Thoughts Are Not Facts

It is very hard to lose an argument in your own mind. That’s because there is no one to successfully argue the other side. It is not possible to live and not be exposed to events that are likely to cause stress. These events can include changing jobs, buying a home or car, getting married, having a child, losing a friend or relative, etc. Nevertheless, most people adapt to these stresses well and continue to lead useful lives. Some do not and the stress can become debilitating and disease promoting. Why? There are a number of reasons why each person reacts to stress differently. For most it is the contexts of which the stress occurs and other factors that mitigate or dissipate that stress. The key is not to see the source of the stress as the final arbiter.

When I was a third year medical student at New York University, I was assigned to the Bellevue Hospital Psychiatric Ward as part of my psychiatry rotation. One day, I was asked to process the admission of a man, whom I will call John, who was in his late-twenties, who presented himself to the emergency room as being depressed and suicidal. Accordingly, he was admitted to the hospital for a period of observation. When I did my admission evaluation with him, I asked him why he was depressed. His response caught me off guard and still resonates with me today, some 30 years later. He responded, “I always get screwed.” My initial reaction was that he was exaggerating but that he nevertheless believed it to be true. 

I probed deeper why he felt that way and he simply responded that everything went wrong for him and he was very depressed and wanted to kill himself.  I hoped we could do something for him but I wasn’t sure as a mere third year medical student how one deals with such a predicament. Over the ensuing few days, John underwent psychiatric counseling but still seemed to remain fairly depressed.  After about three days, he summarily informed me that he wished to go home. I dutifully advised the attending physician who felt that John was not ready. The concern was that depressed patients who contemplate suicide are more likely to perform the act once they are more energetic. Therefore, if John was really feeling less depressed, then he was in a particularly dangerous zone. When I told John the doctor did not feel it was time to go home just yet, John became quite agitated, arguing that he had brought himself to the hospital and that he now felt better and was insisting on going home. There was little I could do to assuage John who became increasing petulant. I went back to the attending physician and explained John’s reaction and the doctor remained steadfast in his opinion that John was not ready to be released. Over the next 24 hours whenever John and I spoke, he repeatedly expressed his growing anger about the doctor refusing to let him go home.

After a day or so, the doctor relented and agreed to let John go if he signed a form releasing the hospital of any liability for his medically ill-advised release. John angrily signed and I was asked to fetch John’s street cloths which the hospital had taken into storage. However, when I tried to do so, I was informed that John’s leather coat had gone missing.  I was afraid to tell John because of his now constant overtly manifested anger that he was without a coat in the middle of winter because the hospital had either misplaced it or had allowed it to be stolen.  Sheepishly, I approached John with the bad news expecting him to blow up at me. Then something eerily memorable happened. I told John and he did not react. I thought perhaps he had not heard or understood me and so I repeated myself. Again, he did not react. Finally, I asked John why was he not reacting and he responded, “I told you. I always get screwed.”

Is it possible that some people truly experience more than their share of bad luck? Is life for some a Greek tragedy where fate determines how they ping pong from one misfortune to another?

John thought so, but he was wrong. There is always a certain amount of predetermination in our lives. We can’t control who our parents are and the nature of the environment they create for us, including who we get for siblings. We can’t control the level of affluence we are born into and how that determines how we live, where we live, and what role money plays in our lives. We can’t control if we are born during a peaceful time or during a threatening war.  We can’t redo our childhoods regardless of its influences.

So what can we control? Just about everything else. Even though we may have certain genetic predispositions towards particular diseases, our lifestyle will to a great extent, scientists say 70%, will determine whether we develop chronic diseases like diabetes, heart disease, and cancer, the leading killer of Americans.  We may not be able to choose relatives, but we can to a great extent choose friends and significant others.  Louis Pasteur once said, that “chance favors the prepared mind.” While he was referring to the field of observation, his words ring true for virtually everything in our lives.

My older patients often tell me of aches and pains they suffer. Once I determine that the cause is not serious, I tell them the following. Life is full of aches and pains. It is what makes us feel alive. We can become victims and captives of such nuisances or we can ignore them and live our lives to the fullest. The twists and turns in our lives is what gives life color and flavoring. We can wallow about things that didn’t quite work out the way we wished. Or we can recognize that life may not be perfect but it doesn’t need to be to still be worth living and enjoyable.

 Two personal anecdotes bear evidence to the truth of these statements. One involved my first health care service company which I had founded with investment from others. The investors proved to be meddlers and I spent much of my waking time complaining about them rather than doing something about it. I thought I was stuck. Then one day after complaining about my predicament as had become my norm to an almost stranger (a friend of a friend), I got a wake-up call when he responded that I “sounded pathetic.” It was a rude awakening to say the least. I did not see myself as a whining, pathetic person, but that is what I had become. I had invested too much time and energy in what was wrong as opposed to in finding solutions. Those words changed my perspective and I took action that ultimately made everyone happy, including my investors.

A second anecdote took place more recently. Having grown up lower middle-class where money always factored into limitations and issues, I always thought that selling my company some day for enough money that would allow me to retire would be the highlight of my life. Little did I know the truth, but I found out. About three years ago, I retired after selling my company and I began to wallow in self-pity that I now longer had purpose in life. I had money, the freedom to pursue any hobby or activity, but yet I was miserable. I had always wanted to get more physically fit but I could not find the motivation to do so. I thought that if I only ran my old company again, all would be well. Well I got the opportunity and that reminded me why I sold it in the first place.  It was unfulfilling and I realized that my though process was flawed. It became clear to me that no external factor would be the genesis of my ultimate happiness.  I came to appreciate that happiness, satisfaction, and wellbeing had to be generated from within. Over the past year, I have discovered what it takes to be happy and healthy. It takes finding ways to help others. It takes finding meaning and pleasure in whatever we do whenever we do it. It takes being thankful for what we have and blocking out what we don’t need. It takes nurturing relationships with family, friends and strangers alike.  It takes realizing that “thoughts are not facts” and to spend less time thinking about what will make me happy and more time practicing it.

So if you want to focus on what is wrong in your life, no one can stop you. But that would be a shame because you would miss out on all the ways to find true happiness many of which cost nothing but a new perspective.

America Is In Midst of Obesity Epidemic; MDPrevent Offers Practical and Clinically Proven SolutionsDelray Beach, Fla - America is in the midst of an obesity epidemic. From infants to the oldest adults, we are a nation of bulging waistlines. The current rate of obesity is cited as representing 34% of the population, expected to climb to 40% within three years. The situation is so bad that despite Medicare’s financial woes, the Federal program felt compelled last week to begin covering 100% intensive behavioral therapy for obesity for qualified beneficiaries. Even the visit to determine if one qualifies is covered 100%. Numerous studies have linked obesity to heart disease, diabetes, cancer, and strokes, the leading killers of Americans. Among the populace there is a debate if obesity is a disease or a choice. A recent billboard in Indiana put up by a local hospital which stated that Obesity is a disease and not a choice garnered many negative reactions. It is difficult to believe that anyone would make a natural choice to be obese weighing its consequences. My name is Steven Charlap, MD and before I suggest solutions, let’s reviews what contributes to obesity. Obesity is the result of many factors of which any combination may be in play for an individual. On the clinical front, obesity may be the result of slowing of one’s metabolism due to such factors as insufficient thyroid hormone or an overabundant release of cortisol, a natural steroid that causes retention of water among other issues. Aging past 50 years old also can contribute as our metabolism, hormones, and digestive capabilities begin to lose certain functionality. Depression can also be a major cause of obesity. For some, other psychosocial issues may lead to obesity being the solution to a problem rather than the problem itself. For example, a recent study demonstrated a linear correlation between adverse childhood events, such as abuse or lose of parent before the age of ten, and unhealthy behaviors. Early childhood abuse can result in the gaining of weight as a protective shield of sorts. Identifying the root cause of one’s obesity is more important than rushing to judgment. Other causes of obesity include simply eating too much food. I am not referring to consuming too many fruits and vegetables; rather, I refer to unfettered access to foods that contain large amounts of processed sugar and flour. Fried foods high in saturated fats and any food containing trans-fats are among the guilty as well. The time of day food is consumed also makes a difference. Evolutionarily, when man did not eat during the first part of the day, the body assumed that food was in short supply and slowed down metabolism to retain as much of any food consumed later in the day. Also, the lack of food results in the release of neuro-hormones such as leptin and ghrelin. Leptin is an appetite stimulant that is activated after no intake of foot for a while eating and ghrelin, an appetite suppressant, is repressed under the same circumstances. Therefore, when a person finally eats, the stage is set for them to overeat and in particular crave foods with a high sugar content. This same hormonal process goes into effect when a person does not get enough sleep and so inadequate sleep, typically less than 7 uninterrupted hours, may also contribute to obesity. In his recent book Willpower, Robert Baumeister states that decreased blood sugar levels contribute to depleted neurotransmitters leading to poor decision-making. Exhausted capacity for decision-making leads to bad food choices later in the day, often including fast-food takeaways. It is claimed that sumo wrestlers gain their enormous girth by starving themselves all day, then consuming heavy fats and carbohydrates dinners and then immediately going to bed. Although I am unaware of any scientific evidence for this anecdote, it is consistent with what happens when one does not eat all day and overeats at dinner. For some people the cause of their obesity may be that they just love food so much that unlike their European counterparts who are said to eat to live, these individuals simply live to eat. Finally, some obese individuals and this is particularly true for children, have little choice but to consume obesigenic foods because their parents either are ignorant regarding the consequences of such diets, misinformed to believe that they can only afford to offer such unhealthy foods, or are hard-pressed for time to prepare healthy meals. Of course, schools offering similar fare such as pizza and French fries are major contributors to the problem as well. In fact, last week, some congressman tried to keep pizza on school menus claiming that the tomato sauce used to make the pizza qualified it as a vegetable. The french fries won as potatoes. Finally, food and supplement marketers, media reporting of inconclusive and mostly observational studies, coupled with well-intentioned but misguided populist bromides coming forth from media personalities like Dr. Oz, has completely confused the American population. For example, last week I spoke to a Medicare patient who came in for her 100% covered Annual Wellness Visit. AS part of her visit, I reviewed her supplements and vitamins. She brought them with her and included was Milk Thistle, which she was taking to promote liver health because she heard Dr. Oz say to do it. I suggested otherwise, in the face of the absence of her having any known liver disease. She also had a bottle labeled sleeping pills which actually contained diphenhydramine, an ant--histamine typically used to control cold, flu, and allergy symptoms. Again, my patient was immediately advised to stop taking it. In addition, she was taking Vitamin D and calcium from three different sources which were contributing to potential toxicity and she was advised to take only one. This experience has been repeated multiple times because patients have never had a good resource to identify what supplements if any, they really need. In a recent Time Magazine article, a writer by the name of John Cloud did his own social science experiment by taking some 3000 supplements over a 5 month period. He gained over ten pounds because of what he describes as the “licensing effect,” a misguided belief that while taking such pills he had the license to eat unhealthy and weight contributing foods regardless of the consequences. So what is America to do under the weight of this problem? The answer is obviously not simplistic or solutions would have been widely implemented already. As the United States Preventive Services Task Force recommends, the first step is medical assessment by a primary care practitioner to rule out an underlying clinical condition as the potential root cause of the obesity. Secondly, I recommend a consultation with a psychologist to rule out any psychosocial reasons for the excessive weight. If the trained professionals do not identify any medical or psychosocial reasons for the problem, then I recommend consultation with a registered dietitian and exercise physiologist to develop a nutrition as well as exercise plan. In addition to private consultations, I firmly believe that group sessions are critical to achieving meaningful weight loss. The dynamics of group interaction and peer pressure, as well as a nurturing, non-judgmental, and supportive environment provide the critical and practical information needed to change one’s lifestyle and achieve improved health and weight loss is a clinically proven approach. As referenced earlier, for Medicare beneficiaries, there is great news because Medicare now covers weight loss counseling by a primary care practitioner in a primary care setting at no cost to the qualified beneficiary. It is hoped that other insurances will follow Medicare’s lead and implement such coverage in the near future. So if you have Medicare and need to lose weight, MDPrevent can help. If you don’t have Medicare, we have a similar program offered at an affordable price. We call our clinically proven program LEAN (Lifestyle Education And Nutrition) Weight Loss. Our program was developed off a very successful program developed by the Veterans Health Administration which we enhanced. Our team of Preventioneers, so called because we are pioneering new approaches to prevention includes MDs, nurse practitioners, health psychologists, nutritionists/registered dietitians, exercise physiologists, certified yoga instructors, and health educators who are ready to help you. So if you are interested in learning how you can improve your health, take control of your weight, and live a more fulfilling life, call us today at (561) 807-2561 or visit us at www.mdprevent.net . About MDPrevent MDPrevent is a new concept in primary care and preventive medicine. The healthcare services and education company helps Americans reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare for seniors) or self-paid Total Health Assessments, and the development of a five- to 10-year prevention plans. Its MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, exercise physiologists, fitness and yoga instructors and educators also provide interactive group courses on health, diet and nutrition, fitness and exercise, stress management, relationship and social network building, and other key elements of a healthy life. The company also offers the LEAN (Lifestyle Education and Nutrition) program which helps people of all ages not only get healthier, but lose weight, while having fun and decreasing dependence on medications. The goal: to improve aging and well-being by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, dementia and some forms of cancer. Learn more at www.MDPrevent.net.

Delray Beach, Fla - America is in the midst of an obesity epidemic.  From infants to the oldest adults, we are a nation of bulging waistlines. The current rate of obesity is cited as representing 34% of the population, expected to climb to 40% within three years. The situation is so bad that despite Medicare’s financial woes, the Federal program felt compelled last week to begin covering 100% intensive behavioral therapy for obesity for qualified beneficiaries.  Even the visit to determine if one qualifies is covered 100%. Numerous studies have linked obesity to heart disease, diabetes, cancer, and strokes, the leading killers of Americans. Among the populace there is a debate if obesity is a disease or a choice.  A recent billboard in Indiana put up by a local hospital which stated that Obesity is a disease and not a choice garnered many negative reactions. It is difficult to believe that anyone would make a natural choice to be obese weighing its consequences.

My name is Steven Charlap, MD and before I suggest solutions, let’s reviews what contributes to obesity.  Obesity is the result of many factors of which any combination may be in play for an individual.  On the clinical front, obesity may be the result of slowing of one’s metabolism due to such factors as insufficient thyroid hormone or an overabundant release of cortisol, a natural steroid that causes retention of water among other issues. Aging past 50 years old also can contribute as our metabolism, hormones, and digestive capabilities begin to lose certain functionality.

Depression can also be a major cause of obesity.  For some, other psychosocial issues may lead to obesity being the solution to a problem rather than the problem itself. For example, a recent study demonstrated a linear correlation between adverse childhood events, such as abuse or lose of parent before the age of ten, and unhealthy behaviors.  Early childhood abuse can result in the gaining of weight as a protective shield of sorts. Identifying the root cause of one’s obesity is more important than rushing to judgment.

Other causes of obesity include simply eating too much food.  I am not referring to consuming too many fruits and vegetables; rather, I refer to unfettered access to foods that contain large amounts of processed sugar and flour. Fried foods high in saturated fats and any food containing trans-fats are among the guilty as well.  The time of day food is consumed also makes a difference.  Evolutionarily, when man did not eat during the first part of the day, the body assumed that food was in short supply and slowed down metabolism to retain as much of any food consumed later in the day.  Also, the lack of food results in the release of neuro-hormones such as leptin and ghrelin. Leptin is an appetite stimulant that is activated after no intake of foot for a while eating and ghrelin, an appetite suppressant, is repressed under the same circumstances. Therefore, when a person finally eats, the stage is set for them to overeat and in particular crave foods with a high sugar content.  This same hormonal process goes into effect when a person does not get enough sleep and so inadequate sleep, typically less than 7 uninterrupted hours, may also contribute to obesity.

In his recent book Willpower, Robert Baumeister states that decreased blood sugar levels contribute to depleted neurotransmitters leading to poor decision-making. Exhausted capacity for decision-making leads to bad food choices later in the day, often including fast-food takeaways.  It is claimed that sumo wrestlers gain their enormous girth by starving themselves all day, then consuming heavy fats and carbohydrates dinners and then immediately going to bed. Although I am unaware of any scientific evidence for this anecdote, it is consistent with what happens when one does not eat all day and overeats at dinner.

For some people the cause of their obesity may be that they just love food so much that unlike their European counterparts who are said to eat to live, these individuals simply live to eat.  Finally, some obese individuals and this is particularly true for children, have little choice but to consume obesigenic foods because their parents either are ignorant regarding the consequences of such diets, misinformed to believe that they can only afford to offer such unhealthy foods, or are hard-pressed for time to prepare healthy meals. Of course, schools offering similar fare such as pizza and French fries are major contributors to the problem as well.  In fact, last week, some congressman tried to keep pizza on school menus claiming that the tomato sauce used to make the pizza qualified it as a vegetable. The french fries won as potatoes.

Finally, food and supplement marketers, media reporting of inconclusive and mostly observational  studies,  coupled with well-intentioned but misguided populist bromides coming forth from media personalities like Dr. Oz, has completely confused the American population. For example, last week I spoke to a Medicare patient who came in for her 100% covered Annual Wellness Visit. AS part of her visit, I reviewed her supplements and vitamins. She brought them with her and included was Milk Thistle, which she was taking to promote liver health because she heard Dr. Oz say to do it. I suggested otherwise, in the face of the absence of her having any known liver disease.  She also had a bottle labeled sleeping pills which actually contained diphenhydramine, an ant--histamine typically used to control cold, flu, and allergy symptoms. Again, my patient was immediately advised to stop taking it.  In addition, she was taking Vitamin D and calcium from three different sources which were contributing to potential toxicity and she was advised to take only one.  This experience has been repeated multiple times because patients have never had a good resource to identify what supplements if any, they really need.  In a recent Time Magazine article, a writer by the name of John Cloud did his own social science experiment by taking some 3000 supplements over a 5 month period.  He gained over ten pounds because of what he describes as the “licensing effect,” a misguided belief that while taking such pills he had the license to eat unhealthy and weight contributing foods regardless of the consequences.  

So what is America to do under the weight of this problem?  The answer is obviously not simplistic or solutions would have been widely implemented already.

As the United States Preventive Services Task Force recommends, the first step is medical assessment by a primary care practitioner to rule out an underlying clinical condition as the potential root cause of the obesity.  Secondly, I recommend a consultation with a psychologist to rule out any psychosocial reasons for the excessive weight.  If the trained professionals do not identify any medical or psychosocial reasons for the problem, then I recommend consultation with a registered dietitian and exercise physiologist to develop a nutrition as well as exercise plan.  In addition to private consultations, I firmly believe that group sessions are critical to achieving meaningful weight loss. The dynamics of group interaction and peer pressure, as well as a nurturing, non-judgmental, and supportive environment provide the critical and practical information needed to change one’s lifestyle and achieve improved health and weight loss is a clinically proven approach.

As referenced earlier, for Medicare beneficiaries, there is great news because Medicare now covers weight loss counseling by a primary care practitioner in a primary care setting at no cost to the qualified beneficiary.  It is hoped that other insurances will follow Medicare’s lead and implement such coverage in the near future.

So if you have Medicare and need to lose weight, MDPrevent can help.  If you don’t have Medicare, we have a similar program offered at an affordable price. We call our clinically proven program LEAN  (Lifestyle Education And Nutrition) Weight Loss. Our program was developed off a very successful program developed by the Veterans Health Administration which we enhanced. Our team of Preventioneers, so called because we are pioneering new approaches to prevention includes MDs, nurse practitioners, health psychologists, nutritionists/registered dietitians, exercise physiologists, certified yoga instructors, and health educators who are ready to help you.

So if you are interested in learning how you can improve your health, take control of your weight, and live a more fulfilling life, call us today at (561) 807-2561 or visit us at www.mdprevent.net .

About MDPrevent

MDPrevent is a new concept in primary care and preventive medicine. The healthcare services and education company helps Americans reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare for seniors) or self-paid Total Health Assessments, and the development of a five- to 10-year prevention plans. Its MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, exercise physiologists, fitness and yoga instructors and educators also provide interactive group courses on health, diet and nutrition, fitness and exercise, stress management, relationship and social network building, and other key elements of a healthy life. The company also offers the LEAN (Lifestyle Education and Nutrition) program which helps people of all ages not only get healthier, but lose weight, while having fun and decreasing dependence on medications. The goal: to improve aging and well-being by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, dementia and some forms of cancer. Learn more at www.MDPrevent.net.