part of why I have chosen to pursue family medicine.  I’ve been warned many times that friends and family make the worst patients- they’re notorious for not listening to someone they’ve known since “way back when”. That’s fine- I really am OK with that (just keep your griping to a minimum when your low-fat, low-cal, low-“food” diet fails to leave you feeling great.). I do hope, however, that when my friends do need me, I can live up to the last line of that fantastic poem.

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Oh, and if you’re curious, this is polocrosse.  Check out americanpolocrosse.org for more info. 

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!

Playing this horse (Cripple Gray Zeta) was a privilege and a thrill. Thank you, thank you, Susan and Paul!