Monday, December 31, 2012

What Can You Eat If You Have Cancer?

The other day, I saw a patient who had been diagnosed, a number of years ago, with metastatic breast cancer (it had already spread to the lymph nodes in her arm).  She was advised to undergo chemotherapy, but decided instead to undergo a rigorous process of fruit and vegetable juicing. Here she was now years later standing in front of me with no apparent evidence of cancer.  What is the take away from this story? For me, there is none. Anecdotal stories of cures from cancer by food alone offer no compelling scientific evidence. Perhaps the surgeon had effectively removed all the cancer and that is why the patient had no recurrence?  Perhaps she had a very slow growing tumor that continues to spread but goes undetected?  Maybe the fruits and vegetables actually did make a difference? Nevertheless, there can be little doubt that eating healthy foods helps ward off diseases, but the question remains: can you depend on them for a cure?

The problem is that cancer is a confounding disease and can act dissimilar from one person to another even when it is of a similar histology (micro-anatomy) such as squamous, adeno, or sarcoid types of cells. Also, our bodies immune responses to cancer is also different because of our diverse genetic make-ups. That's why we sometime hear of someone being diagnosed with cancer and then passing away a few short months later, while others with similar cancers enjoy many more years of life. It is also true that certain cancers, such as pancreatic cancer, are often discovered very late in their course and often portend very poor short-term outcomes.  Ultimately, the staging (how extensive it is and if it has spread beyond its primary location) of a cancer really does make a difference. The sooner you find cancer, the more effective interventions usually prove to be.

Yesterday, I spent time reviewing various websites that proffer advice on how to eat properly when one has cancer.  What I found was frightening and I am sure very confusing for someone searching for the right answers. The government based sites recommended eating meat and milk products to maintain strength while virtually every other site discouraged consumption of such food materials because of their links to causing and propagating cancer.  The government sites seem to offer their information on the basis of what the government considers healthy eating.

There can be little doubt of the sway of the Dairy and Cattle Associations on the government's recommendations. This is well established.  Nevertheless, a person with cancer is left guessing which set of directions to follow. Unfortunately, I profess some uncertainty in answering this very question. However, I will try.

Based on everything I have read to date, meat and dairy products seem more problematic than helpful when dealing with cancer.  Fruits, vegetables, nuts, beans, seeds, whole grains, and wild Salmon seem more helpful than problematic.  Sugar, other than the natural fructose found in in fruits (don't confuse with high fructose corn syrup, which is horrible), seems universally bad.

Given the choice between conventional therapies and home grown remedies, I would choose both.  My relative battling cancer has made that very choice. He is being bombarded every day with a heavy dose of juicing which includes pomegranates, papaya, berries, apple, citrus fruits, collard greens, turmeric, cinnamon, etc., while also taking prescribed medicine. He is getting the best of both worlds.

As a side note, the person who prepares his food got carried away one day and tried to sneak some very healthy sardines into his smoothie. Suffice it to say, it did not go well. There are limits to what kind of foods can be combined together at one time and still be palatable.  Cancer patients with taste buds need to at best enjoy their food like everyone else, and at worse, not detest it.  There are ample good recipes for combining healthy ingredients; while some experimentation is encouraged, it is advised to not get carried away such as by throwing blueberries and sardines together.

For example, while recently traveling, I got to enjoy a smoothie of my own. There was an airport kiosk offering a smoothie they called "Habit." It contained fresh squeezed orange juice, whole banana, fresh pineapple, raw kale and spinach, and nothing else other than ice. There was no sugar of any type added and I must tell you it was delicious. I understand why they call it "Habit" because I could get use to drinking one of those smoothies every day.

By the way, on another note, this morning I received an email from Harvard Medical School titled "The Top Health Headlines of 2012." The fifth headline was "Do vitamins and other supplements live up to their promise?"

I read the accompanying article and here is a quote from it worth noting:

"Despite their popularity, there is no evidence that multivitamins enhance health or prevent illness. In fact, both the U.S. Preventive Services Task Force and a National Institutes of Health State-of-the-Science Conference concluded that multivitamins do not offer protection against heart disease or cancer."

Now the truth be told, I don't agree with everything I read from Harvard Medical School because sometimes the information provided is outdated or simply wrong. Therefore the information provided is merely offered as another view about the ubiquitous multivitamins and dietary supplements.  As always, consult with your physician before initiating taking any pills.

In summation, although no one can tell you definitively what foods can stop cancer once it develops, it seems prudent, if you or someone you know find him or herself in that situation, to eat like we ate thousands of years ago when meat and dairy were in short supply, and we lived off the land and ate fresh oily fish.

Wednesday, December 19, 2012

Are Dietary Supplements and Multivitamins Addictive?

The Merriam Webster dictionary definition of addiction is a "compulsive need for and use of a habit-forming substance characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly: persistent compulsive use of a substance known by the user to be harmful."

Psychology Today defines it as "a condition that results when a person ingests a substance (alcohol, cocaine, nicotine) or engages in an activity (gambling) that can be pleasurable but the continued use of which becomes compulsive and interferes with ordinary life responsibilities, such as work or relationships, even health."

Pursuant to such definitions, one who takes multivitamins and supplements would not classically be deemed an addict because he or she doesn't know that such pills may be harmful and typically would not experience physiological withdrawal symptoms from the use of such products.

Yet, I would like to offer an alternative definition of addiction.  My definition is the compulsive use of a substance in the absence of any evidence that the product enhances health or that it is not harmful. Furthermore, my definition includes the use of such a product as a crutch and substitute for otherwise engaging in healthy behaviors such as a health promoting diet, physical activity, stress management, etc.

Under my definition, we have an epidemic of supplement addictions in the U.S.

Over the past year, I have been giving lectures to over a thousand people on why supplements and multivitamins are mostly worthless and may be harmful. Yesterday evening, I gave this presentation to a group of about 70 people. As often happens with this lecture topic, I was peppered with questions both during and after the presentation.

Despite citing specific very large studies that demonstrate potential harms related to the use of such products, I was asked repeatedly if there was definitive proof that taking such products is absolutely harmful. One audience member went so far as to state that she had been taking such products for years and had suffered no apparent harm so why was I certain in my pronouncements. Certain audience members shook their head in agreement challenging me to refute this apparent fact.

As the intensity of the pro-supplement voices rose, I took a deep breath, composed my thoughts and answered as follows. First, I reminded the audience of Mark Twain's quip that "It's not what we know that gets us into trouble. It's what we know for sure that does." I explained that that I could not state with absolute certainty, given the biological diversity of people, that all multivitamins and supplements were equally worthless and/or harmful to everyone.

People have different medical histories, use different prescriptions, engage in different lifestyles, eat different diets, and have different genetic predispositions. Such diversity often challenges and complicates the application of research results to any given individual. Furthermore, some people may actually suffer from a deficiency that for one reason or another can't be addressed simply by regular food. By the way, this is extremely rare.

I also explained that sometimes the evidence of harm can be many years in the making. The development of a mesothelioma, a cancer, may not be evident until thirty years after exposure to a single strand of asbestos. Also, many of the diseases that afflict most western civilization inhabitants such as heart disease, stroke, dementia, etc. do not develop for many decades after steadily engaging in unhealthy behaviors. Even most sugar addicts and cigarette smokers don't develop diabetes and lung cancer respectively for many years of use. (True, some never develop it.)

Yet, something more nefarious was underfoot. I felt like I was suddenly challenging certain people's religious or political beliefs. There was palpable angst in the audience. Then it hit me. Instead of sharing my facts about such products, I should be asking questions.

"Hold everything," I said to the audience, "Why has the burden fallen on me to produce evidence that such products demote health, are harmful, shorten life, etc.?" I further queried, "Why are you not demanding proof of benefit and of no harm prior to spending your hard earned money on products that offer no such evidence?" Why are you blindly following advice from people who have a pure profit motive in getting you to buy their products?"

I shared with the audience an encounter three weeks prior at another such lecture when a Shaklee representative (Shaklee is a multilevel marketing supplement distributor) chimed in from the audience that based on a landmark study it performed, Shaklee offers such proof that it's products are worth the money spent on them.

I've since obtained the study to which he was referring. It is a ridiculous study confabulated by Shaklee to produce desired results. Basically, Shaklee compared selective data they gathered from their affluent product users to data collected by the government from many poor and elderly citizens.  It is not a valid comparison and the study was essentially a worthless (not for Shaklee) piece of marketing propaganda. No surprise there.

The bottom line is that the supplement industry has sowed so much confusion that even doctors no longer know which products are valid, when they are necessary, how much to recommend, etc. As Consumer Reports published in September 2012, there are now 55,000 products for sale and over $100 billion of nutritional products sold each year.

The weight and consistency of the marketing has been so effective that people are no longer asking the most basic of questions. Will this product help or hurt me? Is there any scientific validity to the use of this product for the reason I am taking it? Is it worth the money I am spending?

Since 1994, the law of this land is that supplement product companies need offer no proof of effectiveness to market their products--and so they don't. But like lambs to the slaughter, people continue to line up sheepishly and buy millions of these pill bottles of uncertain value. It is estimated that somewhere between 50 to 80% of Americans now take one form or another of supplement.

The value of these products, now occupying only 80 years of our 150,000 year chronicle (millions more if you include early man), may be the single biggest hoax in mankind's history.

Taking invalidated, potentially harmful supplements may not seem like an addiction to you, but it sure does to me.

Saturday, December 8, 2012

It's Never One Thing

It would be an understatement to state that I have become fascinated with all aspects of longevity and disease prevention. Over twenty thousand studies and a dozen books later, my search for the quintessential answer to a long and healthy life goes on.  The body of knowledge is so vast and the hours are so short that I suspect that I shall never fully grasp all the intricacies of what allows any single person to optimize his or her longevity and minimize susceptibility to disease. While scrutinizing certain cultures that appear more successful at longevity may offer some clues, even among their members you will find those that die far younger than others despite similar lifestyles.

However, one thing has become abundantly clear to me: a long and disease free life is never dependent on just one thing.

This statement is made with the caveat that obvious detriments to health, such as consuming lethal poison or jumping off a perilous cliff, offer certain consequences.  Nevertheless, when one removes from the list such immediate threats to continued living, it becomes crystal clear that a host of factors contribute to the life we live and the day we die.

Foremost, but often not close to the most important factor, is the role that genetics plays. This is the influence least under our control as we obviously have no role in choosing our parents. But numerous studies, and in particular, the Swedish Twin Studies (that began in the 1870's, involving tens of thousands of identical twins who happened to grow up separately with varying lifestyles who developed different diseases and died at vastly different ages),  have demonstrated that genetics plays no more than a 15 to 30% role in our overall longevity and disease development. Of course, those born with Down's syndrome, hemophilia and other genetic disorders would argue otherwise and they would be right. But for most people, genetics at most represents a predisposition for diseases whose ultimate manifestations are under our control.

So what does matter? For one, but not alone, it is environmental factors. Which? That's the $64,000 question. Is it processed foods, gluten, pesticides, household chemicals, pollution, contamination, etc., or could it be some mix and match of all of them?

Anyone who tells you they know with certainty is either delusional or just flubbing.

The reason no one can tell you the absolute answer is that it is often different for different people. For example, there are smokers who live to 100 and others that die far earlier. Some obese individuals have heart attacks in his or her 30's while others survive into their 90's.

More importantly, no one can do better than hypothesize because the scientific method can never be applied to such a multivariate question. The gold standard of scientific inquiry into a population's health would require a double-blind, randomized controlled study where all confounding variables are controlled. Unless we could snugly place people in a bubble, we could never firmly establish a definitive working conclusion.

Nevertheless, scientists slog on trying to make sense of what they can. They can show a strong correlation between smoking and lung cancer, alcoholism and cirrhosis of the liver, obesity and heart disease, etc. What they can't do is tell you if you simply avoid or consume one particular food then your longevity is guaranteed to be positively or negatively impacted, respectively.

For example, I think there is a strong basis in science to call sugar a human poison, albeit a slow acting one. My patients are cautioned to avoid it and to go to great lengths to minimize their exposure to it. Nevertheless, I don't believe that avoiding sugar alone guarantees a long life.

I often tell my audiences that if they eat plenty of fruits and vegetables, nuts and beans and seeds, whole grains and wild fish--they are going to die.  I suspect they expect a different conclusion than the one proffered, but it's the truth.  Long before processed foods even existed, people died and some at relatively young ages from a myriad of other factors--infections foremost among them.  Food allows you to live by providing essential nutrition, but it doesn't guarantee health. Healthy eating doesn't offer protection against many simple infections like chickenpox and viruses or more esoteric infections like tuberculosis and tetanus.  These sometimes life-threatening ailments often depend on passing exposure to these pathogens.

So what else matters? The mind.

Many an otherwise healthy person has been befallen by stress, anxiety, depression or any other number of mental health issues. Such factors may have a genetic or familial disposition. Some may be purely situational. Sometimes it's both. The connection between the mind and body is well established. It facilitates innocuous placebos to work and allows real, measurable systemic diseases to develop in the absence of any other factors.

I have witnessed this first hand. Learning about my family member's cancer brought back my heartburn which I thought I had banished forever. No diagnostic medical test, and I've had plenty of them searching for a clinical reason, has shown any other identifiable cause for this phenomenon. I know it is because of stress.  Despite eating, sleeping, and living well, I have struggled to control my own guttural reaction to difficult news. I know that I must learn to manage my reaction to difficult news and I strive everyday to naturally manage my stress to relieve my symptoms.

This is why I know that the complex human body forged over 150,000 years to it's current form, and millions of years earlier in prior forms, is at once and always will be a very vulnerable and fragile system, highly complicated and efficient-- a veritable miracle of nature subject to forces sometimes beyond our control.

Although many would have you believe by the titles of their books such as "Why We Get Fat" or "Wheat Belly" that your health depends on one thing, I will tell you that it's simply not true.  No pill, prescription or supplement, no food described as super or otherwise, no exercise routine, done in the gym or in nature, will guarantee health.  Alternatively, certain vices like smoking and excess alcohol, consumption of certain processed foods, a sedentary lifestyle, poor sleep, great stress, etc. while expected to have a detrimental effect on your health, don't always factor in your death.

Your health depends on a combination of factors that affect both your body and mind.  Ignoring any of these factors shifts the odds against you for a long and healthy life.

But please take note, it's never one thing.

Saturday, December 1, 2012

Is Dr. Oz Nuts Over Ice Cream? or The Worst Food Advice Dr. Oz Ever Gave!

Many readers of this blog know of my disdain for Dr. Oz's reckless proclamations on his nationally televised show. From Green Coffee Extract for weight loss to two baby aspirins at night for unknown pain, I find such advice irresponsible and dangerous. After watching numerous shows and finding much to object to, I simply stopped watching.

Occasionally, I am reminded of his showmanship when a patient presents to MDPrevent with a heaping batch of worthless supplements in tow. The patients are often surprised when I surmise before even asking that they are a fan of Dr. Oz. "How did you know? they ask. The answer is simple because many of the products they are taking are among the worst of his recommendations, offenders like Raspberry Ketones, Sage Leaf Extract, Glucomanan, etc.  I am always delighted to relieve them of the expense and chicanery of such products.

So after stopping to waste valuable time watching his show, I thought I had finally effectively distanced myself from Oz. It was not meant to be.

Last week, I came across a magazine cover on an airport newsstand. The large picture of frozen food colorfully displayed on the cover immediately caught my eye and the name below ultimately proved too intriguing to pass by.  I say ultimately because I first ignored it and took a seat at my terminal only to shortly thereafter return to the newsstand to peruse the article behind the cover. (Yes, I actually read it standing there as I could not bring myself to pay for such anticipated nonsense.)

In the December 3, 2012 issue of Time magazine, I read an article written by Dr. Oz's titled 'Give (Frozen) Peas a Chance--and Carrots Too."  The article starts innocently enough with Oz explaining that frozen vegetables retain the same nutrition as their fresh counterparts. On this point, the science supports the good doctor. As I kept reading, his other assertions also seemed hardly controversial.  Then it came and couldn't believe it.

Mid way through the article, Dr. Oz shares a personal story of how he and his father use to drive together to the ice cream store when he was a child.  During these wonderfully memorable rides, he writes how he learned much of what he knows about his father. Accordingly, he has fond memories associated with eating ice cream. This is not surprising.

Almost all patients I care for relate some positive (or negative) association with certain foods. Some enjoy steak because it represents a positive correlation to family dinners celebrated over some good news.  For me, it's watermelon. It reminds me of returning from romantic dates on Saturday nights and enjoying a sumptuous slice of cool watermelon alone and undisturbed in the kitchen.

For Dr. Oz, it is clearly ice cream. On the surface there is nothing wrong with that. In fact, it's a very nice story and sentiment.  Except he feels that his sentimental story warrants telling his readers that they should therefore consume ice cream (albeit in reasonable quantities).

There can be no doubt that Dr. Oz is aware of the epidemic of obesity that is ravaging our country. 36% are obese, two-thirds are overweight, over half die from heart disease, 8% have diabetes, etc. At the center of this huge problem is sugar, the very kind one would find in the ice cream touted by Dr. Oz.

In my clinical experience as well as in countless studies, many people clearly identify themselves as addicted to sugar and sugar has been demonstrated to cause the same areas of the brain to light up as drugs do for drug addicts and alcohol does for alcoholics. Recent studies also closely correlate sugar consumption with cancer stimulation and growth (by stimulating insulin release which then binds to insulin receptors on the cancer surface to signal uptake of such sugar to meet the energy needs of the cancer cells trying to multiply).

A recent article in Mother Jones magazine chronicles the efforts of the sugar industry over the past five decades to squelch negative publicity about the dangers of sugar and to confuse the populace about its perils.  Sugar and related simple carbohydrates are also primarily responsible for the development of diabetes and high triglycerides.  You don't have to be a doctor, let alone a cardiovascular surgeon, to know of the dangers of sugar even in small amounts for certain people and in larger amounts for virtually everyone.

Now don't even get me started on the fat content of the full fat cream used in most ice creams or the hormones, antibiotics (despite the law), and cornstarch fed to the cows that produce the milk used to make such products. And what about the food additives and coloring added for a myriad of flavors that range from cookie dough to maple walnut?

"Everyone knows that ice cream isn't good for you — it's a splurge," says Jayne Hurley, a senior nutritionist at the Center for Science in the Public Interest. "But most people don't realize how much of a splurge it is."

In 2009, the Center for Science in the Public Interest commissioned a study that looked at saturated fat and calories in some of the most popular treats from Baskin-Robbins, Cold Stone Creamery, Friendly's, Ben & Jerry's and TCBY. Most of the information in the nutritional analysis was provided by the companies.

(The following is excerpted from an article that appeared on a CBS News website in 2009.)

"Among the findings in "Living Large: The Scoop on Ice Cream Shops":

A chocolate-dipped waffle cone at Ben & Jerry's has about 320 calories and 16 grams of fat. Add one scoop of Chunky Monkey ice cream and the total surges to 820 calories and 26 grams of saturated fat — roughly as much as a one-pound rack of ribs.

Cold Stone Creamery's regular-size "Mud Pie Mojo" — coffee ice cream, roasted almonds, fudge, Oreo cookies, peanut butter and whipped topping — has a saturated fat and calorie level equal to two personal pan pepperoni pizzas from Pizza Hut.

At 1,270 calories and 38 grams of saturated fat, eating a Haagen-Dazs "Mint Chip Dazzler" sundae is like eating a T-bone steak, a Caesar salad and a baked potato with sour cream."

This appears to be the same type of ice cream that Dr Oz is advocating that people eat when they go to the store for this dangerous treat.  He just says don't eat too much. Right.

(By the way, for further proof if his unreliability, on a website in which Oz has an ownership stake, a video is posted featuring him with the label, "Ice cream is delicious, but it is packed with fat and calories. In this video, Dr. Oz presents his concoction for a healthier ice cream treat.")

Folks, I don't care what sentimental attachment Oz has for ice cream. I hope you agree that it is reprehensible to tell a population struggling with weight problems to continue to eat one of the foods most closely related to avoidable chronic diseases such as heart disease, diabetes, strokes, cancer, etc.--even in small amounts. Most people can't control such urges and studies have demonstrated that faced with such willpower choices, willpower will often fail them. One study even demonstrated that when confronted with flavorful food, the body will release a hormone that will stimulate people to eat even when they are not hungry.

On further thought, maybe it's a good thing if Oz keeps eating ice cream. Then I may not have to waste time educating others of the danger of taking health advice from him on TV, on the web, or in print.

That's not true. I really don't mean him or anybody harm so I hope he knows better and just keeps his mouth shut when it comes to eating and giving advice about ice cream. It wasn't the first time he made such a blunder, but for all our sakes and particularly those who hold him in great esteem and follow his every pronouncement, let's hope it's the last.

Monday, November 12, 2012

Do Fruits and Vegatables Prevent Cancer?

The answer in one word is "unproven." A large study involving 500,000 Europeans over a multi-year basis failed to show a definitive correlation between cancer development and fruit and vegetable consumption.

So if that's the case, why is it important to eat such whole foods?

Before I give you an answer, I want to point out the trap that you may have fallen into by even considering this question. If you've been reading this blog for some time, then at this point you should realize that when it comes to your health, X usually does not cause or prevent Y.

Yes, there are some notable exceptions like cigarette smoking causing lung cancer, trans-fats causing heart disease, etc. but it's almost never so simple.  True, we also know that sufficient levels of Vitamin A prevent night blindness, of niacin prevent pellagra, of Vitamin C prevent scurvy, etc. In other words, there are known cause and effects for certain diseases, but it's usually not one thing alone that causes the major killers such as heart disease, cancer, etc.

Why? The human body is a very complicated machine that is usually able to handle many imperfections (like autoimmune diseases, etc.) and environmental assaults (unhealthy foods, etc.) before it breaks down and stops working completely. It has many built-in mechanisms such as the immune system, the complement system, etc. that fight to fix problems before they wreak havoc.

Even in the case of really harmful things like smoking, not everyone develops lung cancer, one of the known consequences. Sometimes smokers die from the heart damage that smoking does and sometimes they die from something completely unrelated. (Many smokers who don't develop cancer from smoking do develop other lung diseases like emphysema and Chronic Obstructive Pulmonary Disease (COPD), the fourth highest killer of Americans.)

The point here is that it would be a mistake to think that anything, including fruits and vegetables, considered in isolation would prevent major diseases such as heart disease, the leading killer of Americans, and cancer, the second leading cause of death.

It is the sum of the parts that ultimately make a difference. If one eats lots of fruits and vegetables but simultaneously eats lots of processed sugar and other known carcinogens, the fruits and vegetables are unlikely to yield a high preventive effect.

So now let's come back to my question of why it is important to eat fruits and vegetables in regards to cancer.

The answer is that while no study has distinctly proven a cause and effect relationship between the amounts of fruits and vegetables one consumes (once above the deficiency threshold and below the toxicity level) and the development of cancer, there are certain factors that have proven to be strong risk factors for cancer development. One is weight. Overweight and obese people appear to have a markedly increased risk for development of a variety of types of cancer affecting both men and women. It is also a strong risk factor for cancer recurrence. For most people, their weight is a direct result of the types of foods they eat. People who typically eat more fruits and vegetables usually eat less processed foods like breads, crackers, pasta, etc. and weigh less. (See my previous posts 'Why You Get Fat?'  and the two part 'Why You Stay Fat?' for a more exhaustive discussion.)

As I previously wrote about a close relative that was recently diagnosed with cancer, I have taken a keen and deeper interest in the subjects of cancer prevention and survivability so that I may offer this relative the best guidance.

After review of hundreds of cancer prevention studies, I have reached some very tentative conclusions.

Fruits and vegetables alone (and clearly supplements including vitamins, minerals, antioxidants, etc. naturally found or synthetically produced to mirror such chemicals) do not alone prevent cancer.

However, as part of an otherwise healthy lifestyle that includes avoidance of known carcinogens such as smoking, drinking lots of alcohol, being overweight, exposure to environmental hazards such as asbestos and numerous other substances and chemicals such as acrylamide that develops on the surface of french fries during the frying process, nitrites used to preserve cured meats, certain food dyes, pesticides, and other chemical additives, etc., eating fruits and vegetables is likely to cut down one's risk of both developing cancer and dying from it.  As I previously wrote, the risk of men developing cancer is 1 out of 2 and of dying from it is 1 out of 4. For women, the numbers are slightly better with the risk of developing it being 1 out of 3 and of dying of it being 1 out of 5.

Cancer remains mostly a disease of random mutations instead of genetics.  What causes these mutations, why some get it versus others, and why some survive the exact same cancers while others die from them remains an issue of scientific debate. While science continues to try to figure it out, do yourself a favor and shift the odds in your favor. Substitute fruits and vegetables in place of processed foods, in addition to making many other known healthy lifestyle choices such as regular exercise, getting proper sleep, etc.  By doing so, you will give your body every opportunity to function at the optimal health level and to continue functioning for many more good years.

Thursday, November 1, 2012

Waiting for cancer?

Let me tell you a very personal story. About three weeks ago, I got a phone call in the evening from a close relative. During the call, I was informed that this person had been diagnosed with cancer. A week later the person called again and notified me that a second cancer had also been diagnosed.  I was devastated and I am still reeling from the news. I love this person very much and can only imagine how dreadful it is for someone to be diagnosed with cancer and what fear it must invoke. Of course, when a close relative develops a serious illness, other family members are surely also concerned about the risk to their own health of developing a similar disease.  Such news brings pain to all quarters.

According to the American Cancer Society, the risk of a man developing cancer is 1 in 2 and of dying of cancer is 1 in 4. The risk of a woman developing cancer is 1 in 3 and of dying of cancer is 1 in 5. You have to be a Luddite not to be concerned about such odds and the personal risk to you of developing this horrific illness.

Although there is clearly a genetic basis for some people to develop cancer, most cancers are random mutations.  In general, it is now believed by credible scientists that virtually all people have cancers cells of one type or another in their bodies at all times due to such random mutations. However, their properly functioning immune system is often capable of dispatching with most of these fledgling cancer cells before they develop into life-threatening tumors.

At this point you may be thinking that if it's only a question of odds, then why not just hope that you will be lucky because what else can you do?  Well, I am here to tell you that there may be a lot to do.

It's well known that professional gamblers using a variety of techniques are able to improve their odds in casinos. For example, counting cards while playing the card game black jack shifts the odds in one's favor over the house. Such subtle shifts can make the difference between vast losses and gains.

In life, can there be any greater loss than the loss of health?

As with gambling, certain human behaviors shift the odds in favor of avoiding or even curing cancer.

Dr. Dean Ornish, in a landmark experiment, demonstrated that a change in diet could stop the expression of prostate cancer. In a limited study, he showed that with certain men, he could arrest the progression of the disease.

It is well established that breast cancer survivors who are overweight have a much higher rate of recurrence of their cancer than comparative normal weight ladies.

There are countless credible studies that support the role of diet and lifestyle in cancer development and death and at this point, almost all doctors agree that lifestyle, including diet, plays a major role in one's health and risk of dying from cancer.

Let's get back to my painful story. After researching the specific types of cancers that my relative had developed, I offered directed recommendations regarding changes in diet and lifestyle that offered hope for improved health and survivability.  After sharing a number of suggested changes, my close relative suddenly uttered that he/she was not prepared to go crazy about his/her diet.

What prompted this response?  My suggestion to eliminate all processed sugar products from the diet.

There has developed a growing body of evidence that sugar stimulates the growth of cancer. It does so by causing the release of insulin which binds to insulin receptors on the surface of solid tumors and stimulates them to grow faster.

When I shared this with a friend yesterday, she asked me why she hadn't heard about the role of sugar in cancer before?  She said her father had died from cancer and one of the country's leading oncologists had never mentioned the need for her father to avoid the sweet stuff.  Unsure of how long it had been since her father passed, I queried and she said that it was about ten years ago.  My response to her question was that scientists did not have as clear an understanding ten years ago as they do today about the dangers of sugar and other dietary intakes on their role in cancer development, progression, and survivability.

As fate would have it, a patient gave me an article two days ago that recently appeared in Mother Jones magazine chronicling the efforts of the sugar industry to suppress the alarming facts regarding the dangers of sugar not only for cancer development, but for heart disease and diabetes as well. Like Big Tobacco before it, the sugar industry has been very successful in confusing the general population into being unalarmed and apathetic about the dangers that sugar poses.

It's gotten so bad that most people actually believe that eating sugar 'in moderation' (however they define moderation) poses no threat to their health. Yet, our country suffers from an epidemic of obesity, heart disease, diabetes and dementia, with a rising tide of metabolic syndrome in which people have elevated blood pressure, sugar and cholesterol.

It may be unfair to single out sugar and its precursors (high glycemic index carbohydrates) as the worst culprits, but the label may actually be accurate. Clearly there are numerous other protagonists responsible for our health problems, including trans-fats, saturated fats, food additives, etc., but sugar laden products such as those containing High Fructose Corn Syrup, deserve special attention.

There are many ways to die, but I can't imagine a much worse way that wasting away from cancer. I still vividly remember as a medical student when I was asked to see a patient in the hospital.  As I entered the room, I saw a very jaundiced looking man with the outlined remains of what I could only imagine were once extremely good looks, who had wasted away and was now close to death from cancer. After addressing his immediate concern for which I had been summoned, I asked if there was anything else I could get him. I still get chills thinking about his response. He answered softly, but assuredly, that I could give him back his health. Then he smiled at me, apparently resigned to his fate.  He died a few days later.

As scientists now know about the major role that food plays in the cancer story, it would be a shame not to take heed of preventive measures that could very well save your life and allow you to enjoy many more years of disease-free living.  I wish I knew in medical school what I know now and I wish I had been able to do more for this stranger. He is long gone, but there are many more than can be helped now.

Let me start by suggesting some basic rules of staying healthy. The top rule is to eat mostly foods that have no labels, such as fruits and vegetables.  Enjoy large amounts of beans, lentils, chickpeas, nuts, and seeds. Consume whole grains on a regular basis particularly the ancient grains such as spelt, quinoa, and millet. Make Wild Salmon a staple of your dinner table, consuming it even every other day if possible.

Of course, you can ignore this advice and gamble with your life and the increased risk of developing cancer.  Or maybe, you now understand the risks and aren't willing to play the odds.

In addition, make sure that you stay physically active by walking at least 7,500 steps (3.75 miles) per day with at least 15 minutes of more intense exertion each day. Get at least 7 hours of sleep a night with at least 3-4 hours of uninterrupted sleep. Manage your stress by learning techniques to deal with life's inevitable stressors such as relatives informing you that they are ill.

The great American poet Robert Frost once wrote that "two roads diverged in the woods" and he "took the one less traveled by, And that has made all the difference."

Are you going to stay on the road traveled by most people of eating whatever they want blinded to the dangers of developing cancer and other horrible diseases that prematurely shorten their lives or simply make life far more difficult OR will you take the road less traveled by, by eating healthier and see if that makes all the difference?

Are you waiting for cancer? Please don't. It's not worth the wait.

Sunday, October 28, 2012

Vitamin D Takes A Hit

Faithful readers of this blog (May 18 and August 29) have read my railings against Vitamin D for some time now. It never made sense to me that so many Americans were deemed to be Vitamin D deficient nor did it make much sense that as people got heavier that their blood test for Vitamin D would report lower levels although they wouldn't develop any deficiency symptoms. I even raised the question if it was possible that fat stored Vitamin D (fat soluble) is available to the body when needed.  While this question remains unanswered, the question of what defines a Vitamin D deficiency just got a new answer and I think it makes sense.

The Institute of Medicine (IOM) just revised the guidelines for what defines a Vitamin D deficiency.

First, a little about the IOM.  The Institute of Medicine (IOM) is an independent, nonprofit organization that
works outside of government to provide unbiased and authoritative advice to decision makers and the public. 
Established in 1970, the IOM is the health arm of the National Academy of Sciences, which was chartered under President Abraham Lincoln in 1863. Nearly 150 years later, the National Academy of Sciences has expanded into what is collectively known as the National Academies, which comprises the National Academy of Sciences, the National Academy of Engineering, the National Research Council, and the IOM.

Under the new IOM guidelines, you are considered to have adequate Vitamin D levels if your level is above 20 ng/mL. The previous level was 30 ng/mL. In one fell swoop, the IOM has essentially removed almost all Americans from the category of being Vitamin D deficient. 

You will no doubt hear push-back from those quarters that make money peddling Vitamin D and related advice, but you should essentially ignore them. The IOM is trustworthy.

So if you didn't have enough reasons yet to push aside your multivitamins and Vitamin D supplements, perhaps this one will do the trick for you.

For the umpteenth time, eat whole foods including a wide variety of vegetables, fruits, beans, nuts, seeds, whole grains and Wild Salmon and you will consume all the vitamins, minerals, antioxidants and all the other health promoting nutrients you need for a healthy mind and body. Get 15-30 minutes of sun each day (earlier or later in the day and avoid reddening) and Vitamin D is also well covered. (You also get it from Wild Salmon.)

The key to a healthy life is to eat healthy every day.

Sunday, October 21, 2012

Do Multivitamins Prevent Cancer? Part 2

The media is having a field day with the recent study titled Physician Health Study II (PHS II) which claims that multivitamins may slightly decrease cancer rates among men.  If you simply read the headlines and you are a man that wants to decrease your risk of developing cancer, you would think that you should immediately run out and buy a multivitamin, and if you are taking one, you should keep taking it.


The results are not quite living up to all the hype.

According to the study, after 11.4 years of taking multivitamins, only men, predominantly older than 70, showed mild decreases in certain cancers. In fact, this study included men who had previously been diagnosed with cancer, among whom for some unknown reasons were found the best results.

This study, paid for by the multivitamin manufacturers, including Pfizer, actually showed the following:

Slight increases in prostate cancer (662 placebo takers versus 667 among multivitamin users) and melanoma (89 increased to 100).
Slight decreases in total cancer (1253 to 1195).
Slight decrease in colon cancer (95 to 88).
Total mortality (death) slightly decreased from 1,134 to 1,092. That means for over 13,000 total men in the study, there were still over 2,200 deaths and only a decrease of 42 total deaths.

Get this. By my calculation, over 26,000,000 (million) pills over 11 years were taken by 6,660 men to spare 42 deaths. Ouch!  No wonder the drug companies want to push the results of such a study.

Basically, the men who took a daily multivitamin for over 11 years so no improvement in prostate, colon, and bladder cancer and no change in their overall cancer mortality. Also, a careful review of the study shows that the multivitamin users were also slightly less likely to smoke and slightly more likely to eat fruits and vegetables.

Finally, the study did not identify if any of the men had vitamin deficiencies prior to the start of the study. As they focused on physicians, who generally work long hours, there is a high probability that these men spent little time in the sun and therefore had an increased risk of Vitamin D inadequacy or deficiency.

Ladies and gentleman, overall, this study and the numbers presented basically prove nothing. With the overall cancer rate decreasing from 18.4 to 17.6 for every 1,000 years, there remains no reason to believe that multivitamins offer any benefit in the absence of deficiency.

The bottom line is that most importantly, despite taking a multivitamin every day, about 20% of the men still developed cancer and about 20% died.  Save your money!

So once again you are chastened to remember, Caveat Lector! (Let the reader beware).

Wednesday, October 17, 2012

Do Multivitamins Prevent Cancer? Part 1

If you are tuned in to health news, you may have heard about the new study that showed that among older men who took multivitamins, the incidence of cancer was reduced by 8%. Just like the studies that showed increased death rates in women who took multivitamins, this study failed to control for overall health.  

Therefore, when considering the relevance of these findings one does not know if the results were due to cause and effect or coincidence.

Undoubtedly, almost everyone, including the authors of this study, agree that foods that contain such multivitamins in their natural form as those studied have value in cancer prevention. Therefore, without controlling for the diet of the subjects of this study, one cannot reach conclusions whether the moderate reduction in non-prostate cancer rates (there was no reduction in prostate cancers, which represented half of the cancers that developed) we're due to pills or food.  Also, the study did not identify those who had nutritional deficiencies that can impair proper immune system functioning that can lead to cancer growth. 

Furthermore, this research was paid for by companies that provided the vitamins used in the study, which always raises red flags. 

So what's the take-away?  Eat whole foods like vegetables, fruits, nuts, beans, whole grains and wild salmon that contain all the essential vitamins, minerals, fatty acids, and amino acids our body needs that exist in a presumed synergistic relationship with hundreds of other nutrients and avoid synthetic pills of isolated chemicals.

But don't take my word for it. Tomorrow I will give you the actual numbers from the study and you can reach your own conclusions.

Monday, October 15, 2012

Why You Stay Fat...Part Two

This is Part Two. Please read Part One from yesterday first.

In the next step of my initial encounter with a patient, I always share a personal anecdote about my children and college. It starts with my denoting the perceived value of a great education. I believe there are few equals, in terms of value gained in knowledge, future employment possibilities, and self-esteem, compared to an excellent education. Today, college is a necessity for most, but an increasingly expensive proposition, and the more rigorous, higher vaunted and sought after private and public colleges are no exception. Accordingly, I confess to a bias that all teenagers should strive to get the best possible college education for the money (or their parents' money for the fortunate ones) spent.

To gain admission to the more intellectually challenging schools, a high school candidate most usually presents an exceptional academic record (except if you are a gifted athlete or have legacy).  What does such a record entail?  Mostly As.  How does one get mostly As?  By studying to get A pluses. You see, when you study for an A minus, you may and can often end up with a B. Study for a B and failure becomes an option.  Studying for an A plus offers no guarantees, but it does increase the likelihood of success.

Suffice it to say that my three, now adult children, were exposed to this philosophy early in life, and I am glad to say they all made it their own. Effort, diligence, attention to detail all paid off for them as it usually does for most people. (Just ask my children the three personal traits that lead to success and each will independently rattle off "persistence, perseverance and tenacity." I began to share these ideas with them when they were barely out of diapers.)

Regardless of one's mental capacity and education acumen, there is no substitute for motivation and effort when it comes to any level of success.

Likewise, people who want to change their weight status and health, most also strive for similar excellence. Even if you didn't go to college or an A was not your usual grade (or you never even saw an A), the pursuit of excellence is inherent in all of us. You must believe as much if you are to make changes in your life. I have yet to meet a regular person incapable of making changes. I know you can, but you must believe in yourself as well.

How does this rah-rah cheer-leading apply to your life and what does my excellence-in-school example have to do with anything? For that, you need answer, as my patients do, the next question.

What percent of food in your house would you deem unhealthy? To qualify as unhealthy, let's include the following: bread, crackers, cookies, cakes, chips, pasta, yellow cheeses, creams, margarine, butter, ice cream, fruit yogurts, fruit juices, etc.  What ever number comes to your mind that is less than 20% should be doubled as you probably missed a few.  Now think back to my school example. If there is any unhealthy food in your house, what is the probability that you will not consume it at some point, any point? Are you aiming for an A+ or are you aiming from the get go for a B or C?  Are you setting yourself up for failure before you even start?

If the unhealthy food is there, regardless of your excuse that it's for your spouse, your children, your guests, etc., you are rationalizing trouble ahead. The reason is because if you are depending on willpower to save you from devouring the food, it will eventually fail you.  Willpower almost never does well against constant temptation. In fact, according to scientific studies (see the book Willpower by Roy Baumeister), willpower gets depleted as you repeatedly make decisions to spurn temptation. At some point, mistakes, weakness, if not disaster looms. It is said that the average person makes about 200 food related decisions per day. With so many decisions to make throughout the day, isn't it likely you will make a few bad choices? That's just one of the reasons you can't rely on willpower. The best approach to willpower is developing a process, such as food shopping when you are not hungry, but that's a topic for another day.)

So what's a person to do to avoid the trap of eating unhealthy foods and snacks at home? Remove in their entirety (donate to homeless shelter or just discard) such unhealthy foods from your house and replace them with health promoting foods like vegetables, fruits, beans, seeds, nuts, whole grains and wild salmon. This is the FIRST step towards taking control and reinventing YOU.

So the first reason people stay fat is that they deceive themselves into believing that they can control their urges at all times and they don't need a process in place to make good choices consistently.  This is true whether they eat at home or at restaurants.

But I'm not done with the analogies just yet.

Have you ever owned a car, or know someone who has, that required premium fuel only. If you or they owned (as opposed to leased) the car, did you or they put anything, but premium gas in the tank? The common answer I get to this question is "no" and the reason I'm given is that the person believes that the car will not function as well with inferior quality gas.

But more importantly, most would agree that the engine of a car that requires one level of gas and receives an inferior level may ultimately fail. So what's the big deal? Can't you replace the car if the engine fails? So you are out of pocket a few bucks, but who doesn't like to get a new car once in a while? Cars are replaceable!

Well by now you probably get the point. Your body is not replaceable and yet many people, particularly those who eat poorly, treat it like they can swap it out anytime. (Maybe when science fiction collides with reality that may become true, but don't depend on that happening any time soon.)

Therefore, the secret to losing weight for health reasons is not to focus on losing weight, but to focus on getting healthy. To borrow again from the car analogy, if you feed the car premium gas, the engine will run better and last longer. Just like premium gas helps maintain the value of your asset, health promoting foods enhance the vitality of your life.

Accordingly, the second reason people stay fat is because of the type of foods they eat far more than the amounts of foods they eat. Premium foods like whole foods mostly promote health without weight gain; processed foods do the opposite.

Therefore, although I am not a psychologist, I know if people can't wrap their minds around the notion of changing their behavior and are not fully committed to make critical changes to their food selection, they simply aren't going to succeed. BUT... if they can light the candle of inspiration so it shines bright...if they can flip the switch and make the connection in their minds...if they can follow the label that says 'Premium Fuel Only"...and they are willing to work for the A...wonderful things can and will happen.

I often ask my patients if they are religious and the answer is usually no. They always have this immediate look of concern as they wonder if I am a proselytizer? I am not. In which case, I tell them that losing weight will require them to find religion. I am not referring to the religion of believing in a sovereign being (as I do); rather, I am denoting the religion of faith and conviction in one's own actions. I tell them, using a wide variety of references to holy war such as "crusades" and "jihad," that it's time to take up the battle against their fat-craving bodies and regain control. (I mean no offense to anyone that thinks such terms should not be used lightly given their historical consequences. I use them because they strike powerful images in people's minds and I am prepared to go to great lengths to help people get healthy.)

The battle of the bulge is as great a fight as any human being can ever be expected to fight on their own terms.  It takes that level of consciousness to win this war of attrition and claim back which is rightfully yours--your health and waistline!

As partners with my patients, I help them help themselves realize their aspirations, whether to look and feel better, or for whatever reason they are motivated to do so. Together, we take the first steps to a higher quality, healthier life. Yes, the process begins with what feels like a psychological intervention. But this is merely the first step of a method proven to work without drugs, supplements, and surgery to improve health and lose weight.

We teach how to eat right at all times without ever feeling hungry: No tricks, just a changed attitude that results in changed needs.

You can change your life, improve your health, and have more energy today if you are clear about your motivations. If you are not, let's speak.
(561) 807-2561

Sunday, October 14, 2012

Why You Stay Fat...Part One

In my previous blog "Why You Get Fat...," I explained that there are five factors that contribute to weight gain (medical, diet, physical activity, sleep and stress). Of course, to lose weight you must address these factors. But once you have gained weight, to shed the unhealthy excess pounds becomes more complicated than just confronting the factors that caused you to get fat in the first place. That's because your body actually doesn't want to give up it's fat stores. It sees fat as energy storage and is invested in the rainy day theorem that you can never have enough fat for difficult times.

(In fact, according to a recent study dealing with diabetes, as the disease progresses, the human body begins to waste away. Therefore, the study showed that those with more body fat actually fare better because they survive longer. Diabetics take note: Just because extra fat can sometimes have perverse benefits, please don't let your disease get to that wasting away stage because there are ways to prevent such progression.  Nevertheless, for most people excess weight actually causes problems like the metabolic syndrome with elevated blood sugar, cholesterol, triglycerides, and blood pressure.)

So, why you stay fat has a lot to do with why and how you try to lose the weight.

The most simplistic, albeit meaningless, answer as to why must people stay fat is because as Albert Einstein once gave as the definition of insanity, they do the same thing over and over again and expect a different outcome. They bounce from one diet plan to another. Or they look to miracle cures, magic pills and quick fixes, offered by the likes of Dr. Oz and thousands of other pill-pushers. They know such approaches never offer permanent solutions, but they are so desperate, they will  try anything. (I make this point in the hope that by sheer dint of repetition it will eventually sink in.)

They try diets that include cookies, low-carb and high fat, hCG injections, appetite suppressants, calorie restrictions, gluten free, vegan, etc. and still inevitably end up around the same weight or worse.

The real problem is that most people never truly understand why they got fat other than thinking they simply ate too much. In response, they spend their time and money floundering around in search of ways to control their appetites, chasing the latest and greatest fad.

Everyone knows and many have tried diet programs with names like Atkins, The Zone, South Beach, Weight Watchers, Medi-fast, etc. and yet.... if it was only that simple. Diet programs fail for most people.

I think, based on now treating hundreds of patients with weight problems, that there's a much more profound reason why people keep their excess weight. Please read on to learn what I hope will be a new, life-changing perspective.

Patients who come to me for treatment of a weight problem often ask me during our first encounter if I am a psychologist or a physician. (I am the latter.) The reason is that our first meeting often begins with a discussion about their motivation.  When someone has gained a lot of weight, even reaching a point where they are defined as obese, the road back can be difficult and challenging.  In order to succeed, one has to have the right attitude and be optimistic, if not confident that if he or she does the right things, success will follow. Most importantly, they must be motivated to do so.

In order to gauge such motivation, I often ask a simple question, "Why are you here?" If they answer "to lose weight," I counter with "Why do you want to lose weight?" Some look at me puzzlingly when asked such a question as if the answer is obvious. Others chip right in with answers that range from the aesthetic, "because I want to look better" to the practical "I want to feel better." Some proceed to elaborate how they are sick and tired of feeling sick and tired.

But virtually all patients pause to answer my next question which is a variation of "Why do you want to look or feel better?" They puzzlingly ponder how I could ask such a question, so much so that I often have to repeat it to get an answer.

After a few more iterations of my probing deeper into their answers, we eventually settle on that aspect of their life which is what they label as their number one priority. We identify that aspect of their life for which they are motivated to make sacrifices to succeed. While I encounter a wide variety of ultimate answers, with most often including reference to grandchildren and spouses, we also sometimes settle on what appear to be mundane core statements such as "I truly enjoy life and just want to keep going" or "I have a fear of death and want to delay it as long as possible." These actually reveal a far deeper motivation as they strike to the essence of one's perspective.

With a candid answer finally in hand, my questions turn to how much do they want to succeed on a scale of 0 to 100.  Any answer that is less than 100 is met with further probing questions about why they are not 100% motivated to succeed. There is no right answer and 100 may simply never be in the cards for some, but it is very important for both the patient and I to know exactly what their motivation is to lose weight and how motivated they truly are to succeed. (The spouse sitting next to them and prodding them usually doesn't work.)

Take a moment and ask your self the same questions. Challenge yourself to find YOUR truth. Keep asking yourself the question until you reach past the easy, cheap answers. Dig deeper until you are absolutely certain you fully understand your motivation(s) and how deep they run.

Everyone's reasons are different. One poignant example illustrates this point.  A patient once shared that although she was married, she loved another man. Although she longed to be with this other person, she was committed to her husband and was steadfast in her fidelity. However, she believed that if she outlived her husband (of course, dying from natural causes and not foul play), then she may eventually have the opportunity to spend some time with her true love.  Her commitment to increase her health and lose weight was based on this single desire. It is difficult as a physician to hear about a patient's torment, but I was delighted to help the woman articulate her ikigai (Japanese for purpose in life) that would lead her to make positive life-altering changes to her health.

(By the way, it is never my place to judge, but it is always to help. I respect the diversity in people and recognize the very different lives they have lived. No one can, or should ever presume why someone does what he or she does. Studies show that some people gain weight because it offers a protective shield around them from the cruel world in which they suffered childhood adverse events.  Some studies have shown a direct linear correlation between the number of vices, such as binge eating and alcoholism, and the number of adverse childhood events, like the loss of a parent, living with an alcoholic parent, or experiencing some form of abuse before the age of 10.  In such cases, identifying such traumas and dealing with them is vital to changing eating habits. So the next time you see a heavy weight person, please hold back judgment. You certainly have no idea what led to his or her weight gain.)

End of Part One. See next blog for Part Two.
(561) 807-2561

Wednesday, October 10, 2012

Why You Get Fat...

I recently read a book called "Why We Get Fat" by Gary Taubes. It was an enjoyable read as long as I ignored the facts. You see the facts of the book were that getting fat is all about insulin control. Taubes, with apparently limited knowledge of metabolism, completely tied his weight boat to insulin as the single hormone that controls why we get fat. It's an interesting thesis except for the problem that there are at least 10 more hormones that are known to play a role in metabolism and weight gain, including Proneurotensin which was recently added to the list.

Here's the list:

Neuropeptide Y
Growth Hormone

Each of these hormones plays a distinct role in weight gain and loss. When and how they play their role is still a matter of some debate, but we know that we can control them to some extent.

So when somebody, or for that matter anybody, tells everybody exactly why they get fat, consider it rubbish.  As a doctor that treats obesity and related weight problems, I can tell you honestly that it's a different reason in every case.  Many claim the reason is the conventional wisdom that it's simply "calorie in, calorie out," but they would be wrong because not all calories are created equally. For example, recently it was discovered that the fat in nuts are not as well absorbed as previously thought due to the fat's attachment to the fiber which prevents full absorption, and therefore it turns out that nuts produce less calories than previously believed. However, the biggest problem with "calories in and out" is the simple saying doesn't explain why you may have a problem controlling your calorie intake.

Most people gain weight because of a combination of five main reasons, but in each case each reason contributes a different percentage and that's why each person is different.  The reasons include an underlying medical condition, a sedentary lifestyle, a poor diet, insufficient sleep, and undue stress.   Diet is a usual suspect. Yet for example, undiagnosed thyroid disease can be a major culprit in weight gain, but it can only be diagnosed definitively with a medical assessment including blood test. For sleep related problems, it's well known that insufficient sleep affects the hormones ghrelin and growth hormone, releasing them in greater amounts. Both these hormones cause increased appetite, which leads to added weight.  Don't even get me started about stress and sitting around all day.

So when evaluating someone with a weight problem, the only reasonable and meaningful approach is to systematically identify his or her own root causes and then develop a plan to address the guilty parties. My practice does this with a combination of factors including:

1. For medical: evaluation by a MD
2. For stress, emotional and psychological support: counseling by a Clinical Psychologist (PhD) who also leads a weekly mindfulness meditation class; massage therapy and acupuncture to help people relax
3. For nutrition and diet: nutritional counseling, meal planning, and food shopping by a registered dietitian/nutritionist who also leads healthy cooking classes
4. For exercise: support through cardio and yoga classes
5. For sleep: sleep hygiene counseling and referral to a sleep study as needed

By tackling each of these areas individually and collectively, we help people get healthier, feel better, and -- lose weight.

So when someone tells you off the cuff, or you read in a magazine or a book, why you gained your weight, just ignore them. Until they know you, they really don't know why you gained weight.  There are healthy and unhealthy ways to lose weight, and which way you choose can have a profound impact on your long-term health.

Sunday, October 7, 2012

Can You Trust Bill Sardi?

I've often used this blog to identify people who I think pose a public danger. Oftentimes, it's people who lack the training, licensing or any form of validation to give them credibility. Today, I found a doozey. I thought I would share the entire unedited exchange with this gentleman for those with the time on their hands to be entertained, and to recognize how easy it is to try to mislead people with lots of fast and loose, but mostly misleading, facts.

It all started with a recent article that appeared on October 1, 2012 in The Wall Street Journal titled "Questioning the Superpowers of Omega-3 in Diet," to which after reading I submitted the following comment online:

"According to Consumer Reports' September 2012 issue, there are over 55,000 dietary supplements for sale in the U.S. That's 55,000 products sold by commercial interests trying to convince Americans that we can't live without them. There's hardly anyone on the other side shedding light on their value to overall health. In fact, there is not a single study ever published that shows that a supplement in the absence of deficiency extended a single day of human life.

Furthermore, there were no such products for the first 150,000 years of our history until about the 1930s. (Yes, some plants were discovered early to have medicinal purposes but they were often used in their natural state without factory processing.) Yet Michelangelo lived to 87 and the Greek philosophers into their 90s. The Sardinians' trace their extended longevity to the Bronze Age.

However, virtually every day now a new study comes out that questions the usefulness of taking one of the many popular supplements like Fish Oil, Vitamin D, Ginkgo, etc. Each time people leap to the opportunity to defend or criticize the validity of the studies. The nature of such studies that look at isolated variables offer plenty of room for debate. This means they completely ignore the synergism among hundreds of other nutrients found in different foods.

What is not debatable is that most (some exceptions best determined with the help of a knowledgeable physician) people would be better off eating whole foods like vegetables, fruits, beans, nuts, seeds, whole grains, and wild fish (this is obviously debated by Vegans, but it's hard to argue with the health benefits of wild Salmon, a non-predatory fish, low in contaminants like mercury and PCBs, but high in Vitamin D, DPH, EPA, and an excellent source of amino acids.) Aspects of such a diet has been the staple of multiple cultures around the world for thousands of years that count among them the highest percentage of centenarians.

The bottom line is that people should not take any supplements in the absence of a known deficiency, which should only be determined by proper testing with the input of a knowledgeable physician or registered dietitian, and should stick with non-processed foods to the extent possible and stop looking for salvation in the form of a pill.

Finally, I say Caveat Lector, "Let the reader beware." Don't take medical advice from the mass media. As Mark Twain once said, "Don't take advice from a health book. You could die from a misprint." This equally applies to health websites, newsletters, magazines, and TV shows.

They don't know YOU (your medical and social history, medications, diet, stress, etc.) and the advice may not apply. Find a physician willing to invest the time to know you well and who has spent time to acquire (usually not taught in medical school) knowledge of nutrition so he or she can guide you appropriately."

In response to my submission, a gentleman by the name of Bill Sardi posted this response.

"Of course, studies show ~40% of Americans are deficient in magnesium, ~40% are short on vitamin B12, most Americans have low levels of vitamin D at some time of the year, few Americans achieve optimal levels of vitamin C, a large portion of Americans are deficient in vitamin B1 due to poor absorption caused by drugs (diuretics, digitalis), coffee, tea, alcohol or refined sugar. Nearly all smokers are vitamin C deficient. Many older Americans are zinc deficient. Growing kids and pregnant and lactating mothers have nutritional needs that are not commonly met by the best diet. Stress, medications, and lack of stomach acid induce essential nutrient deficiencies. And yes, too many Americans have undetectable levels of omega-3 oils in tissues. So much for the idea of skipping supplements. --Bill Sardi, Knowledge of Health, Inc."

To which I responded:

"It's wonderful that you can rattle off a number of statistics to prove your point. However, I must challenge their accuracy. In the most recent 2012 CDC study of American's nutritional state, none of the numbers you cite proved to be accurate. Can you provide a valid source for your reference?

I'm not sure what your agenda is to push supplements, but as a doctor who regularly checks for vitamin deficiencies, I believe you to be misguided. When relying on studies, it is important to subject such studies to close scrutiny to determine their validity and applicability. I find that most dietary supplement studies that claim proof of usefulness fail these two tests.

For example, a recent study showed that Vitamin D decreased cold symptoms. However, the Vitamin D was given to people with extreme levels of deficiency. The study did not show efficacy in inadequate to normal levels of Vitamin D.

No one would disagree that someone with very levels of Vitamin D would benefit from correction. But before I would prescribe a pill, I would suggest increased sun exposure, albeit in small doses (about 15-30 minutes during the late day) and without exposure to the face, and ingestion of wild salmon and Almond milk, both rich in the vitamin.

The bottom line is no one should take a single supplement without consulting his or her physician. It's often been said that a doctor that threats him or herself has a fool for a patient. I say that someone that treats him or herself has a fool for a doctor.

Please let's leave medical decision-making to trained and licensed professionals. Of course, patients should always ask questions and challenge assertions if they see fit."

After writing my response, I became curious as to who exactly is this Bill Sardi. So, I found his email address and wrote him the following email.

"Hi Bill,

Can you please let me know what scientific credentials or degrees you have?

To your health,


Here is the response I got:

"Dr. Charlap

Doctors only ask that question when threatened.  Don't throw your credentials in my face.  It is a disgrace that a well-trained physician like yourself makes such a foolish and uninformed statement as to recommend others not take supplements unless they have a known deficiency.  Patients often walk in and out of a doctor's office with burning feet, sore tongue, short-term memory loss, all overt symptoms of pernicious anemia, and doctors may or may not order a B12 test, which is often normal, meaning the norm on the test is flawed.  This is well documented.  A patient can get a blood calcium or blood magnesium level, which only measures how much mineral is being lost, not conserved (red cell magnesium levels may be more helpful).  Serum zinc levels are notoriously inaccurate.  A vitamin C and B serum levels only reflect recent consumption as they are water soluble nutrients. Why are all diseases considered drug deficiencies?  

You are an advocate for health, but do you know what that is?  The absence of disease?  Everyone has the disease of aging.

Why is it that the biological action of most prescription drugs can be replicated with a nutritional supplement that is far cheaper and less problematic, yet doctors continue to prescribe drugs to the point of breaking the insurance pool financially?

Tell me what prevention is.  You advocate that.  Is it colonscopies, PSA tests, mammograms?  All this is is scouting for more disease to treat.  It prevents no disease.  

In regard to your statement that no supplement has ever been shown to add a day of life unless a deficiency exists, I submit to you the following:

A study of 11,000 Americans over 10 years revealed that individuals with the highest level of vitamin C intake, only about 300 milligrams, suffered 35 percent fewer deaths than those with the lowest intake, about 50 milligrams a day. This amounts to about 6 added years of life to those who consume higher levels of vitamin C. Since 300 mg of vitamin C is difficult to obtain from dietary sources alone, the primary group that exhibited increased life span were the vitamin C supplement users. A person would have to consume five oranges a day to get 300 milligrams of vitamin C from their diet alone.  Reference: Cowley G, Church V, Live longer with vitamin C, Newsweek May 18, 1992 and Enstrom JE, et al, Vitamin C intake and mortality among a sample of the United States population, Epidemiology 3: 194-202, 1992.   There are other examples, but this one will suffice.

You need to be cleaning up your own profession before you give advice to the public.

Bill Sardi"

And finally, here was my response:

"Hi Bill,

I would be happy to review the study you cite if you would send it to me. I am well aware of all the NHANES research, having previously carefully reviewed the  body of it. If my recollection is correct, no conclusions can generally be drawn from NHANES data, however, It's been a while since I last reviewed such data.

From the study abstract I reviewed, this particular study you cite appears to be a retrospective, observational study the type that almost always fails to show causality.  Also, quoting from the abstract, it states the Vitamin C data was from "detailed dietary measurements and use of vitamin supplements," which means that the vitamin C came from both diet and pills, thereby skewing the results even further for validity for cause and effect. Vitamin C is an essential vitamin and a deficiency is known to cause disease.   If I am wrong about the study, after reviewing again whatever you send me, I would be happy to admit my error. 

Also, if you are aware of the NHANES related data such as the CDC's Second Report that came out in 2012, then why did you cite inaccurate deficiency data in your Wall Street Journal response?

Beyond that, the presumptive answer based on your response is that you have no formal scientific training. If I am wrong, please correct me.  Although I am sure that one can self-teach themselves quite a bit, there is no substitute for formal training, testing, and validation. You, may I assume, have no clinical experience, other than your own or family's medical encounters. Yet, you think you have it all or mostly figured out and it's all a BIG pharma conspiracy. 

Well, I have news for you, I don't meet with pharmaceutical reps, don't take personal compensation for my services, and aren't tied to any school of thought other than that unlicensed, and therefore lacking credibility people like you should stop giving other people dangerous advice.

BTW, have you even read any books on how to evaluate clinical studies for relevancy, validity, accuracy, etc.? If so, which ones?

Now let's turn to your insults such as "disgrace…foolish…uninformed." You are obviously the defensive one as you chose to insult as opposed to just answer my question and engage.

It's a shame that you don't have a license, in which case I could notify the appropriate authorities and have you censured for presenting science fiction as science. But as this is a free country, you have the right to spew forth your diatribe, regardless of how inaccurate, misdirected, and meaningless it may be.

As to your question, "what is prevention?", the answer depends on what level you are referring, primary, secondary, etc.  I believe in primary prevention, which is based on lifestyle modification.  I always prescribe dietary changes and other lifestyle adjustments before drugs for high blood pressure, obesity, depression, pre-diabetes, etc. 

The bottom line is you decided to insult the wrong person who actually gets it and practices it clinically every day. 

Finally, I will say it again. Supplements have no role to play until such role is defined by a knowledgeable physician who has done an appropriate evaluation. To do otherwise, is to put people at risk unnecessarily.

To your health,


Beware of Bill Sardi. 

Update as of March 21, 2013 

Bill Sardi or someone working on his behalf sent me two copies of his book, The New Turth About Vitamins & Minerals. On the cover of the book, he displays Purity's Perfect Multi, the multivitamin he sells.  The entire book is dedicated to persuading the reader that if you want a quality multivitamin, only he sells it. In fact, in the back of the book, Sardi includes a survey of multivitamins where he grades the major brands out of 100 points. Not surprisingly, his product gets a 96, with the next closest product is graded 68 out of 100, with the numbers dropping fast from there.

Out of curiosity, I started reading the book, but had to stop when I realized that although he occasionally quoted some reasonable studies, many were studies done in animals, which hold little relevance to humans. The book was the most self-serving book I have ever tried to read. After a few pages of copious notes, I had enough.

Again I caution, beware of people telling you how great are the supplements they are trying to sell you.

Sunday, September 30, 2012

Don't Get Caught Up In The Gluten Free Or Wheat Belly Mania

The book, Wheat Belly, is a perfect example of why I often say, Caveat Lector, 'let the reader beware.'  It is yet another example of a writer, in this case a physician, selectively picking and choosing facts, and sometimes even distorting the truth to push a particular agenda, in this case the benefits of a gluten-free diet. However, to say that the book is nonsensical would also be unfair. The reality is that some people have problems with gluten, a protein composite found in wheat, barley, rye and triticale (a wheat/rye hybrid).

The general argument often raised against gluten is that it is a protein that triggers an immune or allergic response. Pundits recommend avoiding it because they claim all wheat has been genetically modified and our bodies are not well equipped to process the new increased chromosome varieties. (By the way, the more ancient grains like Kamut, have not been altered.)

About 1% of the population suffers from a disease called Celiac-Sprue which is an auto-immune disease and about another 2% or so (some say as many as 15%, but I'm not buying it) are gluten sensitive. Gluten sensitivity has been implicated in a wide variety of abdominal symptoms including bloating, discomfort, cramps, pain, and diarrhea, as well as a number of non-abdominal symptoms including headaches and migraines, lethargy and tiredness, attention-deficit disorder and hyperactivity, schizophrenia, muscular disturbances as well as bone and joint pain.

The point of today's blog is not to exhaustively review the state of the science related to gluten and its health consequences. Rather, I hope to point out that everything you've ever heard about gluten and the problems it causes based on statistics probably doesn't apply to YOU.  97% (some claim as low as 85%) of the population does not seem to have any problems with gluten despite the recent hoopla. If you are among the unlucky 3% (or15% by some exaggerated accounts), then you should avoid it.

How do you know if it is a problem for you? First, if you don't have any of the problems mentioned above, gluten is not a problem for you. If you have such symptoms, simple blood tests can detect if gluten is causing celiac disease or if you have a wheat allergy. If both these tests are normal, but you have these problems, gluten may still be the culprit. Eliminating gluten products for three weeks and watching if symptoms disappear is a great way to check. I suggest restarting the gluten products in moderation after three weeks to see if symptoms return.

You may ask why bother and not just eliminate gluten? According to Peter H.R. Green, MD, director of the Celiac Disease Center at Columbia University, "For people with celiac disease, a gluten-free diet is essential. But for others, "unless people are very careful, a gluten-free diet can lack vitamins, minerals, and fiber." The facts are that although gluten itself doesn’t appear to offer unique nutritional benefits, the whole grains that one would need to stop consuming to avoid gluten are a rich source of fiber and contain an array of vitamins and minerals, including B vitamins and iron. Whole grain foods should be considered part of a healthy diet which lowers the risk of heart disease, type-2 diabetes, and some forms of cancer.

So most people have no problem with gluten and shouldn't avoid it and some people do and have to eliminate it from their diets. The best way to figure it out is with a knowledgeable primary care physician or gastroenterologist. Don't self-diagnose and unnecessarily deprive yourself of healthy whole grains. There is no reason to single out gluten as a food to eliminate without good cause. 

But I'm not done yet. But what really gets me is that gluten has taken on a hyperbolic, almost mythical status.

The author of Wheat Belly, in an interview published in Natural Awakenings, describes his almost miraculous transformation when he abandoned gluten. He states how while eating gluten his triglycerides were very high, he was diabetic, and had high blood pressure and excess weight around his middle, but when he stopped everything went to normal including his developing increased focus and attention. I'm calling him out that it wasn't the elimination of gluten that gave him these results even if he's telling the truth and it actually happened. Why? Gluten is a protein, not a carbohydrate. Eliminating a protein such as gluten shouldn't provide all these benefits. Also, the author advocates for increased consumption of other proteins mostly derived from animals that eat gluten in large quantities. Finally, my personal experience is just the opposite. I consume gluten every day for breakfast and lunch. Instead of cutting out gluten from my diet, I eliminated or restrict a host of other foods.

I severely limit my meat and chicken consumption, limit starchy vegetables such as potatoes and corn, eat no pasta, cakes, cookies, ice cream or other milk products (I'm lactose intolerant), or any processed foods other than non-preservative, non-sugar added breakfast cereals (with kamut and other whole grains) and freezer section breads (with sprouted grain and spelt).

I also markedly increased my consumption of wild fish, such as salmon and cod, to at least 4 times a week, added unlimited fruits (and by unlimited I mean at least ten portions a day) and vegetables, and a fair share of nuts, seeds and beans (including lentils and chickpeas as chummus).

My verifiable results including dropping my cholesterol from 290 to 160 without a statin, shedding about 25 pounds, decreasing my blood sugar from pre-diabetic to normal, eliminating my irritable bowel syndrome and reflux, and markedly decreasing my osteoarthritis in my left hip. I can't tell you what exactly did the trick other than sharing exactly what happened and telling you that my diet INCLUDES gluten. I know that what works for me or anyone else for that matter may not work for others and it is ridiculous for people to suggest otherwise.

So if you haven't read Wheat Belly, save your money and forget it. If a friend tells you how great they feel on a gluten-free diet, be happy for your friend, but realize that it may have no bearing to you and it may also be a self-described placebo effect.

If you have the symptoms described above, don't ignore them and have them checked out. You may actually be part of the small minority that have a gluten problem and there is no reason to suffer needlessly.

Either way, maintain a healthy level of skepticism about things that sound miraculous or like quick fixes. Gluten seems to fit that bill for most people. To belabor the point, Caveat Lector.

The best thing you can do to live a healthy life is to stay informed, but share any concerns with a doctor you trust. Find one that invests the time to really know you, is willing to discuss your issues, and patiently explains decisions. Think like a doctor, but act like a patient.