Another Benefit of Wild Salmon

To say I am a wild salmon fan would be an understatement. The more I learn about it, the more excited I get. The other day I wrote about how I was in heaven consuming it in the great Northwest.

Here's another reason (for some a caution) to ingest wild salmon. Interestingly, I just learned about this not very well known benefit.  It's why I say you can never stop pursuing knowledge.

The omega-3 fatty acids in Salmon, eicosapentaenoic acid (EPA, 20 carbons and 5 double bonds), docosahexaenoic acid (DHA, 22 carbons and 6 double bonds), in addition to their positive anti-inflammatory, cholesterol lowering, and brain health effects, also have apparent anti-coagulant benefits that can prevent blood clots.

For most people that's a really good thing to have a natural source of blood thinning as protection against heart attacks and strokes. However, for people on anti-coagulants such as Coumadin, aspirin, Plavix, etc. this may be problematic. If you are on any anti-coagulant(s) and commonly consume salmon, my favorite food, please check with your doctor to determine if your medication needs to be adjusted.

Do not take fish oil pills for this purpose because they are not processed similarly in the body. Flax seeds, which also contain the α-linolenic acid (ALA, 18 carbons and 3 double bonds) omega-3 fatty acids are also noted to have similar benefits.

This is not intended as medical advice and consulting with your own physician is always advised.

Wild Salmon Country

Regular readers of my blog know that I haven't written much of late.  There are two reasons for my literary absence. First, I recently returned from visiting Seattle and Vancouver, Canada. For a wild salmon lover,  I had died and gone to heaven. I was in Wild Salmon country.

Here on this east-side of the country, it is a foregone conclusion that unless stated otherwise, any salmon sold in a restaurant is farm-raised. In Seattle and Vancouver, it is just the opposite. In fact, I got tired of having restaurateurs and wait staff look at me strangely when asked if the fish they were serving was wild. "Of course," was the repeated response.

It was nirvana. I even visited a place where you can see the salmon leap up out of the water and swim against the current. It was an amazing sight to behold. I just couldn't get enough of the wild fish and its incredible nutritional contents. Rich with omega-3s, Vitamin D, and the healthiest saturated fat, it is the perfect source of fatty acids and protein for almost any diet.  In fact, I love wild salmon's bounty so much that I carried about six pounds of an assorted variety back home with me.

The other reason for my absence was my ongoing work on my two forthcoming books. One book is about eating and living for longevity based on centenarian diets and lifestyles, and the second book is on the dangers of taking medical advice from celebrity doctors and the mass media.

Much progress has been made on both books and one publisher has already offered to publish one of the books. So stay tuned and I'll keep updating you when something worth writing about comes along.

The Pain of Prescribing Pankillers

Pain is a terrible thing, but you know that already. It can make life unbearable and for some, it does. Having once ruptured a disk in my back that pressed on my spine due to a foolish maneuver in a gym, I can imagine what experiencing incessant horrible pain truly means. My pain was so severe, I couldn't think, I couldn't sleep, I could hardly breathe. I was in horrible agony. I finally understood why a terminal cancer patient in such pain may want to call it quits. So, yes, I can emphasize with someone suffering from pain. Nevertheless, we have an epidemic of painkillers being prescribed here in the U.S. and often times it is inappropriate and unnecessary.

In fact, one of today's headlines in the NY Times titled, "Rise In Pill Abuse Forces New Look At U.S. Drug Fight." The first paragraph reads, "America’s drug problem is shifting from illicit substances like cocaine to abuse of prescription painkillers, a change that is forcing policy makers to re-examine the long and expensive strategy of trying to stop illegal drugs from entering the United States."

In the practice of medicine, one invariably is confronted by a patient seeking pain medication. I am stingy with such medication, not because I lack empathy for it's need, but because I want to make sure that it's really needed and I am not trading pain for addiction. No doctor, myself included, can claim absolute expertise in determining who is telling the truth and who is malingering. We listen very carefully to the patient's complaints and concerns, and then use our knowledge and honed intuition to try to make the best judgements.

Prior to starting MDPrevent in Florida, I had read many articles about so called "pill mills." These are medical practices run by unscrupulous doctors who feed the painkiller market's need for easy access. Wary of being bombarded by painkiller seeking patients and concerned about not making proper differentiation between those truly in need and those looking to feed an addiction or resell the pills, I decided to enlist help.

Among the many other benefits of having a health psychologist on my team, this is one of them. When I am unsure if a patient is consulting with me only for drugs, I often ask him or her if they would be willing to see the psychologist. I find this appropriate because pain usually, but not always, has a strong emotional and mental health component tied to it. I also want the patient evaluated to see if there are healthy alternatives to pills. MDPrevent's psychologist, Dr. Jessica Kordansky (PhD, trained at Emory University) specializes in Mindfulness Meditation, a natural way to deal with stress, anxiety, pain, etc.

The key concept here is at the root of how I practice medicine. I prefer to find long-term solutions over quick fixes when appropriate. Writing a painkiller prescription requires no effort and often appeases the patient, but may not necessarily be the best thing for him or her. I know this will anger some of the patients who turn to MDPrevent for care; I also know that it will decrease the number of patients who return to the practice.

Nevertheless, I must follow what I consider to be good medical practice and do what is in the best interests of my patient. This doesn't mean I will never write a prescription for pain medicine, depression, anxiety, etc.; it just means I will think long and hard before I commit a patient to this course of action, and when possible, I will solicit the help of a trained professional to improve my decision-making and offer alternatives.  Too many patients have already come to my practice on such medications having long forgotten why they were prescribed it in the first place.  It is truly an epidemic. The insanity must stop and I will do my part.

Perhaps, if other doctors did the same, the U.S. could return to fighting drug imports and not have to use precious limited resources to stop our internal painkiller problem.

Nan Kathryn Fuchs Replies

On Wednesday, July 4th, you may remember I wrote a blog about a Dr. Nan Kathryn Fuchs, who writes a woman's health newsletter. The blog was titled,

Supplement peddlers, supplement peddlers every where, Nor any drop of truth to drink.

Paste http://mdprevent.blogspot.com/2012/07/supplement-peddlers-supplement-peddlers.html into a browser to read the blog.


I told you that I had inquired about her educational degree and if I ever got a response, I would share it with you. Today the response came and here it is:

"Nutrition, from Donsbach University, which is no longer in existence."

That's all there was. No salutation, nothing else.

Here's what I could find about this Donsbach University, now no longer in existence, and apparently for good reason. 

http://www.quackwatch.com/01QuackeryRelatedTopics/donsbachuniv.html

Not a pretty picture.  As I've written before, Caveat Lector, let the reader beware of advice offered by so called experts.  I find, in general, the advice offered by Fuchs and many of her so called self-proclaimed expert peers to be offensive. Nevertheless, they are protected under the laws of free speech so you are advised to simply ignore them. If you do, maybe they will go away. We can only hope.

Is Obesity A Problem?

You probably think you know the answer to this question. From a medical perspective, your answer probably evolves around the fact that obesity leads to the development of chronic diseases such as diabetes, heart disease, cancer, dementia, arthritis, etc. These diseases lead to costly medical care which still leads to premature death. That sounds like a problem.

Well, based on a new study from the University of California Davis published in the Journal of the American Board of Family Medicine, you may be wrong. The study, which tracked 50,994 Americans between the ages of 19 and 90 for a total of six years, suggests that obesity itself may not be a harbinger of impending death; rather, hypertension and type 2 diabetes, which are often associated with obesity, are what leads to an early meeting with the grim reaper.

You may ask isn't that a question of semantics? Aren't obesity, diabetes, and hypertension so closely related that they may be considered one and the same? Isn't diabesity, as some call it, the right name for it? The answer may surprise you.

The study showed that obese people without these conditions were no more likely to die than non-obese people, and non-obese people with these conditions were more likely to die than obese people without them. So it's not weight per se that kills you, but the diseases that often, but not always, accompany excess weight.

In fact, in my practice I have seen many people who did not suffer from a weight problem, but were still struggling with diabetes. Well, that seems to make sense because weight itself is not the main factor in the development of diabetes and some people who are naturally heavier than others, still seem to enjoy good health.  (I remember many years ago when I worked in a summer sleep-away camp that there was a rather heavy young man that was an incredible athlete. He moved faster and stronger than most of his leaner peers. One would be hard pressed to say that he was unhealthy.) 

Nonetheless, this California study is consistent with a new movement that advocates HAES, which stands for Healthy At Every Size. The HAES camp believes that your health is more important than your size or body mass index (BMI) and I agree.

From the inception of MDPrevent, I have been telling patients not to focus on their weight loss; rather, I have been teaching, begging, exhorting, cajoling, and a number of other words ending in 'ing' to improve their health by eating certain foods and avoiding others, by staying more physically active all day long, by taking steps to ensure a good night's rest, and by developing strategies to manage stress effectively. My lectures often also focus on the need for a strong social network, the benefits of engagement and purpose, and the value of surrounding yourself with like-minded individuals. So, yes, one study doesn't prove anything, but it's not the first study to show the wisdom of focusing on your health and not your weight.

So now you may be thinking that obesity is not a problem, but you would be wrong. Obesity is still often associated with the predominance of chronic disease development. Even in the Albert Einstein College of Medicine study that identified Eastern European Jews who seem to have a longevity gene and who claimed to eat whatever they want, the results showed that those who survived into their 90s were almost always lean. Perhaps they had a genetic predisposition to being lean, but again, lean won almost every time.

I think the most serious reason obesity is a problem is because we don't as a society really seem to understand it. Quite frankly, my head is spinning from reading all the studies and books that purport to have defined, if not offered the perfect solution, to the problem. The list is almost endless.

Here's my abridged version of solutions offered (not saying they work or don't work; just listing to make a point):

Don't eat processed foods that contain white sugar and flour, avoid almost all carbs even the complex ones in fruits, eat more proteins, be a Vegan, eat more meat, drink more dairy, avoid saturated fats, avoid gluten, drink more water, balance your energy intake and output, don't live near fast food restaurants, eat more smaller meals, snack, don't snack, use small plates, eat breakfast within 30 minutes of waking up, don't eat breakfast until after you exercise, don't eat past seven at night, take dietary supplements that speed up metabolism, avoid anything other natural foods, stay physically active all day, go to Weight Watchers, follow the Adkin's diet, the South Beach Diet, the Zone Diet, the Cookie Diet, the grapefruit diet and countless other diets, take HCG and other appetite suppressants, take medications like Orlistat or Tenuate, have lap-band or stomach bypass surgery, etc.

Yes, there are quite a number of pundits that feel they have the solution, and that's a huge problem. Given so many choices, analysis paralysis sets in and we end up doing nothing or a little of this and a little of that, and that my friend is what I think is the biggest problem with obesity.

At this point, after reading countless books, articles, and studies, watching documentaries, attending conferences,  speaking to thought leaders, and working with patients, my solution is simple. Pick something that you think you can live with that has at least some decent science supporting it and STICK WITH IT. Getting healthy and losing weight takes time to do it right. It takes effort and concentration and it doesn't happen overnight. For many it will be a life-long struggle. Sacrifices will have to be made. Favorite foods may need to be given up perhaps forever. Trade-offs will be made and battle-lines drawn. That's the reality of the situation for most and I challenge anyone to prove otherwise.

If you need support, get it. If you are a do-it-on-your-own type of person, that's fine, but have a plan and follow it religiously.

If you are looking for some direction and/or insight, here's my suggestions: avoid processed foods, stay active during as much of the day as possible, drink fluids to keep your urine a pale yellow, don't take any pills you don't absolutely need to take, make fruits, vegetables, beans, nuts, and whole grains the bulk of your diet, eat some wild salmon at least 2-3 times a week, get at least 7 hours sleep a night, learn how to manage stress better, nurture relationships, and find something that gives you pleasure to engage in consistently both physically and mentally.

If you follow this advice, I can't promise what weight, if any, you will lose, but I'm pretty sure you will be healthier than you are now. In the final analysis, I hope you agree that being healthy is the most important goal.

Busting Myths: Does Dr. Oz Have A Monopoly?

Yesterday, I wrote about Dr. Oz's suggestion to snack with up to 200 calories two hours before eating your dinner in order to lose weight. There seemed to be no good logic to doing so. Imagine my surprise when today I get an email from RealAge.com, which is at least partially owned by Dr. Oz (see http://www.realage.com/press-release-sharecare) with the headline, "3 New Weight Loss Myths Busted."

Here is my favorite myth the article clams to bust.

"Myth 1: Eat five mini meals throughout the day.
The initial idea was to eat small, healthy amounts of food every couple of hours to keep blood sugar levels steady and energy high. The trouble is, many people end up eating what amounts to five full meals. "I find that people do much better when they sit down and have three balanced meals a day with two small snacks in between," says nutrition counselor Katherine Tallmadge, MA, RD. "Real meals stave off hunger. If you eat tiny bits throughout the day, you're hungry all the time."

This is diametrically opposed and mutually exclusive to Dr. Oz's concept of eating a small meal, which he calls a 200 calorie snack, two hours before dinner. Which is it? He probably doesn't even know, but busting myths seems to be one of his favorite concepts on his show. It's as if he has a monopoly on doing so. However, I never thought that in the span of one week, I would see him connected to both creating and busting a myth.

Here is another myth supposedly debunked by the article.

Myth 2: Eat less by using small plates. Studies have shown that large plates lead to more eating because they make portions look smaller, but the small-plates idea only works if there's a limited amount of food to put on the plate. In a recent diet study at Texas Christian University in Fort Worth, Texas, 10 overweight and 10 normal-weight women were randomly assigned a large or small plate for eating lunch on two different days, then allowed to serve themselves. The result? The ladies ate until they were full, regardless of plate size. "Make what you need, or measure the amount before putting it on a plate, then put things away," recommends Tallmadge, who was not involved in the study. "It's having easy access to food that keeps you eating more."

Contrary to what RealAge would have you believe, there is actually science that confirms the small plate approach to weight loss. See http://smallplatemovement.org/doc/big_portions.pdf for a review of the science. Brain Wainsink of Cornell University is one of the leading food investigators in the U.S. After reading his book, Mindless Eating, I am more inclined to trust his studies over the new study. I also know it works because it worked for me. I switched from a larger to a smaller bowl for my breakfast and never missed a beat on my way to a 20+ pound weight loss. Either way, with the conflicting study results, I hope you agree that this does not fall into the myth-busting category; however, it should fall into the sensationalistic headline one.

Here's a quote from Dr. Oz's website under the title "5 Diet Myths Making You Gain Weight" about the small plate issue:

"Dieters have been advised to eat from smaller plates in order to limit the amount they eat. Why? Because smaller plates make regular portions look larger. However, new research published in the Journal of Human Nutrition and Dietetics found that plate size had no impact on the calorie consumption of either normal weight or obese individuals. Despite these findings, Dr. Oz still recommends using small plates to help guide you in terms of how much you eat. But use them the right way – a small plate is not an excuse to pile on food vertically or go back for seconds."

So what are we expected to trust? The Dr. Oz Show or a website Dr. Oz has ownership in?


The third myth the article purports to bust is "it doesn't matter what meal plan you're on because you'll lose weight as long as you stick to it." Really, any food you eat as long as you stick to it will help you lose weight? The study the article referenced used 5 specific plans. There is definitely more than one way to lose weight, but the meal plan (and total number of calories) will always matter.

It is because of articles such as this one and the Dr. Oz Show that there is so much confusion out there that allows anyone to claim he or she is busting a myth. Besides, I caution trusting anyone that constantly claims they are a myth-buster. Wouldn't it be better if shows and websites just presented the science in layperson's terms and let intelligent people make the decision on their own. I think so. Do you agree?

Ignore Dr. Oz on Sage Leaf Tea and Alpha Lipoic Acid

Contrary to what some may think, I don’t enjoy blogging about Dr. Oz.  Why? It requires a lot of effort to identify the facts and if I don’t exert the effort, I am ultimately no better than him with his inaccurate proclamations.  Having written about the good doctor ad nauseum, I had planned to ignore his most recent show called "Snack Attack: Eat More and Weigh Less" this past Friday that originally aired February 17, 2012.   

As fate would have it, one of my guests at Friday night dinner asked me about the show and specifically about the Sage Tea he recommended to lose weight.  My short respite from analyzing the products Dr. Oz recommends was over.

So here we go again. The episode started with Dr. Oz claiming that “recent studies prove that snacking on the right foods at the right time can turn your body into a fat-burning machine.” He then went on to present that eating certain snacks of 200 calories or less two hours before dinner will result in less food consumed at dinner. One of those snacks he presented included prosciutto, a cured ham, which he recommended wrapping around 2% mozzarella cheese, and adding 2 olives, 1 cup zucchini, and 1/4 cup chickpeas.

I’d like to see a study that showed that eating prosciutto and mozzarella cheese two hours before dinner helps you lose weight. I highly doubt it. What do you think? He also states on his website in reference to this episode that “Get your metabolism going with a pre-dinner snack, 1-2 hours before your main meal. Doing so will help you stop eating once you're full, which is sometimes hard to do.” Why would snacking help you stop eating when you are full if eating non-snack food often doesn’t do that?  Enough said.

Of course, he also recommended a product—in this case a cup of Sage Leaf Tea--as a way to lose weight. After a few hours of research, including pubmed.com, Cochrane.org, naturalstandard.com, and infopoems.com, I could only find one reference to the use of Sage Tea for anything whatsoever related to weight.

It was a study titled “Antihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial.” This single study involving a whole 67 people showed that Sage Leaf may be useful in decreasing lipids. Mind you, that doesn’t mean losing weight. 

By the way, where do you think the study was done. Wait for it, here it comes—Iran.  Yes, that’s right--The People’s Republic of Iran, that bastion of scientific integrity known for its war-mongering, terrorist-supporting, Holocaust-denying oppressive government. Now that’s a source of a study I’m not sure anyone should rely upon.  There was not a single additional scientific reference to the use of Sage Leaf tea for weight loss, metabolism booster, etc. that I could find.

But Dr. Oz wasn’t done for the day pushing pills.  He then recommended 200 mg. Alpha-Lipoic Acid (ALA) as another weight loss aid.  Now here’s where it gets good. 

Like with Sage Leaf, I began an intensive search and here’s what I found--a South Korean study titled, “Effects of Alpha-Lipoic Acid on Body Weight in Obese Subjects” published in early 2011, that stated to the authors’ knowledge, “this is the first study to show that alphalipoic acid treatment led to a significant weight reduction in obese human subjects.” There appears to be no published study since, so this seems to be the first and only study of its kind. 

Second, the study initially involved 360 obese subjects (of which about 1/3 dropped out for different reasons including adverse side effects) consuming 1,800 mg (9 times the dose recommended by Dr. Oz).  

After 20 weeks of treatment with 1800 mg per day of alpha-lipoic acid, the results showed “modest but statistically significant reductions in body weight and BMI.” How much weight did they lose after 20 weeks of 9 times the dose recommended by Dr. Oz? They lost 1.8% of their weight. In a two hundred pound person that would be 3.6 pounds.  At 1,200 mg (or six times the Dr. Oz’s recommended dose) the weight loss was even less at about 2 pounds for a 200 pound person.

For full disclosure, there was another study, published in 2010, for which I could only access the abstract titled, “Alpha-lipoic acid supplementation: a tool for obesity therapy?” The conclusion of this Italian study according to the authors was “Our study indicated that LA is an ideal antioxidant candidate for the therapy of obesity related diseases. Further clinical studies should be considered to highlight the role and efficacy of LA treatment.” However, this was not a double-blind randomized controlled study and no data on caloric intake was given. By the way, they consumed 800 mg, or 4 times the dose recommended by Dr. Oz. Apparently, the South Koreans discounted this study as well based on their statement that they had performed the first study on the effects of ALA on weight loss.

Need I say more? Dr. Oz has little scientific basis (and for that matter, no business) recommending such a product at a dose that has no valid and conclusive scientific evidence to support his recommendations.

Of course, that never seems to stop him and it didn’t here.