Alignment

Auckland, New Zealand
September 2023

“And though you think the world is at your feet, it can rise up and tread on you.”
- From the book Atonement by Ian McEwan

August finally arrived, and with it my chance at alignment.

Boarding Falcon, I ripped up north to Auckland and hopped on a placid flight to San Diego, United States. As per my custom, I fasted for several days before, during, and after the flight so as to prevent any jet-lag whatsoever.

My cab pulled up to the Horton Grand Hotel just after midnight, and I crashed. As morning dawned, I ventured out to find the closest 80s-style diner for some unlimited (albeit, watered-down) coffee. I am infatuated with North American diners - probably has something to do with the vibe, which hearkens me back to childhood. 

Next day, I trundled over to the Wyndham San Diego Bayside Hotel, where I was granted an oceanfront room overlooking the majestic USS Midway, an old aircraft carrier launched in 1945 and the largest ship in the world until 1955. I was at this venue to attend the Symposium for Metabolic Health, hosted by Low Carb USA, which I was also speaking at (1).

I met up with several people before the conference, including Doug and Pam, the main organizers, as well as Anthony and Elle, the Plant-Free MD couple who live in Perth, Australia. Anthony advocates the carnivore diet for optimal health (2). To show my support, I ordered a 1 kg tomahawk steak at a dinner with Doug and Pam, which was sublime, although I was taken aback at the immense cost of it.

The inaugural day of the conference was devoted to metabolic aspects of cancer. On my way down, the first person I ran into was Dominic, a research scientist at the University of South Florida and general all-around good guy (3); we caught up briefly before the day began. Both Dominic and Anthony spoke in the morning, and gave superb talks, as usual. I spoke in the afternoon, which seemed to go reasonably well. 

During the break that day, I was honoured to meet Rishi and Jeeva, as well as their parents, Paranika and Senthil. About 1 year ago, and entirely of their own volition, Rishi and Jeeva started up a nifty youtube channel called Dr Matt's Metabolic Kitchen (4). During the conference, they interviewed me for a special episode of the channel (you can watch it to the right). It was a pleasure to speak with them and, as you can see, they challenged me with many novel questions. That evening, the whole family hosted me for a memorable ketogenic dinner that was straight out of my own program (except they made it better than I do).
​
There were many others there whom I knew either in person or by email association, and it was nice to align my brain with the the reality of their presence. One such person was Ron, one of the oldest fellows in the low-carb space, who had travelled from afar to say hello. He has been very supportive and is full of great ideas. Another was Tracey, a health coach based in Melbourne, Australia, who also briefly interviewed me for her channel. She is passionate about metabolic health and a fantastic listener. Others included the pediatrician Lauren who works on metabolic health in psychiatry, Hal, a businessman who operates a high-level-of-care facility that offers metabolic therapies to residents (such that he has been able to return some of those residents home), and many others that I don't have enough room to write about here.

Conferences like this are always invigorating, as the emphasis of the people who attend them is on restoring health, as opposed to managing disease. Moreover, given that I live in New Zealand, it was nice to break the self-imposed isolation I have instilled in that sea-locked country by meeting other people in the metabolic sphere. As always, I discovered insights into my work and self. 

Streets of San Diego.

Symposium for Metabolic Health, courtesy of Low Carb USA.

Speaking about cancer at Low Carb USA.

It was a pleasure to speak with Rishi and Jeeva on an episode of their Dr Matt's Metabolic Kitchen youtube channel.

Catching up with (from left) the mighty Rishi and Jeeva, followed by Lauren, Paranika, and Senthil.

Hanging with Anthony, The Plant Free MD.

Earth and Water

Post-conference, I flew to Miami and then on to Nicaragua, a small country in Central America, where I had arranged to do some volunteer work in a medical clinic. On arrival, I was greeted at the airport by Emanuel, one of the primary administrators of the clinic, and Felix, one of the two ambulance drivers.

Emanuel was concerned that he would miss me at the airport as we could not communicate beforehand. I refuse to use my phone when travelling, nor I not use WhatsApp (which apparently is what everyone in Nicaragua uses). He reckoned I might get lost or into trouble, something like that. But I figured my appearance would help me stand out amongst the locals, and I was right - Emanuel and Felix spotted me instantly as I walked out of the airport.

We drove in a van for 2-3 hours to the village of El Limon, further south and on the west coast. The village was mainly situated in a jungle. The guys dropped me off at Monoloko Lodge, where I was greeted by Joy, the vibrant young woman running the place. After the usual formalities, Joy showed me to my hut and I rested for the night to the rumbling cadences of the jungle's insects and the howling, jackal-esque calls of its resident moneys.

Although breakfast was complimentary, I only eat one meal a day and it is generally not breakfast, so I declined. However, I was treated to a sublime cup of Nicaraguan coffee, which I rate right up there with the coffee in Italy and Colombia. Following coffee, Emanuel picked me up for my first day at the clinic. Travelling along earthy dirt roads we bypassed numerous local Nicaraguan abodes, most of which appeared to be small farms.

​The Roberto Clemente Health Clinic was much like what I thought it would be - a veritable beacon of light in an area where it was sorely needed (5). I was met by Hazel, the main clinician at the clinic and an utterly committed individual who did not merely restrict herself to treating disease, but also focused on educating the surrounding communities on preventative, health-promoting practices. 

Emanuel and Hazel gave me a quick tour of the clinic, which had all the basics, including a decent-sized plot of land for growing vegetables and a small water-cleaning facility maintained by the very entertaining Marcus. The clinic ran solely on donations and was staffed only by Nicaraguans, both features that attracted me to it in the first place. It was started over 20 years ago by a writer named Julia Guth, who runs it in a broad sense form the United States, but visits the clinic frequently. To my mind, one of the key features of the clinic was that it created an immense volume of clean water on a daily basis, which it then distributed to local schools and communities.

After the tour, I started my neurology clinic. My Spanish is ok enough to make basic conversation, but it was not up to taking a medical history, so I was joined by a young Nicaraguan doctor named Alicia, who translated for me. Alicia had a lovely personality and we proceeded at the easy pace of one patient per hour, during which I wrote my notes on a pad. The examination tools available were modest, but a neurologist really only needs two pieces of equipment - first, a reliable tendon hammer, and second, a decent ophthalmoscope. Fortunately, I had brought both of mine over from New Zealand. The pharmacy was fairly well-stocked, so I was able to prescribe most of the medications I needed.

I spoke with Hazel at length about the main health issues facing Nicaragua. Somewhat surprisingly, infections were not the main problem - metabolic health was by far the dominant issue, with the flagship being a rampant prevalence of type 2 diabetes. Upon reflection, this was no surprise at all to me. I had noticed in the markets and stores that virtually all products were either overtly sugar-based, or laced with sugar. Moreover, the local farmers mainly grew corn and beans. Furthermore, beyond the fact that it was difficult to find, meat was expensive. Hence, the current diet in Nicaragua is high in carbohydrates, particularly ultra-processed carbohydrates. To sustain ketogenesis myself, I bough a few dozen eggs and a couple of bars of butter, and enjoyed a once-daily shot of scrambled eggs and butter over the week.

The clinic had lined up a number of neurological patients for my time there, and I was interested to see what types of disorders I might see in Nicaragua compared with New Zealand. The main disorders were headaches, epilepsy, and functional neurological disorders, although I also encountered a few radiculopathies, neuropathies, and movement disorders. It was all very similar to what I would see in a New Zealand clinic. As is generally the case, the patients were a delight to meet and converse with.

Towards the end of the week, El Limon was beset by a 3-day storm, which I was told only occurs once a year. The unrelenting cascade of water resulted in extensive flooding such that the roads were impassable, and one fellow's truck even got washed out to the sea. Monoloko Lodge lacked a working generator, so we lost power and running water (as the water relied on pumps) for those 3 days. Although I missed out on 2 days of work in the clinic, that storm was a blessing in disguise - I was unable to check my email or the internet, which provided an opportunity for my brain to align itself with the sights and sounds of the living jungle. 

The rains eventually stopped, and I spent the weekend exploring my surrounds, trudging down the muddy roads. These post-flood roads were generally devoid of humans, but there were plenty of pigs, chickens, dogs, and monkeys to keep me company along the way, not that they paid any attention to me.

My unassuming hut at Monoloko Lodge.

Nicaraguan morning coffee.

Typical abode in El Limon.

The Roberto Clemente Health Clinic.

Roberto Clemente docs - from left, Hazel, Norlan, and Alicia.

A traditional filing system.

Performing a tremor exam with an old farmer (he has a cervical dystonia, with an associated dystonic tremor).

Lots of rain and flooded roads.

My friends the pigs (as well as chickens, dogs, and monkeys).

Fire And Wind

After my brisk time at The Roberto Clemente Health Clinic, I changed venues and moved to Hotel Casitas Pacific, a slightly touristy venue right on the beach. Most of the other patrons were surfers. I took a room with charming balcony views of the sweeping waves rolling in from the Pacific Ocean.

Next day, I jumped into the sea for an early dip before I was picked up by Marcus, who drove me back to the clinic for a post-flooding goodbye ceremony hosted by the clinic's staff. It was nice to see everyone again, even though I had only worked there for a few days. They made me some of that sublime Nicaraguan coffee, said some nice things, took a few photos, and presented me with a certificate. I refused the offering of cake though.

Upon saying my goodbyes, I returned to Casitas Pacific and wandered down the local dirt road. Cafes were sparse, and most were closed. I spent the evening on the balcony with a perpetually sleepy-looking cat, whom seemed to occupy one of the chairs on a permanent basis. Due to a lack of imagination, I referred to him as Mr Cat. We enjoyed a couple of fiery sunsets overlooking the ocean. Clearly, the balcony belonged to the cat, not me.

I was only as Casitas Pacific for 3 nights, during which I worked on a scientific paper and spent much time looking past the horizon from atop the balcony. I was buffeted by strong winds during the night - not really a storm, but an incessant and unstoppable force nonetheless. I was strangely comforted by the reverberating gusto of those winds, for they provided my brain an opportunity to align with the breath of nature.

I spent a couple days in Managua at the end, just to see a bit of the big city. I ambled along the streets for a bit, but seeing as I really had nowhere I wanted to go, ended up stopping for coffee more than once. I also found a restaurant with some excellent picanha steaks.

Upon flying home to New Zealand, I mused over my time in the United States and Nicaragua. One moment, everything is going well and the world is at your feet, and then along comes a storm that throws everything into doubt. But the secret to surviving a storm is to forego one's precious illusion of control and to harness the chaos for learning, then apply it towards a greater good. 

For the truth is, storms are necessary in one's life - they provide an opportunity for our brain to calibrate itself back to reality, and ultimately, all tempests lead to solace.

Solace.

Chilling with Emanuel.

Most of the staff at the Roberto Clemente Health Clinic.

My good friend Mr Cat, who greeted me on my balcony every morning (it's probably more correct to say, his balcony).

Nicaraguan solace.

References
(1) https://www.lowcarbusa.org/evolution-of-cancer-a-conversation-with-dr-matthew-phillips/.
(2) https://theplantfreemd.libsyn.com/.
​(3) https://ketonutrition.org/about/.
​(4) https://www.youtube.com/@drmattsmetabolickitchen.
​(5) https://nicaclinic.org/.