tag:blogger.com,1999:blog-38366092113977422472024-03-24T10:43:40.764-07:00MDPrevent: Where Prevention is Preferable to CureSteven Charlap, MD (NYU), surgeon, and MBA (Harvard) founded HealthDrive, a national healthcare practice that served over 5 million seniors, MDPrevent, a primary care, preventive medicine and wellness practice and The Longevity Club, a club to connect like-minded people interested in healthy lifestyles. Dr. Charlap champions the right healthy food over dietary supplements and medications. He most enjoys identifying well-done, reliable clinical studies that offer useful information.Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.comBlogger242125tag:blogger.com,1999:blog-3836609211397742247.post-32311989769544794972018-04-24T15:46:00.001-07:002018-04-24T15:46:09.275-07:00Red Apple Technologies is a Crooked Company<div dir="ltr" style="text-align: left;" trbidi="on">
This is the first time I have every singled out a company for its misdeeds, but Red Apple Technogies, aka Red Apple Tech and Red Apple Business, an India based company, is a worthy culprit.<br />
<br />
I am currently working on a software that may possibly save millions of lives worldwide. This was shared with the CEO and staff at Red Apple Technologies when we first spoke to impress upon them the importance of this software. They claimed it was an honor to work on such a project.<br />
They were given a software development task list and after some study of my existing code, they gave me a price to complete the work. I agreed without negotiation, something I almost never do, and we signed a contract for services. Then they were given an additional set of tasks. Again they quoted a price, again accepted without negotiation and a second agreement was signed.<br />
Two weeks went by and they repeatedly claimed they were making progress. Then after pressing them for a specific progress report, they informed me that they had not started because they needed to rewrite my functional code from scratch and that they would need 50% more payment to proceed. I was a victim of a classic bait and switch in which you are lured in with a promise and once you are hooked, the terms change. <br />
Do not trust them! They lied repeatedly to me and ultimately proved themselves to be con-artists. A word to the wise should be sufficient. Buyer beware.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com9tag:blogger.com,1999:blog-3836609211397742247.post-35999918003513409322018-04-20T12:52:00.002-07:002018-04-20T12:52:50.563-07:00Rethinking Fruit<div dir="ltr" style="text-align: left;" trbidi="on">
Recently, I was invited to give a lecture on food facts and myths. As
usual after such a lecture, many audience questions focused on what is
the best diet. After six years of intensive reading, my arguably
oversimplified, but most accurate working conclusion is that the
healthiest generic diet is for one to eat healthy foods in moderation
and avoid unhealthy food.<br />
This is based on a highly researched conclusion.<br />
1. Given genetic and metabolic differences inherent in all
humans, including varying predispositions to diseases like heart
disease, cancer, and diabetes, it is challenging to be certain that the
consumption of any single food in large quantities, fruits and
vegetables included, has any health benefits. The body needs what it
needs (natural occurring fats, proteins, vitamins, minerals, water,
fiber, and antioxidants) and consumption of anything beyond that appears
to serve no benefit no matter who you are.<br />
2. No study demonstrates that consumption of healthy food,
including so called “super” foods, somehow neutralizes your consumption
of unhealthy foods.<br />
3. Caloric restriction diets have decent supportive science.
Remember, caloric restriction diets are primarily based on the premise
of consuming nutritionally dense healthy food to meet minimal
requirements and avoiding calorically-rich unhealthy food. I say the
science is decent because populations studied have been limited and such
studies need extensive tracking periods and variable control (other
variables e.g., exercise, stress, sleep, social determinants of health,
etc. also play a role) to generate truly reliable data, and such studies
simply don’t exist. (There have been some good primate studies, but not
without debate. One major study showed significant health improvement
measured by longevity and one did not. Pundits argue that the one that
showed benefit included primates that otherwise consumed a traditional
human diet, i.e. an unhealthy one. Therefore, the switch to a healthy
calorically restricted diet extended life. The second study included
primates that already ate a limited healthy diet and further restriction
served no benefit. That makes sense as there is a minimum requirement
to getting what you need and below that there is also no benefit.)<br />
Now, let’s discuss fruits. For the record and with full transparency,
I am historically a huge consumer of fruit – a bona fide card-carrying
member of the Fruitopian Society – actually I just made that society up,
but you get the idea. What is true is that my affection for watermelon
is legendary. Both during the off and on seasons, my watermelon
consumption can be mind-boggling. On many an occasion, I have devoured
half of a large watermelon in a single sitting. (As an aside my
obsession with watermelon stems from positive memories of enjoying its
sweetness after many a pleasant date. Its abundance of lycopene, an
antioxidant some studies have shown to have benefit against prostate
cancer, a not uncommon male affliction that has been spotted in my
family, doesn’t hurt.) In addition, I routinely consume a banana and
blueberries for breakfast. Various melons, citrus fruits, grapes,
cherries, etc. often round out my daily fruit consumption. I choose
organic when available for soft skinned fruits and eat regular for the
rest.<br />
Despite my embrace of fruit for many a year, I have begun to realize
that I have been willfully negligent in applying my own philosophy to
eat healthy foods, i.e., fruit, in moderation. Many a nutritionist has
been challenged by me to identify why I can’t eat fruits with reckless
abandonment. Nutritionists mostly agree fruits are very healthy.
However, they also widely agree that diabetics should limit their intake
to about 15 grams of fruit (equal to a small piece of whole fruit or
about ½ cup of frozen or canned fruit) at any given time. The reason is
that studies have shown that fruit does raise blood sugar levels,
although by a different mechanism than processed sugar. The amount that a
food raises blood sugar is called its glycemic index (GI). Most fruits
have a low GI because of the intermingling of their fructose (natural
sugar) and fiber content. The natural fiber slows down absorption of the
sugar. (That’s why fruit juices, sans fiber, are generally not
recommended by nutritionists worried about their patient’s blood sugar
and weight gain. Smoothies contain fiber, but they also result in far
larger fruit portion consumption and so also violate the eat healthy
food in moderation dictum.) Melons and pineapple have medium GI values
as do some dried fruits such as dates, raisins, and sweetened
cranberries.<br />
Where does that leave us with fruit? Let me answer for myself.
Despite an otherwise ridiculously healthy diet, my fasting blood sugar
levels maintain a rigid position in the pre-diabetes range as determined
by fasting blood sugar levels and my hemoglobin A1C (a blood test that
shows your average blood sugar over a few months.) I have been stymied
by such results and finally realized my potential error – my oversized
fruit consumption. Consequently, I have significantly cut back on fruit
for the past few weeks. I still have a banana and blueberries for
breakfast, had a few apple slices during the day yesterday and an orange
later in the evening; but, my fruit splurging has ended. In eight
weeks, I will check my levels again and will report if I finally see an
improvement in my blood sugar levels. My confidence is high I will<br />
By the way, in case you are wondering, my blood sugar levels have
nothing to do with my weight, which is at high school levels again and
well within the normal BMI (measurement of healthy weight) level.<br />
Stay tuned as I report on this experiment of N equals one - me.
Meanwhile, as I try to now truly practice what I preach, which is eat
healthy foods in moderation and avoid unhealthy food, I implore you to
consider doing the same.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com3tag:blogger.com,1999:blog-3836609211397742247.post-2363447861455255732014-11-02T06:39:00.002-08:002014-11-02T08:36:18.634-08:00Who Are You?<div dir="ltr" style="text-align: left;" trbidi="on">
On a societal level, that’s a relatively easy question to answer.
You’re either living as a man or a woman, are somewhere between young
and old, probably play a role in a family structure as a parent, child
and/or sibling, developed or learned some type of skill, and have some
form of social interaction with others.<br />
<br />
However, on a biological level, there's a much more complicated answer.<br />
<br />
Here’s
what scientists know. You are part of the group known as Homo sapiens
(although some of you contain Neanderthal genes-some 20% of Neanderthal
genes are still prevalent among some of us although no one has more than
1%), you have about three billion gene pairs, and you resemble other
humans in terms of types of genes as closely as 99.9%. But, and it's a
big but, it’s the last .01% that makes you possibly very different from
others, including family members. (Even identical twins do not match up
100% gene-wise.) These genetic variants, as scientists often refer to
these differences, can determine many things that uniquely happen to
you.<br />
<br />
Although I’ll leave it up to the reader to learn more about
genes in general on your own, I will point out that there are two major
creators of genetic variants. Certain variants come from germline genes,
the genes you are born with, and others from somatic mutations, the
genes that can develop over the course of your life. It is now estimated
that there are probably hundreds of millions of such variants and the
combinations of such variants is a really big number, creating all kinds
of scenarios.<br />
<br />
Over the past few weeks, the significance of these
variants were highlighted to me through several studies. For example, a
recent study showed that some type two diabetics with a certain variant
did not benefit from exercise, a finding that really flies in the face
of intuition. Another study showed that people who get a brain
hemorrhage from taking blood thinners are more likely to have a certain
gene variant. It may be prudent to hold their bloodthinner and weigh
the benefit/risk more carefully. A third study revealed that aspirin
prevents colon cancer in certain people with a particular gene variant.
In others, like me, it cause ulcers.<br />
<br />
The most poignant example of
the role of gene variants was the discovery that certain
super-centenarians, people over the age of 110, possess a group of small
variants that collectively appear to protect them from or delay the
onset of certain common ailments such as cancer and heart disease,
despite these old old being obese, smoking their entire lives, and being
sedentary. In other words, they did everything wrong from a lifestyle
perspective and still outlived everyone.<br />
<br />
Ever since the Human
Genome Project, a project whose goal was determining the sequence of
chemical base pairs which make up human DNA, and identifying and mapping
all of the genes of the human genome from both a physical and
functional standpoint, was declared completed in 2003 (although not all
genes were actually identified and the genome was comprised from
multiple people), scientists have been seeking to identify all the
possible gene variants and most importantly, map them to human health
and disease.<br />
<br />
These efforts extend to several research fields, most
notable (in my opinion in terms of most immediate impact) among them
today being pharmacogenetics and epigenetics. Pharmacogenetics is the
study of inherited genetic differences in drug metabolic pathways which
can affect individual responses to drugs, both in terms of therapeutic
effect as well as adverse effects. This means that doctors can adjust
your medications and related dosages based on knowing whether or not you
will respond positively based on your genetic profile. For example,
tens of millions of Americans take statins, yet only one out of a
hundred get a real benefit from them. Imagine if researchers could
identify who that one is and spare the other ninety-nine from taking a
medication unnecessarily, thereby sparing their money and avoiding side
effects.<br />
<br />
Epigenetics is a more complicated as it is research that
tries to determine how environmental factors influence inherited genes.
For example, epigenetics could identify those people at significantly
increased risk of developing cancer from consuming alcohol and eliminate
the guessing game for everyone else.<br />
<br />
There are many companies
springing up around the field of genetics, including companies focused
on biological diagnostics and therapeutics. The trick is to identify
genes that correlate to diseases and then create an intervention to
change them. These research companies range from giants like Google to
small start-ups like Tute Genomics, with many new players constantly
emerging.<br />
<br />
With hundreds of millions now being spent on connecting
the dots between which genes promote health and which lead to disease, I
am extremely optimistic that there will be some major breakthroughs
within the next twenty years. With these discoveries, you will be able
to much better answer the question of who you are, at least from a
genetic perspective. Until then, don’t be surprised that what works for
one person doesn’t work for another. It’s may simply be an unidentified
genetic variant at play.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com4tag:blogger.com,1999:blog-3836609211397742247.post-57420658198107704202014-10-02T08:49:00.002-07:002014-10-05T08:25:31.798-07:00Why You Can't Judge A Chocolate By Its Color<div dir="ltr" style="text-align: left;" trbidi="on">
<div class="article-body">
The other day, I went to the movies (yes,
too much time on my hands) and purchased a DOVE® brand product labeled
as "Dark Chocolate." As I sat watching the movie and snacking on the so
called "dark chocolate," it occurred to me that the product was much
sweeter than what I had come to expect from other dark chocolate
products. Having foolishly failed to read the ingredient list prior to
purchase, and now unable to do so in the dark theater, I stopped eating.
Upon exit, I immediately scanned the ingredients. Much to my surprise
and even greater chagrin, it appeared that the first ingredient was what
DOVE® describes as "sweet chocolate." Here are the ingredients copied
from Dove's website for this product:<br />
<br />
<div class="Facts">
<strong>Ingredient Declaration:</strong>
<br />
<div class="ingredientInfo">
SWEET CHOCOLATE (SUGAR, CHOCOLATE, CHOCOLATE PROCESSED WITH ALKALI,
COCOA BUTTER, SKIM MILK, MILKFAT, LACTOSE, SOY LECITHIN, NATURAL AND
ARTIFICIAL FLAVORS), ALMONDS, TBHQ TO MAINTAIN FRESHNESS. ALLERGY
INFORMATION: MAY CONTAIN PEANUTS AND TREE NUTS.<br />
<br />
So I wrote DOVE® to express my dissatisfaction over having been
misled that the product labeled as dark chocolate actually contained
"sweet chocolate" including skim milk and milkfat, and that the product
did not list the percentage of cacao as do many other dark chocolate
products. In my letter, I asked for both a refund of my purchase and a
clarification of the basis of Dove labeling the product as "Dark
Chocolate" given the ingredients.<br />
Here was Dove's response in its entirety:<br />
"Dear Steven:<br />
<br />
Thank you for your email regarding DOVE®.<br />
We are sorry to hear you are disappointed with the ingredients used in DOVE® PROMISES® Dark Chocolate with Almonds.<br />
If you still have questions, please call Consumer Care at
1-800-627-7852 between 8:30 a.m. and 5:00 p.m. EST. When calling, please
refer to Case Number:40245829.<br />
<br />
Have a great day!<br />
<br />
Your Friends at Mars Chocolate North America<br />
Case ID 40245829"<br />
Even more flummoxed at this point, I called the number and spoke to a
pleasant older sounding lady who explained, after putting me on hold to
speak to a colleague, that DOVE® labeled its product based on Food and
Drug Administration (FDA) guidelines. She was unable to cite the
specific guideline when asked. I told her that nevertheless, the
labeling could be misleading to consumers and should be changed.<br />
Then I called the FDA consumer line and spoke to another rather
pleasant lady who said that the FDA, in fact, has no guidelines in
regards to dark chocolate. Here is the relevant citation that she led me
to:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm<br />
What you will find at the FDA site is that although the FDA does
define what may be construed as "chocolate," it offers no such
definition or guidelines for "dark chocolate." When asked specifically
then what is the basis for a product manufacturer to state that its
product is "dark chocolate," the FDA representative replied that if the
chocolate looks dark, it may be called dark chocolate. She assured me
that she wasn't kidding even when I asked if I could quote her.<br />
<br />
So what's the big deal? Does it really matter if a chocolate is dark
or otherwise? The answer is definitively yes. Study after study has
confirmed a difference. A recent small study published in the Journal of
the American Heart Association showed one such result. here's the link.
http://jaha.ahajournals.org/content/3/4/e001072.full<br />
<br />
To quote a NPR review of the study, "Researchers studied patients
with peripheral artery disease, or PAD, which affects about 20 percent
of adults older than 70 in the U.S. and other Western countries. People
who have PAD can have trouble walking and exercising since blood flow to
their limbs becomes impaired. Cramping can be a problem, too.<br />
<br />
As part of the study, researchers gave half of the 20 participants 40
grams (about 1.5 ounces) of dark chocolate that had at least 85 percent
cocoa. The other half of the group received 40 grams of milk chocolate
that had less than 30 percent cocoa. The aim was to test whether the
dark chocolate could improve those patients' ability to walk on their
own on a treadmill."<br />
It did. The researchers "observed improved blood flow among the
participants who ate the dark chocolate. "Conversely, we did not observe
effects on blood flow and on walking autonomy in PAD patients after
milk chocolate consumption.""<br />
<br />
Back in July 2013, I also posted a summary blog about the nature and healthiness of eating chocolate.<br />
To read that overview of what is actually "chocolate" and the
difference between white, milk and dark chocolate, here is the link:
http://mdprevent.blogspot.com/2013_07_01_archive.html<br />
The basic takeaway from my blog is that that are real differences in
what is contained in the variety of chocolates and what affect they have
on the average person. Numerous reasonable studies have shown health
benefits from dark chocolate products including high cacao percentages,
usually in excess of 70%. I personally prefer 85% or higher and choose
among Lindt, Godiva and Ghirardelli (86% and my favorite) as my sources
of reasonably tasty products. On the other hand, products with lesser
cacao are often heavy in sugar and are basically problematic for most
people who must watch their blood sugar levels and/or their weight.</div>
<div class="ingredientInfo">
So in summation, while dark chocolate with
levels of cacao greater than 70% may actually have health benefits,
"dark chocolate," as referred to by manufacturers such as DOVE® may only
have 15% cacao and be unhealthily high in sugar. In other words, don't
trust a chocolate by its color or label. Read the ingredients to know
exactly what you are getting.</div>
<div class="ingredientInfo">
</div>
<div class="ingredientInfo">
</div>
<div class="ingredientInfo">
As for DOVE®, I say shame on it for misleading me and I suspect many others, and refusing to do anything about it.</div>
</div>
</div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com5tag:blogger.com,1999:blog-3836609211397742247.post-44759661676560422912014-08-16T17:53:00.002-07:002014-08-16T17:53:39.512-07:00168<div dir="ltr" style="text-align: left;" trbidi="on">
Do you know what 168 stands for?<br />
For those who do not know that
number, let me give you some hints. 168 represents something very
valuable, yet often taken for granted. It's also represents something
that most people would think is far less. Ready for the answer?<br />
Drum-roll, please.<br />
168 represents the number of hours in a week.<br />
When
I ask this question to many people, the answer surprises them. I often
ask the question in response to someone inquiring about how I spend my
time these days. When they hear what 168 represents, they first smile to
themselves as they do their own silent calculations -- 7 days times 24
hours a day equals 168.<br />
But the best part is when they look again
at me and grin. For in that moment, they realize that 168 is a pivotal
number for me and that I am transmitting a message with my question.
Before they can speak, I do a little more math for them. I start by
stating that if I sleep 7 hours a day, which is my target, I will use 49
hours of the 168 a week. That leaves 119 hours at my disposal.<br />
That
also leaves 119 hours at anyone's disposal that sleeps 7 hours a night.
If you work, subtract at least another 40 to 60 hours that includes
transportation time and you are left with a neat 59 to 79 hours to eat,
shop, bathe, toilet, have sex, and generally meet human needs. That may
knock of another 25 to 30 hours off a week leaving you with a sum total
of a low of 29 to a high of 54 hours.<br />
Depending on the speed at
which you do life, you should have time left over for more pleasant
activities such as parenting (both to children and your own parents;
yes, I know that it's not always pleasant), enjoying hobbies, reading,
exercising, watching (may not actually be better), and socializing. <br />
I suggest you do your own tally and figure out how you spend each week.<br />
Why bother?<br />
Two reasons.<br />
First,
as you only go around once, don't you want to figure out if you are
making the best use of your time? It seems that many people don't
appreciate the value of their current time and instead 'plan' to make
good use of time only when they retire. <br />
That's a shame. You never know what life may bring when you retire, such a state of health, and you shouldn't wait for it.<br />
Second,
and far more personal to me, retirement for most people doesn't appear
to be all that great. What, you may say? Are you crazy? You may feel
that when you retire, you won't have to set your alarm clock, get ready
for work, travel to work, work all day to make a living, go home, and
repeat the same regiment the next day. Wouldn't that be great? I know I
felt that way.<br />
Then I retired. I like to read, watch, socialize,
eat, have sex, shower, sleep, exercise, etc. The problem is that even
when I'm done, I'm still left with too much time to spend. (No speedy
sex jokes, please)<br />
Okay, you may say, how about some charitable or
volunteer work? I've tried that by getting involved in community,
non-profit work. It just wasn't all that satisfying for me because there
always seemed to be more talking than action. In fact, it almost seemed
like people joined these boards to hear themselves speak. (By the way,
I'm not saying that such organizations don't play an important
role--just that they weren't my cup of tea.)<br />
So what's my point here? <br />
Stop
wasting your time because you never know what you will find at the end
of the rainbow. Find work that you enjoy if that is possible. Work is
for most people a necessity, but that doesn't always mean you have to
spend spend your life doing unpleasant work in the hope that retirement,
even an early one, will make it all worth it. A terminally ill cancer
patient once told me that no one states on their death bed that they
wished they had spent more time at the office. <br />
So back to 168
hours a week. It's actually plenty; so make sure you are using them all
well. If not, maybe it's time you started. <br />
My last piece of
advice is never retire. Keep working until you can't physically or
intellectually work any more. If you work because you are trying to save
for retirement or to put food on the table then keep doing what you
must until you are financially comfortable (whatever that means for
you), then switch to work you enjoy so it won't feel much like work.<br />
Finally, always find a reason to get out of bed every day. It sure beats the alternative.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com5tag:blogger.com,1999:blog-3836609211397742247.post-20923993288853241182014-08-08T09:06:00.002-07:002014-08-08T09:06:23.852-07:00No Really, It's All About You. <div dir="ltr" style="text-align: left;" trbidi="on">
<br />
<div id="article-body">
I’ve been as guilty as anyone who tries to give the best health
advice to family, friends and even strangers. I’ve answered countless
questions and initiated endless discussions about food, nutrition,
dietary supplements, exercise, and many other facets of presumed healthy
living. This advice has always been based on the weight of the evidence
of the available science. But in my heart, I always knew that my
recommendations were based on statistical significance. In other words,
the evidence would show that there was a statistical advantage to
following one approach over another based on the conclusions of any
number of studies.<br />
These studies may have nothing to do with you
at all. The problem with basing recommendations on such studies ignores
the fact that they don't ultimately account for YOU as an individual. <br />
For
example, although smoking is strongly linked to lung cancer and other
lung related diseases, it doesn’t equally affect all smokers. That
doesn’t mean smoking is ever good for you, but for some it actually is
harmless. (Today, as there is no way to know if you are at real risk,
it’s still best to avoid.)<br />
While some people have a disease
(Celiac) that absolutely requires them to avoid gluten and others have
an intolerance to it, there are still many that are not affected,
whether it’s genetically modified or not. The same can be said for sugar
and simple carbohydrates. There is no doubt that for some the
consumption of sugar is lethal as it leads to deadly weight gain,
diabetes, heart disease, etc., while there are others completely unfazed
by consumption of large amounts. I have a friend Steve that consumes it
non-stop with no apparent consequence. He has no family history of
diabetes and his blood sugar is not elevated above normal levels despite
his relentless consumption. He is also very physically active and that
may explain his apparent immunity.<br />
Now I’m not saying that just
because you don’t know for sure whether or not something is bad for you
it’s okay to throw caution to the wind and ignore the statistics.
Rather, I’m saying that you really have to pull together all the clues
your body is giving you to try to make sense of what is and is not right
for you.<br />
Those clues include family history, genetic testing, blood work, the mirror, how you feel, etc.<br />
None of these clues in and of themselves carry absolute weight. <br />
You
are not your parents or your siblings. First, you inherit two sets of
genes, one from each parent. Second, factors such as mutations and
environmental exposures affect if these genes turn on or off. At this
point, science cannot predict except in very rare circumstances how
one’s genes will ultimately affect your overall health. That’s because
it’s a complex, multifaceted hormonal and transcriptional system that’s
at play.<br />
Complicating the matter further, over the span of one’s
lifetime, genes can change the way they act or even actually change in
what are called somatic mutations. That may explain why something that
was never a problem suddenly becomes one and vice a versa. The science
of how the environment affects our genes is called epigenetics and it is
still a fledgling field.<br />
What about genetic tests? They have yet
to become mainstream and for good reason. Genetic tests only identify
the genes we know and understand and potentially ignore many other genes
that we don’t fully understand their roles and how they may affect the
genes we do seem to understand. More importantly, gene therapy is still
in its early stages and so identifying a gene problem for which there is
no practical solution today could best be described as a frustrating
exercise in futility for the current sufferer. While there is great
promise in what lies ahead, genetic testing today plays at best a
marginal role. Yes, it may induce a woman with a family history of
breast cancer and a known BRCA gene mutation to undergo mastectomy, but
it may not have been necessary if we had a better grasp of what other
factors, such as the presence or absence of other genes or gene
mutations, would change the risk profile and eliminate the need for
surgery.<br />
Blood tests provide good, but also imperfect information.
Their results are generally markers, rather than causes of diseases. I
generally favor them as more information is usually better than less,
but even that’s not always the case. The Prostate Specific Antigen test
for prostate cancer is a case in point. Reasonable doctors can disagree
if and when having such a test is indicated as so many men pursue
further expensive, invasive, and unnecessary testing based on misleading
results.<br />
The mirror is my favorite clue. How do you look? The
most specific clue is do you look your age. Again, not the perfect clue
because you can look great and still have underlying disease or even
trouble pending. That’s also true for how do you feel. Feeling good is
obviously better than the alternative, but it’s no guarantee of good
health.<br />
My point is that although no clue in isolation should give
one complete peace of mind, taken collectively they offer a decent
roadmap when reviewed by someone capable of properly making such a
determination. <br />
Now you may say that all this concern about clues
about health is much ado about nothing because there is actually very
little you can do to change anything--and you may actually be right.
Until we know more, no one can answer that question with certainty, or
what is certain today may not be tomorrow<br />
However, to the extent
that you continue to seek advice about the best foods to eat, what
supplements you need, what form your exercise should take, etc., please
be aware that unless the person giving you such advice knows a lot about
you such as your family history, your blood results, your genetic
profile, your state of mind and body, such advice is merely general and
generic. That’s because at the end of the day it’s all about what
does/will affect you as an individual and not some statistic. Don’t
chase or accept unsolicited advice from people who don’t know YOU or
your history. Such advice is usually not meaningful and may lead to bad
results.<br />
By the way, this does not apply to medical advice given
by a health professional following a proper consultation. That’s more a
question if you trust the professional’s knowledge and judgment (a whole
topic on its own).<br />
Nevertheless, you don’t need to be a
narcissist to realize that when it comes to your health and the best
approach, it really is all about YOU.<br />
</div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com3tag:blogger.com,1999:blog-3836609211397742247.post-84147117467584792782014-07-01T19:03:00.003-07:002014-07-04T09:02:23.742-07:00Next Stop: Stanford University<div dir="ltr" style="text-align: left;" trbidi="on">
<div id="article-body">
In 1955, Albert Einstein was quoted that one should "learn from
yesterday, live for today, hope for tomorrow. The important thing is to
not stop questioning. Curiosity has its own reason for existing." Like
Einstein, I have always believed in lifelong learning and satisfying my
ever curious mind.<br />
You may think that at the age of 55, with a
medical school education, surgical training, a business degree, and a
career that included founding, building, and eventually retiring from
HealthDrive, a national health care company serving the extended care
industry, my learning days and quest for more knowledge might be done.
You might also think that after the shutdown of MDPrevent, (see my other
post on what happened), my full throttle, but unsuccessful foray into
life extension and disease prevention by lifestyle modification, my
interests in longevity and preventive medicine would have waned. If you
thought so, you would be incorrect on both accounts. That's because I believe if you don't succeed at first, try again.<br />
About two
months ago, I learned about a new program starting up at Stanford
University called the Distinguished Careers Institute or DCI. The DCI,
the brainchild of Philip Pizzo, MD, the former dean of Stanford’s
Medical School, offers people who have had successful careers, but are
eager to discover what comes next, an opportunity to expand their minds
at Stanford by pursuing a scholarly pathway under the guidance of
faculty mentors and advisers. When I read about the program in a press
release, which I accessed through my daily Google alert on the keyword
‘longevity,’ the idea so excited me that I suspect I was the first
person to apply online. <br />
I am excited to announce that my
application was accepted and I received an invitation to join the
inaugural group (20 individuals) of Fellows to start the program in
January 2015. Yesterday, I made the decision to accept the invitation
after consulting with a number of professors at the Stanford Center for
Longevity and the Stanford Prevention Research Center, including Doctors Pizzo and Kathy Gillam, the executive director of the DCI program, who
all impressed me with their knowledge, friendliness, and willingness to
help me identify my next career. Although I have always believed that
success is the byproduct of one’s own hard work (and good luck), I have
also learned the value of getting help from others. <br />
As a believer
in making the most of one’s life until you can’t do no more and in doing
well by doing good, I can’t believe there can be a better place for me
than Stanford as the next stop on my life journey. Wish me luck.</div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com3tag:blogger.com,1999:blog-3836609211397742247.post-60907239091819150122014-06-11T16:02:00.000-07:002014-06-11T16:02:50.221-07:00Caveat Lector -- Let The Reader Beware!<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">A new study shows…</span></div>
<br />
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</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">How many times have you heard that phrase followed by some new big
revelation? It’s usually a new discovery because few scientists want to study and
merely confirm what is already known. If they do, the confirmed results often
don’t see the light of day. However, if they discover something new then watch
out. </span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">More importantly, the media doesn’t grab attention by generating headlines
about widely accepted knowledge.<span style="mso-spacerun: yes;"> </span>Often
times, the new information creates a buzz because it conflicts with previously accepted
science; not surprisingly, often these types of studies grab the most
headlines.<span style="mso-spacerun: yes;"> </span></span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">The problem with such studies and the headlines they generate is
that no single study proves anything—it merely adds to our knowledge. That’s
why people are cautioned to not accept any media science headlines at face
value without knowing the full scope of the study reported and how its
conclusions fit in with the greater body of evidence surrounding the topic.</span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">At a recent wedding, three of my cousins approached me to ask nutritional
questions. One even asked me during the meal if what he was eating was healthy.
<span style="mso-spacerun: yes;"> </span>Another commented that they should watch
me to see what I eat to determine what was good for them. <span style="mso-spacerun: yes;"> </span>That approach would be a horrible
mistake.<span style="mso-spacerun: yes;"> </span>A healthy diet should never be
judged by one meal alone; healthy food should never be judged on the basis of
isolated nutrients.</span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<span style="color: windowtext; font-size: 12.0pt; line-height: 107%;">One would
think that it is well understood that a healthy diet should be viewed
holistically (in its entirety), but you could be forgiven for thinking
otherwise when studies like the one recently published by the CDC hits the
media circuit. The study, titled </span><b><span style="color: windowtext; font-size: 12.0pt; line-height: 107%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Defining Powerhouse
Fruits and Vegetables: A Nutrient Density Approach </span></b><span style="color: windowtext; font-size: 12.0pt; line-height: 107%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">attempts to clarify the value of consuming certain
fruits and vegetables over others based on the levels of certain nutrients they
contain. </span><br />
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<span style="color: windowtext; font-size: 12.0pt; line-height: 107%;">As part of
the study, Jennifer Di Noia, an associate professor of sociology at William
Paterson University in Wayne, N.J., crafted a list based on the nutritional
density of fruits and vegetables, using data from the U.S. Department of
Agriculture. As the basis of determining nutritional value, she used 17
nutrients including potassium, fiber, protein, calcium, iron, thiamin,
riboflavin, niacin, folate, zinc, and vitamins A, B<sub>6</sub>, B<sub>12</sub>,
C, D, E, and K.<span style="mso-spacerun: yes;"> </span></span><br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<span style="color: windowtext; font-size: 12.0pt; line-height: 107%;">By her own
admission, because she felt that since it was not possible “to include
phytochemical data in the calculation of nutrient density scores, the scores do
not reflect all of the constituents of a fruit and vegetable that may confer
health benefits.” By phytochemicals, Dr. Noia is referring to all the
antioxidants, like anthocyanins, polyphenols, carotenoids, etc., and other
nutrients that naturally occur in fruits and vegetables; the same antioxidants
that are believed to work synergistically with all the other nutrients in the
fruits and vegetables to deliver the full nutritional value of a food item; the
same naturally occurring antioxidants that are believed to play a role in neutralizing
free radicals.</span><br />
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">In addition, her qualification list only includes 17 nutrients while
there are 13 vitamins, 15 minerals, two fatty acids, nine amino acids (she did include
proteins, but did not clarify if they were complete proteins that by definition
contain all 9 essential amino acids), and water, all of which are considered <b style="mso-bidi-font-weight: normal;">essential</b> to human functioning. So even
though there are 49 absolutely essential (as identified by current science—of course
subject to future revision) nutrients, her list was based on only 17. Nevertheless,
she concluded that they were apparently the most important.</span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">What were her conclusions? Leafy green vegetables are good.<span style="mso-spacerun: yes;"> </span>No big surprise. Raspberries, tangerines,
cranberries, garlic, onions, and blueberries are essentially a waste of time
when it comes to their nutritional soundness. Why? Because they didn’t have
enough of the 17 nutrients she deemed important. Forget about what else they
have in them; they just don’t make the cut. That’s just plain absurd.</span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">An essential nutrient is an essential nutrient.<span style="mso-spacerun: yes;"> </span>None is more important than another. Further,
it’s renders her study meaningless when she leaves out phytochemicals.<span style="mso-spacerun: yes;"> </span>If you followed Noia’s logic, you shouldn’t bother
eating fruits and vegetables at all. Just pop a pill that includes the same
amounts of her 17 key nutrients and call it a “Powerhouse Pill.” Shameless.</span></div>
<br />
<div style="text-align: left;">
</div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nevertheless, I am very surprised, given the study’s limited
utility, that the CDC published it in the CDC’s journal, Preventing Chronic
Disease. <span style="mso-spacerun: yes;"> </span>More importantly, until I read
the actual study, I was baffled by its reported conclusions. Once I knew what
criteria had been used, I also knew its true value—zero.<span style="mso-spacerun: yes;"> </span>I disdain the use of “powerhouse” to describe
any food as being more important than other foods contributing to an overall
healthy diet. Using such a word is nothing more than an attempt at hype to grab
more media attention. Uch.</span></div>
<div style="text-align: left;">
</div>
<br />
<div class="MsoNormal" style="text-align: left;">
<span style="font-family: "Calibri Light","sans-serif"; font-size: 12.0pt; line-height: 107%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">For me it invoked once again the saying, <i style="mso-bidi-font-style: normal;">Caveat Lector</i>—let the reader beware! </span></div>
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<br /></div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com1tag:blogger.com,1999:blog-3836609211397742247.post-38605998764080292302014-06-06T15:14:00.002-07:002014-06-09T06:51:32.869-07:00Dr. Oz Show Canceled???<div dir="ltr" style="text-align: left;" trbidi="on">
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FOR IMMEDIATE RELEASE<br />
New York, NY. June 6, 2017 --After riot police were summoned, Harpoon
Productions, the producers of the Dr. Oz Show bowed to public outcry and the rapidly
growing crowd outside it’s studios that stretched down Manhattan’s Sixth Avenue,
blocking traffic for miles in any direction, by announcing today the immediate
cancellation of the syndicated television show that ran for ten years featuring
Dr. Melvin Oz.<span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
The problems with the show had been steadily increasing due
to mounting scandals plaguing Oz such as a lawsuit concerning burnt diabetic
toes.<span style="mso-spacerun: yes;"> </span>Another scandal involved Dr. Oz denying
the fact that he and his family take no supplements and never have despite
stating the opposite on many episodes.<span style="mso-spacerun: yes;"> </span>In
the face of incontrovertible evidence, Oz has continued to claim that he
consumes dozens of supplements a day to prevent colds, hair loss and fungal
infected toenails. However, the most troublesome revelation about Oz was the discovery
that he is paid $1 every time he endorses a supplement. It is believed that Oz
has joined the Forbes 300.<br />
</div>
<div class="MsoNormal">
Problems for Oz and his show escalated on Wednesday when a group
of several hundred morbidly obese women and men gathered outside the studio at
Rockefeller Plaza in New York.<span style="mso-spacerun: yes;"> </span>They came
to protest against the show and its star. Waving banners that read, “You Did
This To Us” and “Stop Feeding Fat Lies To Skinny People,” the protesters were
presumably reacting to Oz’s now almost daily proclamations of new ways to lose
weight, including his most recently touted<span style="mso-spacerun: yes;">
</span>“One-Minute Rapid Weight Loss Plan” and “How To Lose Ten Pounds By Donating
An Organ.“<br />
</div>
<div class="MsoNormal">
These newfangled, unscientific, and radical plans were
touted by Dr. Oz pursuant to what he declared was “recent research that showed
they worked.” <span style="mso-spacerun: yes;"> </span>In addition, these “quickie”
weight loss plans, described by Oz as “miracles” had joined a long list of his other
rapid weight loss schemes like Raspberry Ketones, Garcinia Cambogia, and
Glucomannan.<br />
</div>
<div class="MsoNormal">
One hefty protester by the name of Pop Goestheweasel, a 64
year old construction worker from Yonkers <span style="mso-spacerun: yes;"> </span>said that he had enjoyed a 34 inch waist before
watching the show based on his wife’s advice.<span style="mso-spacerun: yes;">
</span>Goestheweasel,, who now appears to have ballooned to at least four
hundred pounds, cut the interview short to snack on a pizza and milkshake Oz
had recommended on a recent show as “a magical weight loss elixir.” <span style="mso-spacerun: yes;"> </span>He also admitted that he was a sucker for Oz’s
medical persona and until today continued to hope that the next Oz advice would
be the one that finally restores his waistline.</div>
<div class="MsoNormal">
Events really started to get out of hand when the original
protesters were joined by thousands of once happy, but now neurotic women who
joined the fray waving medical bills.<span style="mso-spacerun: yes;">
</span>These bills estimated to total in the millions of dollars were the
result of faithful viewers seeking immediate medical attention after Dr. Oz aired
multiple episodes about the dangers of ignoring warning signs, such as sneezing
once may indicate breast cancer, and an eye sty may be a sign of a heart attack.<span style="mso-spacerun: yes;"> </span><br />
</div>
<div class="MsoNormal">
One woman in the crowd identified as Gota Migraine, a 47
years old housewife from Queens, revealed that she had seen five internists and
thirteen specialists after hearing Dr. Oz tell his TV audience that fatigue may
be due to Overexertion, a newly discovered illness.<span style="mso-spacerun: yes;"> </span>After researching Overexertion on the
internet, this lady was determined to seek appropriate medical attention to
combat her life-altering condition. Despite numerous medical exams and tests,
alternative medicine doctors she sought out after seeing them repeatedly featured
on The Dr. Oz Show who had been unable to pinpoint why Overexertion was causing
her fatigue. After being told to take no less than three thousand different
supplement pills and nutritional foods, many of which had been emphatically
endorsed on the Dr. Oz Show, Mrs. Migraine realized that her fatigue was due to
carrying around hundreds of bottles containing her daily supplements.<br />
</div>
<div class="MsoNormal">
The final straw for the Dr. Oz Show’s producers was when the
crowd expanded to include hundreds of thousands of scalpel wielding doctors who
traveled from all over the world to beg Oz to stop spewing pseudoscience to their
patients.<span style="mso-spacerun: yes;"> </span>In fact, it was noted that
some doctors were actually breathing heavily from the burden of listening to
their patients for years tell them that “Dr. Oz said this…and Dr. Oz said that.”<span style="mso-spacerun: yes;"> </span><br />
</div>
<div class="MsoNormal">
The crowd, including the panic-stricken doctors, went into a
frenzy when an announcement was made that Dr. Oz had issued a message for the
crowd that “protesting against the Dr. Oz Show was bad for their health.”<span style="mso-spacerun: yes;"> </span>Fortunately, the crowd quieted and was noted
to have uttered a collective deep sigh of relief when news of the show’s cancellation
reached them.<span style="mso-spacerun: yes;"> </span>Even as the crowd began to
dissipate, some doctors were noted to be tending to the morbidly obese men that
had overdosed on Glucamannan and were suffering from intestinal blockage, while
other doctors were seen comforting the neurotic women that everything would be
okay now.<br />
</div>
<div class="MsoNormal">
As for Melvin Oz, who could not be reached for comment, authorities
report that he was taken into protective custody pending resolution of the incident.
At the same time, it’s been announced that all his ubiquitous images on TV,
magazines, internet, newspapers, and billboards have been removed to avoid inciting
another mass protest.<span style="mso-spacerun: yes;"> </span>It is clear the good
doctor is no longer in.<br />
</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 12.0pt; line-height: 115%;">This parody is meant as
good fun. It is completely fictitious, as are all the characters and none of it
has happened (at least not yet.) </span></i></b><br />
</div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 12.0pt; line-height: 115%;">In addition, no real
people were harmed in the writing of this parody, but it’s not certain that the
same can be said for the viewers of the Dr. Oz Show.</span></i></b></div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com1tag:blogger.com,1999:blog-3836609211397742247.post-80482178860045638922014-05-26T16:49:00.000-07:002014-05-27T10:58:30.828-07:00Kayaking with Alligators and Other Calculated Risks<div dir="ltr" style="text-align: left;" trbidi="on">
<div id="article-body">
Jonathan Dickinson Park is a Florida State Park located in Martin County, Florida; the Loxahatchee River runs through it.<br />
<br />
Last
Friday, accompanied by my wife and another couple, I kayaked down the
river to view pristine nature. Watching us from the sidelines were a
number of alligators, with some appearing as large as ten feet long. One
actually swam under my friend's kayak. <br />
<a href="http://i.huffpost.com/gen/1217063/thumbs/o-ALLIGATOR-facebook.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="http://i.huffpost.com/gen/1217063/thumbs/o-ALLIGATOR-facebook.jpg" height="211" id="irc_mi" style="margin-top: 0px;" width="320" /></a><br /><br />
Stroking
the water in my single kayak, I couldn't help but think what possessed
me to go down a river surrounded by ferocious, life-altering creatures
with my only defenses a paddle and a pocket-knife. Coupled with the
knowledge that death had come to a young boy on this very same river
from a similarly situated alligator only added to my puzzlement.<br />
<br />
I am not a risk taker by nature, particularly when it comes to nature.
True, I was a boy scout for three years, but supervised hikes in the
woods was the extent of my trailblazing. Skydiving, motorcycle riding,
hang-gliding, parachuting, bungee jumping etc. are simply not part of my
repertoire and never have been. So what was I doing on that river? I
was taking a calculated risk.<br />
<br />
The Merriam Webster dictionary defines a calculated risk as "<span class="ssens">a
hazard or chance of failure whose degree of probability has been
estimated before some undertaking is entered upon." I think you will
agree that boating down a river inhabited by alligators, one of which
already killed someone, without any rescue in site in order to enjoy a
unique patch of nature is by all means a calculated risk. Why did I do
it and why should my adventure be of any concern to you?</span><br />
<br />
<span class="ssens">Patients
often told me that if they had to give up the foods they loved, there
would be no reason to live. Clearly such people live to eat as opposed
to eat to live. Even when faced with the risks of heart disease, cancer,
stroke, diabetes, etc,, food means too much to them to give up. More
importantly, they know there are no guarantees that if they actually
gave up their pizza, cakes, burgers, french fries, milk-shakes, pasta,
etc. that they would necessarily stay healthy or even live longer. For
them, their calculated risk has their favorite foods trumping over
potential health risks. </span><br />
<span class="ssens"><br /></span>
<span class="ssens">Many
people often make the same calculation about exercising regularly and
managing their stresses more effectively. For example, if you spend one
hour a day exercising for sixty years, you would have spent the
equivalent of over three years of awake time (at an average of 17 hours a
day) of your life exercising. It is estimated that people who exercise
one hour a day, ignoring diet and other longevity factors, will on
average live a few years longer. By some calculations, that seems like a
wash. I say some, but not mine. </span><br />
<span class="ssens"><br /></span>
<span class="ssens">When
I think about the consequences of eating the right diet or staying
physically active over the course of your life, I think in terms of both
possible gains as well as losses. Although there are no guarantees that
exercise will keep you alive longer, as Jim Fixx the runner proved by
his passing, staying physically active has been clearly associated in
every study I ever read with a healthier healthspan, the measurement of
how long in life you feel well. So it's not just a matter of living
longer, it's also about feeling better during the years you live. In
addition, many studies also show that eating healthy </span><span class="ssens"><span class="ssens">when coupled with other healthy lifestyle choices </span>is highly correlated with avoiding the chronic diseases often associated with aging. </span><br />
<span class="ssens"><br /></span>
<span class="ssens">To
eat what you want and to live a sedentary lifestyle is a calculated
risk that you are free to take. It's your life after all. You may think
that it is not as foolish as kayaking with alligators, but it's actually
far worse given that millions of people have died prematurely from
eating too much of the wrong foods while since the 1970s there are only
twenty three recorded alligator deaths in the U.S. I prefer those odds.
While alligators are a frightening topic and when they kill, they garner
major headlines for the gruesomeness, the risk of dying early from
an unhealthy lifestyle is far greater than death by alligator even when
they are swimming nearby. So if you aren't brave (or stupid, depending
on your perspective) enough to go kayaking with alligators, why do you
keep eating the way you do? It's a calculated risk to eat unhealthy and
the odds are not in your favor. </span><br />
<br />
<span class="ssens">Now that's something to chomp on (pun intended).</span></div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com1tag:blogger.com,1999:blog-3836609211397742247.post-10641682632546398842014-05-16T12:49:00.000-07:002014-05-17T11:12:05.455-07:00Is (The End of) Death Inevitable?<div dir="ltr" style="text-align: left;" trbidi="on">
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At a dinner party nearly two years ago, I made a passing comment about the
inevitability of death. The host, an Israeli-Danish economics professor, took
exception to my statement. He responded that one can only speak with certainty
about what has happened, not what usually happens. At first
blush, I thought he was either a wacko or was just being ornery. How could
anyone assert that death was not a fact of life? How could anyone deny the
inevitability of death? <br />
<br />
After the dinner, I began to ponder his statement, and over the ensuing
months gave it ever greater reflection. After reviewing the burgeoning body of
research tackling anti-aging and longevity, I have reached my own conclusion.
You may think I am also a bit looney, but please indulge me for a moment.<br />
<br />
Car analogies are useful tools for explaining the function and longevity of
the human body. Everyone knows that the better you treat your car, the
longer it will last. However, despite utmost care, if the car is
regularly used, at some point, the engine will need to be rebuilt, the tires replaced,
the exterior retouched, etc. A car functions based on the quality of its fuel
and replacing actual fuel with non-combustible liquids means the car can't
function (except for electric cars, a scientific breakthrough in its own
right). Humans similarly need the right care and fuel to function.<br />
<br />
However, car buffs will tell you that even though most cars are useable for
at most a couple of decades, there are cars out there that are nearly a hundred
years old and there are plenty of cars still functioning after many
decades. Yes, they need extra-special maintenance, but their useability is extendable indefinitely with continued care. Cars, like humans, also
require the interoperability of multiple parts to be useful. Without a steering
wheel, you can't meaningfully use the car even if you have a wonderful engine.
Similarly, humans need their hearts, brains, livers, etc. to all function in
unison and the failure of one is the failure of all.<br />
<br />
Of course, cars analogies are of limited utility because the human body is
far more complicated.<br />
Unlike cars, replacing human parts is still a challenge. Yes, we can
transplant some parts like hearts and livers, when they are even available, but
parts like brains and thyroids still remain beyond our abilities. In fact, the
human body is so complicated that many metabolic processes, parts of the
microbiome (the bacteria, good and bad, that share our body space), and both
human and microbiome genes and their related proteins have yet to be either
fully understood or even identified. Even worse, when the body malfunctions
like with auto-immune diseases and cancer, we are still mostly
defenseless.<br />
<br />
Nevertheless, what is unknown is ripe for the finding, analyzing and manipulating.
When smallpox was killing hundreds of millions of people, I am sure many
wondered if a solution would ever be found. It was and the disease and the
plague it caused are now mostly history. When the HIV virus was first
discovered, the prognosis was sure death. Today, many live with the diagnosis
due to effective interventions.<br />
<br />
That is why I now believe that the <b>difference between life and
death is only a matter of undiscovered science</b>. This means that the end of
death as humans now understand it (another essay in its own right) will require
scientific advances and breakthroughs that are only a matter of time. No one can tell you exactly when
these life-altering discoveries will be made, but I suspect it will happen
sooner than expected. Why? Because of the three "Ps":
(Scientific) Progress, People and Purse.<br />
<br />
Real progress is being made. Research into understanding what causes death
is accelerating. Universities across the U.S., Europe, Asia, and Israel
are actively engaged in finding the root causes of death and related processes
that accelerate and impede it. Research into fruit-flies, worms, rodents
and monkeys have already identified a number of gene variants whose presence
and/or manipulation has been proven to extend life by as much as five times (in
worms). Human gene studies have already identified multiple gene variants
associated with super-centenarians, those aged above 110. Scientists recently
created the first living semi-synthetic organism made from synthetic base pairs
after long believing such a feat was impossible. As our ability to identify
genes and proteins grows, so does the possibility for targeted gene therapies
to control their actions. The accelerating progress to date offers the great
promise of much more to come.<br />
<br />
The solution to death will require great effort and that will require people
capable of mustering such effort. Last year, Google announced the formation of
a new company called CALICO, for California Life Company and hired Arthur
Levinson, the former CEO and current Chairman of the pioneering Genentech,
arguably one of the most successful and innovative biotechnology companies of
all times. He is also Chairman of Apple, another technology bellwether.
Levinson has begun assembling a team of leading scientists including recently
adding Cynthia Kenyon, the UCSF molecular biologist and biogerontologist who
has done the groundbreaking research into worm life extension. Not to be
outdone, Craig Venter, the biologist and entrepreneur credited for winning the
race to sequence the entire human genome, announced this year the formation of
Human Longevity, a company dedicated to life extension. Human Longevity
announced that it would first target cancer by collaborating with a UC San
Diego Moores Cancer Center to sequence the genomes of between 40,000 to 100,000
cancer patients a year in order to find gene patterns amenable to novel gene
therapies.<br />
<br />
People like Aubrey de Grey, of the SENS Research Foundation, a non-profit
funding work at universities across the world and at its own Research Center in
Mountain View, CA,. have been getting much airtime about funding life extension
by giving TED talks, writing extensively and circulating widely. Ray Kurzweil,
the prolific writer, inventor, scientist, Google director of engineering, and
futurist purports that the melding of humans and technology, what he calls <i>the
Singularity</i>, will by itself propagate life indefinitely into a new era of <i>Transhumanism</i>,
a perspective that argues that humans will enter a new stage of existence by
using technology to greatly enhance intellectual, physical, and psychological
capacities. Of course, life and death as we know them today would be
redefined under this scenario. Think beyond bionics and The Six Million Dollar
Man and implanted circuitry and the current TV show Intelligence. Think nano-
or even the much smaller femto-technology. Think semi-synthetic humans.<br />
<br />
Perhaps the most intriguing persona in the longevity field is entrepreneur
Laura Deming. Admitted into MIT at the age of 14, child prodigy Deming,
now 19, dropped out to found Longevity VC, a venture capital firm focused on
identifying and funding research into life extension. Deming began researching
longevity at the age of 12 in Cynthia Kenyon's UCSF lab. With an early
start into the field, Deming offers real promise. However, even great people
usually need resources.<br />
<br />
Scientific research is often expensive. To have any real hope for sooner than later
anti-aging breakthroughs, purses must open and they have. On the
government front, the National Institute of Aging has been spending wisely.
Recently, it announced a ten million dollar grant to University of Rochester,
Albert Einstein College of Medicine and Harvard to fund such research. Craig
Venter is purported to have raised fifty million for his venture, and Ms.
Deming is funded to some extent by Peter Thiel, one of the co-founders of
Paypal and a successful hedge fund manager. Although Google has not
publicly announced its investment in CALICO, it is estimated to be in the tens
of millions. By my estimates that easily places the current investment
north of 100 million dollars. That may not be the billions needed, but its a
good start.<br />
<br />
So given the progress, people, and purse now engaged in the search for
immortality, do you think that (the end of) death is inevitable? Maybe the
economics professor was on to something...<br />
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com4tag:blogger.com,1999:blog-3836609211397742247.post-80912145807991560932014-05-08T08:38:00.000-07:002014-05-08T08:38:29.891-07:00When Is Vitamin D A Real Worry? <div dir="ltr" style="text-align: left;" trbidi="on">
On March 14, 2014, I wrote a blog titled Vitamin D and Breast Cancer: Are they married or just acquaintances? The blog explained why study results that showed a relationship between low Vitamin D levels and a poor breast cancer prognosis were misleading by suggesting that raising vitamin D levels would change the course of the disease.<br />
<br />
Last week, a new study reported that in men diagnosed with prostate cancer, the lower their vitamin D level, the worse their prognosis. As with the breast cancer study, this study implied that if men loaded up on Vitamin D, they would improve their survivability from their cancer.<br />
<br />
This was not surprising. Hardly a week goes by without some new study showing a relationship between Vitamin D and some disease. So what's the answer? Should you raise your vitamin D levels to levels above 50 nanograms per milliliter (ng/ml) as many Vitamin D proponents claim is needed to protect yourself against cancer, osteoporosis, falls. etc.?<br />
<br />
I say no. <br />
<br />
The body of evidence is becoming very clear that Vitamin D is more a disease marker than disease causer. That means that your vitamin D level indicates the severity of a disease like cancer as opposed to controlling the severity.<br />
<br />
Although vitamin D is commonly called a vitamin, it is not actually a vitamin<a href="http://en.wikipedia.org/wiki/Vitamin" title="Vitamin"></a> in the strict sense, as it can be synthesized by exposure to sunlight. It can also be consumed like other vitamins through foods like wild Salmon, certain portabello mushrooms, and almond milk (to which it is added). Vitamin D is an essential nutrient, which means that your body cannot function without it. However, there is a growing consensus that as long as your Vitamin D blood level is above 20 ng/ml, you have enough.<br />
<br />
When a doctor tests your blood and finds that your level is low, it may mean one of two things. First, you may not be naturally producing and/or consuming enough Vitamin D. Anything below 20 ng/ml should be immediately addressed by either prudently increasing sun exposure, eating more foods with Vitamin D or taking a 1,000 mg supplement. Above that level, the evidence suggests it's safe.<br />
<br />
However, if your Vitamin D level is below 20 ng/ml, there may be a second more nefarious reason for the deficiency. You may have an illness that you are unaware of. This merits further careful evaluation by your doctor. A low level may indicate an as yet undetected cancer that requires prompt attention.<br />
<br />
When my older brother, z"l, battled against kidney and prostate cancer, his Vitamin D level went below 10 ng/ml. I asked his doctors to try to increase it thinking that somehow that would make a difference. They did; it didn't. That's because his Vitamin D level was simply telling us how sick he was and within a few weeks he passed.<br />
<br />
So the next time you see a headline about the association between Vitamin D and some disease, please remember that although Vitamin D is essential to healthy human functioning, your Vitamin D blood level is one of many indicators on your health dashboard. Therefore, low levels are typically neither a cause of disease (other than rickets/osteomalacia that happen at very low levels) nor make the disease more severe as so many studies would have you believe.<br />
<br />
So have your doctor check your Vitamin D levels at least once every couple of years, but be satisfied if it stays above 20 ng/ml. Think of Vitamin <b>D</b> as your <b>D</b>ashboard Vitamin.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com4tag:blogger.com,1999:blog-3836609211397742247.post-75430984147111053072014-04-29T13:58:00.000-07:002014-05-08T07:50:58.553-07:00Don't Fall Prey to The Licensing Effect<div dir="ltr" style="text-align: left;" trbidi="on">
Although I cannot find the original source of this term, the 'licensing effect' is commonly referred to as the subconscious phenomenon whereby increased confidence and security due to one action<a href="http://en.wikipedia.org/wiki/Self-concept" title="Self-concept"></a> tends to lead that same individual to worry less about the consequences of a counter-productive action. In other words, they think that one action gives them a license to perform a different action.<br />
<br />
For example, suppose a person is prescribed a statin, a cholesterol lowering drug, because his physician is concerned that the patient's cholesterol is too high thereby increasing the risk of heart disease. The reason for high cholesterol can range from hereditary factors to a diet high in fats, such as fried foods, that are capable of raising cholesterol levels. So following the advice of his physician, the patient fills the prescription and begins to take the statin confident that his cholesterol will be lowered and his risk for heart disease decreased.<br />
<br />
Over the ensuing days, weeks, and months as the patient uses the drug, he feels like his cholesterol is no longer a concern. So when he comes across french fries, pizza, cake creams made with trans-fats, etc., he doesn't think twice of the potential harms of eating such foods.<br />
<br />
You may say that's ridiculous. No one could be that foolish to not realize the consequences of eating these unhealthy foods known to cause long term heart issues for many. (I say many, because of the lucky few who seem to get away with eating anything and everything like my friend Steve.)<br />
<br />
If you are one of those naysayers, you may have trouble with a new study that showed <br />
that people who took statins in 2009-2010 consumed
more fat and calories than those who took the drugs 10 years earlier.<br />
<br />
That's right, they experienced a "licensing effect" to eat more.<br />
<br />
And in case, you thought everyone ate more, that was not the case. There was no similar increase in fat and calorie intake among people who
didn't take statins, according to the University of California, Los Angeles (UCLA)
researchers. Furthermore, their analysis of U.S. National Health and Nutrition Examination
Survey (not always perfect nor reliable, but pretty good) data showed that statin users in 2009-2010 consumed 9.6 percent
more calories and 14.4 percent more fat than statin users in 1999-2000.<br />
<br />
The clever ones among you may think that people who need statins probably always consumed more calories and fat and that's why they needed the statin in the first place. You would be wrong as statin users in 1999-2000 consumed fewer calories and fat than people
who didn't take the cholesterol-lowering medications.<br />
<br />
That has clearly changed per the study that was published online April
24 in <i>JAMA Internal Medicine</i> and simultaneously presented at the Society of General Internal Medicine annual meeting in Denver.<br />
<br />
This licensing effect is far more ubiquitous than just the statin example.<br />
<br />
Many people are under the illusion that taking prescription medications and supplements will somehow protect them from eating too much, especially of foods that are unhealthy for most humans.I saw this with patient after patient. They thought everything was okay because their blood pressure was within normal range on blood pressure medication, their blood sugar was within normal range because they took metformin, their cholesterol was within normal range because they took a statin, etc. They thought that if the tests are normal then everything was okay. They didn't realizing that simply lowering cholesterol doesn't prevent heart attacks. In fact, statins typically prevent one heart attack among every 100 users. That's right, 1 out of 100. That shouldn't give anyone a real sense of protection. (However, don't stop your statin without consulting your physician.)<br />
<br />
So please don't make the mistake of thinking you can eat whatever you want, and sit around all day and and do nothing simply because you take some pills and supplements..<br />
<br />
Consider this a friendly warning. Your license has been revoked.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-27142058171458983332014-04-25T11:24:00.000-07:002014-04-25T11:28:03.559-07:00Diets Are For Dummies<div dir="ltr" style="text-align: left;" trbidi="on">
Just in case you think I meant that I have a diet for you that even a dummy can follow, I don't. My headline really says it all--only a dummy would go on a diet.<br />
<br />
Over the past few months, I have spent considerable time reviewing all sorts of diets including intermittent fasting, low carb, low fat, high protein, vegan, gluten-free, calorie counting, calorie restricted optimal nutrition (CRON), paleo, etc. and have come to an educated conclusion that the notion of going "on a diet" is just plain foolish.<br />
<br />
What, you may say? Don't some people need to lose weight? Aren't diets merely a means to an end? What's wrong with trying different schemes to lose weight until you find one that works? These are all valid questions, but unfortunately diets collectively seem to do more harm than good.<br />
<br />
First, the science is pretty clear that the more diets one tries, the more likely that person is to never successfully lose weight and keep it off.<br />
<br />
Second, as most diets are simply focused on weight loss, they ignore something far more important--your health. In most cases, restricting calorie absorption to less than calorie expenditure will result in weight loss. However, such approaches often are not nutritionally sound and can actually be quite inflammatory to the human body, which can lead to systemic illness.<br />
<br />
Third, what often works for one person may not work for you or even be harmful. For example cutting out gluten when you have no gluten insensitivity or celiac disease also deprives you of glucasin, a peptide known to decrease inflammation by reducing interleukin-6. Eating lots of protein in the form of meat and eggs can increase cardiovascualr disease even as you lose weight.<br />
<br />
So what did I learn from all the studies and books I read?<br />
<br />
Diets don't work but principles do. So here are my take-away principles of eating healthy.<br />
<br />
1. Human beings do not need a lot of food to stay healthy and vibrant. Think like the Okinawans who practice <i>hora hachi bu</i>, which means to eat until you are 80 percent full. Once your nutritional needs are met, excess nutrients are not only unnecessary, but may be harmful. There is growing evidence that eating less versus more is the healthiest route as it requires your body to exert less effort to break down, absorb and dispose of what it doesn't need.. So it doesn't matter when you eat what, but make sure that the foods you eat contain all the essential nutrients. <br />
<br />
2. Although the science is inconclusive regarding organic versus conventional grown, natural versus processed, it appears prudent to avoid chemicals whenever possible. Everybody reacts differently to different chemicals and the human body is fairly adept at eliminating toxins, but one can never say conclusively that any certain chemical will not have a negative effect on you. I wouldn't get paranoid about it, but caution is indicated in severely restricting your exposure to chemicals in the foods you ingest. (It doesn't hurt to limit chemicals you are otherwise exposed to as well.)<br />
<br />
3. Eat when you are hungry. The conventional wisdom to eat three times a day, or the oft recommended multiple small meals has no irrefutable science to support it. It is clear that early man could not easily regulate access to food. It is also clear that we don't exactly know what effect this had, but I think it is reasonable to conclude based on the absence of (or conflicting) evidence to suggest otherwise that eating regularly may not have any proven benefit (other than perhaps scheduled toileting for some) as long as nutritional needs are met.<br />
<br />
4. You need to get B12 naturally from fish, chicken or meat. Wild fish is my favorite, but it should not be eaten in excess anymore than any other nutritionally sound foods. Three to four times a week will more than suffice. <br />
<br />
5. Nuts are a great source of minerals and far less fattening than most people think because unless the nut is completely grounded, much of its fat is not absorbed due to being tied up with its fiber.<br />
<br />
6. Natural food rich in both soluble and insoluble fibers are great, but like everything else should be eaten in moderation.<br />
<br />
7. Avoid any overcooked or burnt food.<br />
<br />
8. Eat fruits, but don't feast on them as too much fructose may be a problem. You can eat them at any time of the day or night. Vegetables can also be eaten at any time, but again there is no value in excessive consumption.<br />
<br />
9. If you are around foods you want to avoid, expect to eat them eventually. Therefore, limit your exposure to such foods by not purchasing them for others, having them at your home, or staying exposed to them for extended periods of time like a piece of chocolate cake in front of you at a wedding. Push it away or move away, but staring at it is fraught with danger.<br />
<br />
10. Limit you exposure to restaurant or prepared food containing unknown ingredients. What you don't know may be harmful to you in a myriad of ways.<br />
<br />
11. If you are a compulsive eater or suffer from an eating disorder like a sugar addiction, consult a health certified psychologist to help identify the root cause of your eating problem and get cognitive behavioral therapy to address the issue. Some people need help and you need to figure out if you are one of them. Repeated dieting and failure to sustain weight loss is a good indicator that you are in need of trained help.<br />
<br />
12. Avoid diet pills like appetite suppressants. They are never a good long term-solution and just will add to your total frustration.<br />
<br />
The goal with these principles is that dieting, even under best case scenarios, only sometimes achieves short term weight loss results, but is often followed by long-term frustration.<br />
<br />
Don't be a fool. Eat (enough) to live as opposed to diet for weight loss. It's the best advice that anyone can ever give you. <br />
<br />
<br />
<br /></div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-13779353551643703002014-04-06T12:55:00.002-07:002014-04-08T10:35:46.599-07:00Monkeying Around With Longevity<div dir="ltr" style="text-align: left;" trbidi="on">
The search to extend human longevity spans the ages. More recently, scientists have repeatedly shown that restricting the intake of calories while continuing to supply essential
nutrients extends the lifespan of flies and yeast by as much as
40 percent. An additional research vector that captured much attention were animal studies with rodents that suggested similar benefits from caloric restriction. <br />
<br />
Although positive results were not seen with all strains of rodents, some rodents were shown to live significantly longer when their calories were limited. As with all animal studies, scientists wanted to know if these benefits extended to more complex creatures that more closely resemble humans--such as primates--better known as monkeys.<br />
<br />
When the National Institute of Aging (NIA) completed their studies with monkeys in 2012, the NIA's conclusion was that that caloric restriction made no difference. This hardly put the controversy to bed, but it did seem to dampen some enthusiasm for this approach to extending human longevity.<br />
<br />
This past week, a new study from the University of Wisconsin stirs up new hope for reconsidering this strategy. Over 25 years, Wisconsin researchers studying rhesus monkeys, considered by some the best proxies for humans, found a significant reduction in mortality and in age-associated diseases
among those monkeys fed calorie-restricted diets. The study, begun at the
University of Wisconsin-Madison in 1989, is one of two ongoing,
long-term U.S. efforts to examine the effects of a reduced-calorie diet
on nonhuman primates.
<br />
<br />
The study of 76 rhesus monkeys, reported Monday in Nature Communications, was performed at the <a href="http://www.primate.wisc.edu/">Wisconsin National Primate Research Center</a>
in Madison. When the monkeys were 7 to 14 years of age, they began
eating a diet reduced in calories by 30 percent. The comparison monkeys,
or the control group, which ate as much as they wanted, had an increased risk of disease 2.9
times that of the calorie-restricted group, and a threefold increased
risk of death.<br />
<br />
So which study is correct? According to the Wisconsin researchers the reason for the discrepant results is that the NIA monkeys that were in the control group versus the intervention group were actually already on calorie restricted diets and that's why no difference was found in longevity between the two groups. Also, the NIA monkeys were consistently slimmer (and presumably healthier) that the Wisconsin monkeys, who were allowed to eat what they wanted. (I guess even monkeys, particularly captive ones, overeat when enabled to do so.) The NIA was apparently more careful with all their monkeys to limit their food intake regardless of the study.<br />
<br />
How did the Wisconsin researchers reach this conclusion? Through their own experience in monkey research, and by reference to an
online database recording the weight of thousands of research monkeys,
the Wisconsin researchers concluded that the NIA controls were actually
on caloric restriction as well. “At all the time points
that have been published by NIA, their control monkeys weigh less than
ours, and in most cases, significantly so” stated Ricki Colman, a senior scientist at the Wisconsin Primate Center, who presently co-leads the project.<br />
<br />
More importantly, the NIA control group monkeys were also found to live longer on average that most other monkeys, and the Wisconsin researchers theorized that this was due to even a small reduction of calories. The big conclusion was that it seems that the small caloric restriction in
the NIA control animals had its own benefits, suggesting that a
reduction of as little as 10 percent could meaningfully retard aging.<br />
<br />
As these studies were very expensive to conduct and will therefore not be repeated any time soon, the question remains do primates benefit from calorie restriction as long as they get all essential nutrients? The Wisconsin study would suggest that for rhesus monkeys, the answer is yes.<br />
<br />
So what does that mean for us humans? <br />
<br />
According to the Wisconsin researchers, they were“not studying [caloric restriction]...so people can go out and do it, but [rather] to delve
into the underlying causes of age-related disease susceptibility...It’s a research tool, not a lifestyle recommendation."<br />
<br />
Although the helpful mechanism of why caloric restriction may be beneficial has not been fully identified, it is believed to have something to do with the "reprogramming of the metabolism. In all
species where it has been shown to delay aging and the diseases of
aging, [calories restriction]... affects the regulation of energy and the ability of cells and
the organism to respond to changes in the environment as they age.”<br />
<br />
One of the first break-downs in metabolism results in diabetes, which can be seen as
“an inability to properly respond to nutrients.” Diabetes
damages a whole range of human capabilities including the functioning of muscle, fat and blood vessels. "The Wisconsin scientists began to see diabetes among the control
animals while they were still in the prime of life, within six months
after beginning their study. The contrast with the restricted animals
could not have been more dramatic" Colman said. “Until two years ago, we
did not have evidence of diabetes in any caloric-restriction animal,
but we had a significant number of diabetes, or pre-diabetes, metabolic
syndrome, in the control animals.”<br />
<br />
Although it is generally accepted that very few people can tolerate a 30 percent reduction in calories, the study does merit consideration. Primarily because “the basic biology of caloric restriction in rodents, worms, flies and
yeast seems to carry over to primates," it appears worthwhile to identify the underlying mechanism for this result in order to better understand the potential benefit to human primates who are genetically so closely related to rhesus monkeys.<br />
<br />
The bottom line here is that as long as they all get their essential nutrients it would appear across multiple species, from simple worms to far more complex primates, that eating less is better than eating more. It's not a large stretch to extend that logic to homo sapiens. Accordingly, even cutting back on 10% of your calories may have a huge effect on your longevity--adding years of healthy living to your life. And that's not something to monkey around with. <br />
<br />
<br /></div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-87995026064094085742014-04-02T09:48:00.001-07:002014-04-03T06:15:44.694-07:00If Money Grew On Trees...<div dir="ltr" style="text-align: left;" trbidi="on">
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Many parents like me have often expressed to their children that "money
doesn't grow on trees." The point of this admonishment is obvious: money is
not something one comes by naturally; rather, making money requires time and
effort.<br />
<br />
I've been thinking a lot about this old adage lately. What if money did
grow on trees? Would that make money any less valuable or difficult to come by? Is there any relationship between money growing on trees and your health?<br />
<br />
In the back of my house, I have two fruits trees: a grapefruit tree and a
lemon tree. Both were planted by our gardener about seven years ago. The first
tree has never so much as produced a single grapefruit. The other tree sprang a
few lemons its first year and since then has meagerly grown an annual--wait for
it--solo lemon. The problem is obvious. Neither the gardener nor I have
properly nourished (trees like humans can't function properly without adequate
nutrition) the soil around the trees to enable the trees to effectively grow
fruits. True, the trees get a fair amount of rain and more than adequate
sunshine. But if even one component of what is needed to grow fruits is
missing--you get no fruits.<br />
<br />
Now let's imagine that money was like a fruit that grew on
trees. In order to harvest such money, effort would have to be expended
to ensure that the tree was properly taken care of. First, the tree would need
to be in the proper climate to grow. It would need sufficient water and nutrients
in its soil. Also, during a certain season (did you think it grew year
round?--fruits don't), when the money was sufficiently ripe, it would need to
be harvested. This would require physical work. If you let the money just fall
to the ground, animals would grab it. If you didn't want to do the work or didn't know what to do, you would have to hire a gardener. That costs money as well.<br />
<br />
On the other side of my house there is a loquat tree. (For the curious, the
loquat is a species of flowering plant in the family Rosaceae, native to
south-central China. It is a large evergreen shrub or small tree that grows
yellow fruit.) The loquat is one of my wife's favorite fruits and for good
reason. It is truly succulent. Each year we try to take down as many
loquats as possible. However, many are beyond our reach and many of those
within reach are grabbed by unknown others (they just disappear). By the end of
the season, animals have also joined in the feast by consuming those that fall
to the ground. We could hire someone to pick the higher branches of the tree
for us, but we calculated that it would be less expensive to simply go to a store
and buy the loquats.<br />
<br />
Also, if we had a money tree, it would need to be protected against
infection. For example, a palm tree near my house recently died. It apparently died because of benign neglect. We recognized something was wrong two years ago when we called in the experts.
One told us it was a fungal infection. Two others said it was malnourished. I
believed the second two--it was less expensive to go that route than pay
thousands for a fungal treatment. So I begged my gardener to feed it. He
claimed he did and yet the other day, I noticed it was dead. My
gardener's response: an infection killed the tree and he is not responsible for
infections. Ouch. Then without permission, he cut it down. (Time for a new
gardener?)<br />
<br />
Now let's imagine if my recently departed palm tree was a money tree.
That's easy to imagine because it was. This was a beautiful palm tree
that I had paid a lot of money to have planted (and would have to pay even more
to a new gardener now to replace). It also had great value to me aesthetically
as it sat prominently in front of my house. Despite its value, it still
bit the dust. I had tried to do right by it, but let it down. My tree was gone;
my money (tree) was lost.<br />
<br />
One last fruit tree story. A neighbor has an avocado (actually a
fruit) and mango tree. Each year when the fruits are ripe for picking, she
barters the fruits for things she needs. In other words, they have real
financial value, similar to a farmer harvesting his own fruit trees for sale.<br />
<br />
By the way, it would obviously make a big difference what denomination of money my
tree would grow. If it was a mere $1, then a harvest of one hundred would yield
an annual $100. That would definitely not justify the cost of growing the
money. At $5, it would be $500. Even at $100, it would only yield $10,000 if they were all harvestable. But at that value, you would definitely need to employ very effective and costly security measures to keep others away so your expenses would further increase. Obviously, the higher the denomination the better, but under $100 would still require a lot of trees with plenty of land (which can be expensive) to support them to make a good living.<br />
<br />
So when I summed up the costs of successfully maintaining a fruit tree, let
alone assuring that it gave a bountiful harvest each annual season, one thing
was perfectly clear to me. Fruit trees are money trees and so money does grow
on trees.<br />
<br />
So the next time you hear or read that money doesn't grow on trees, perhaps you
will remember the stories of my fruit and palm trees and realize that it really
does. Parents would be wise to teach their children that even if money did grow
on trees (which arguably it does), in order to fully realize its value would
take much time, effort, and not the least of, money. The lesson
here is regardless if money does or does not grow on trees, in order to make
money you have to invest (no pun intended) your time, effort, and even
money in doing so.<br />
<br />
The same can be said for your health and wellbeing. Like a healthy
tree full of fruits, your body requires nurturing and conscious effort to stay
healthy. My palm tree met a premature death. My fruit trees don't live up to their potential. Try not to let the same
happen to you by recognizing the value of planting the seeds of a healthy life and harvesting the fruits of your labors...(puns obviously intended.)<br />
<br />
Otherwise, you may never live to realize the full bloom of your life.<br />
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-82482910089605264272014-03-20T03:43:00.001-07:002014-03-20T03:43:38.643-07:00Are Statins Really Your Best Solution? Please Consider the Alternative<div dir="ltr" style="text-align: left;" trbidi="on">
About two years ago, I wrote a blog titled, Selenium, Statins and Super Fish Oils, Oh My (here is the link: http://mdprevent.blogspot.com/2012/03/selenium-statins-and-super-fish-oils-oh.html). In that blog, I described what I consider the growing enchantment between the medical community and the use of statins. It's kept growing since then.<br />
<br />
Back in November 2013, the the American Heart Association and the American College of Cardiology issued new guidelines regarding who should take a statin. This week a new study calculated that based on these guidelines, an additional 13 million Americans should be taking a statin, bringing the total to over 56 million users, representing over one out of six Americans. It is estimated that <span id="articleText">about one-quarter of U.S. adults age 45 and older already take such drugs </span><br />
<br />
Even though the FDA issued a warning two years ago that statins may raise the risk for diabetes by 9%, a subsequent study that compared the increased risk for diabetes versus the benefits of statins, concluded that the benefits won. The study found that only among those who already had the highest risk for diabetes was the risk greatest for developing diabetes from statin use. (That's kind of funny in a very sad way as those at greatest risk of developing type two diabetes are the same as those with increased risk factors for having a heart attack such as elevated blood sugar, and obesity.) In addition, although other side effects, like liver dysfunction and leg cramping, and in more severe cases, muscle necrosis has been reported with statin use, these side effects are generally dismissed as irrelevant when compared to the 'great' benefits associated with taking statins.<br />
<br />
So what are those great benefits? The primary endpoint is preventing a heart attack. According to the recent study, it was calculated that if an additional 13 million people took stains, there could be 475,000 fewer heart events. Wow, that's almost a half million fewer people suffering a life threatening event. So that's a good thing, right? It's really not that clear to me.<br />
<br />
If you calculate what percent of people taking the statin would presumably (I say presumably, because it is not proven) benefit, it comes out to about 3%. That means that 97% or over an additional twelve and a half million people would have taken the stain for no benefit, but still possibly suffered some side effect(s) along the way, such side effects estimated at higher than 3% than those deriving benefit to as high as 20% side effects among users by some reports.<br />
<br />
To be fair, I had this discussion multiple times with my recently deceased brother, the cardiologist, who felt that if 100 people took a stain with 99 of those people deriving no benefit, but one life being spared a heart attack, than the use for all 100 was justified. How can one argue against saving a life if no real harm (let's just say that muscle necrosis and liver damage, because they are relatively infrequent don't count) is done to the others?<br />
<br />
I'll tell you how. People taking statins to reduce cholesterol and now based on the new guidelines, to reduce inflammation, are subject to a "licensing effect" bestowed upon them by their statin use. Before I address this "licensing effect," first let's consider some other relevant points. Heart attacks still occur even among statin users so it's no absolute panacea. Second, a number of heart attacks are delayed or prevented among statin users by other physician actions such as the placing of stents and bypass surgery. In almost all cases of high cholesterol and inflammation, other than familial hypercholesteremia, a genetic disorder that runs in families that results in high cholesterol levels, the overwhelming majority of people's cholesterol and vascular inflammation is under the influence of diet and lifestyle and statins buy some relatively short period of time, at best a few years, of reprieve.<br />
<br />
In other words, if a person taking a statin continues to consume foods and live a lifestyle that is conducive to having a heart attack, the effects of the statin are by and large mostly neutralized and nearly twice as many statin users will have a heart attack than will not. <br />
<br />
Unfortunately, it appears that many statin users feel like they have a "license" to keep eating all the artery clogging and inflammatory foods they want, live as sedentary life as they can comfortably endure, and not take any responsibility for what happens inside their body because they are comforted by the knowledge that they are under the care of a physician who prescribed a statin for them.<br />
<br />
(Let's ignore for a moment that there are other major reasons we die such as cancer and strokes that are also affected by our lifestyle choices. True, you may say, death is inevitable today so does it really matter how you go? That's a personal preference, but I vote for avoiding such a fate and letting heaven wait for as long as possible.)<br />
<br />
The question then remains, do we really want to have a vast majority of Americans taking pills, absolved of any personal responsibility, instead of confronting the difficult lifestyle choices that will have a far more profound affect on their overall health? <br />
<br />
Now some reading this post may argue that most Americans are either unwilling or incapable to make the changes necessary to preserve good health and therefore pills like statins are a viable alternative. It is difficult, albeit painful, to argue with this logic. Nevertheless, I write to inform people taking statins that they would ultimately be better off making tough lifestyle changes than placing their bets solely on pills as such pills are not the best answer for most of you. <br />
<br />
No one should discontinue their use of a stain based on this post. If my words, however, resonate with you, please consider speaking with your physician and discussing how you may discontinue your statin by making some changes to your lifestyle and diet that may make such pills irrelevant and superfluous. <br />
<br />
Choices really do have consequences when it comes to good health. It's your health. It's your life. Take control.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com1tag:blogger.com,1999:blog-3836609211397742247.post-16506237733838065152014-03-14T10:04:00.002-07:002014-03-14T12:38:26.927-07:00Vitamin D and Breast Cancer: Are they married or just acquaintances?<div dir="ltr" style="text-align: left;" trbidi="on">
With recent headlines like <i>Vitamin D Enhances Breast Cancer Survival</i>, a woman could hardly be faulted for running out and stacking up on Vitamin D pills. The meta-analysis study (a compilation of studies) upon which this headline and similar ones are based, was published in Anticancer Research and showed that the higher the Vitamin D level at the time of diagnosis, the better the prognosis. On the surface, this would suggest a cause and effect relationship. To the untrained eye, one might conclude that raising Vitamin D levels has some type of anti-cancer effect.<br />
<br />
However, the evidence to date would suggest that this is not the case. First, even in this study, even women with very high levels of Vitamin D were still diagnosed with breast cancer. The higher levels of vitamin D simply meant average longer survival. So what do I think is going on? <br />
<br />
I believe, and a recent study, which I will discuss in a moment, supports my tentative conclusion, that this is a matter of correlation between vitamin D levels and one's state of health.. As correlation does not imply causation, raising vitamin D levels artificially high with Vitamin D supplements will neither prevent cancer, as the first study clearly showed, nor improve its prognosis. Why?<br />
<br />
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In a study published in the Lancet, the British medical journal, titled, <i>The effect of Vitamin D supplementation on skeletal, vascular, or cancer outcomes: a trial sequential meta analysis</i>, the researchers compiled a representative group of Vitamin D studies and divided them into two groups. The first group included studies such as the breast cancer study above that showed consistently that higher levels of vitamin D <u>correlated</u> well with better health and disease outcomes. The second group of studies were double.blind randomized controlled studies that showed that Vitamin D supplementation versus placebo had little effect on overall health.</div>
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The authors of this study proffered what they believe to be the plausible explanation for the inconsistencies between the two groups of studies. They tentatively concluded that raising Vitamin D levels above a certain threshold of adequacy doesn't prevent disease; rather, disease lowers Vitamin D levels. as applied to the breast cancer study, this means that the women with the highest level of Vitamin D at the time of breast cancer diagnosis were healthier than those with lower Vitamin D levels and therefore had a better prognosis. The worse the breast cancer, the unhealthier the patient, the lower the Vitamin D level, the poorer the prognosis. </div>
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As with all studies, one can reach no conclusive decisions from either of these studies. They merely add to our knowledge. My take-away from these studies is that Vitamin D is essential to human health and having levels above 20 mcg is essential and some say above 30 mcg. is ideal. </div>
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The best way to get your Vitamin D remains 15 minutes of daily sun exposure to your torso/extremities. Alternatively, consuming food products with high concentration of Vitamin D like unsweetened Almond Milk and wild Alaskan Salmon are second, with Vitamin D pills coming in third. If you are taking pills because you absolutely can't do the first two then the recommended daily allowance (RDA) if you are below age 70 is 600 iu. and above age 70 it's 800 iu. That's not a typo. By the way, RDAs were developed to cover 97% of the population's needs. </div>
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Supplementing with levels above these numbers has not been shown to have any benefit so save your money. Again, this is what the current preponderance of evidence shows. I'll let you know if something changes. Some large population studies are underway with expected publication in 2016 and 2017 so stay tuned.</div>
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-82909815692934622612014-02-26T02:14:00.005-08:002014-06-02T14:50:24.142-07:00Is Faith In Dietary Supplements A New Religion?<div dir="ltr" style="text-align: left;" trbidi="on">
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In 2012, the Pew Forum of Religion and Public Life published
survey results that concluded that "the number of Americans who do not
identify with any religion continues to grow at a rapid pace. One-fifth of the
U.S. public – and a third of adults under 30 – are religiously unaffiliated
today, the highest percentages ever in Pew Research Center polling. In the last
five years alone, the unaffiliated have increased from just over 15% to just
under 20% of all U.S. adults." Around the same time, the Centers for
Disease Control and Prevention (CDC) reported that dietary supplement use had
markedly increased with more than one half of the U.S. population currently
taking some form of dietary supplement.<br />
<br />
What's going on? Is there any relationship between Americans' growing
dissociation with religion and their expanding use of dietary supplements? I
think so. It appears they are trading one belief system for another.<br />
<br />
I proffer that there is a new religion in America and it is called <i>Supplementiasm,
</i>which is an unwavering belief in the health benefits of consuming dietary
supplements. I believe that <i>Supplementiasm</i> is the fastest growing
U.S. religion based on the CDC's estimates plus dietary supplement industry
reports that now claim as high as 80% of all Americans are users—a number that
has grown some twenty-fold in the past 15+ years alone.<br />
<br />
Like other religions, <i>Supplementiasm</i> has both steadfast disciples who
vigorously defend its tenets and vehement detractors who question its legitimacy.
<span style="mso-spacerun: yes;"> </span>It's more extreme disciples will
ridicule and attack anyone who challenges its omnipotence and veracity.
When three studies published a few months back in The Annals of Internal
Medicine concluded that "limited evidence supports any benefit from
vitamin and mineral supplementation for the prevention of cancer or
cardiovascular disease," including an editorial titled, Enough Is Enough:
Stop Wasting Money on Vitamin and Mineral Supplements, the faithful of <i style="mso-bidi-font-style: normal;">Supplementiasm</i> took the offensive.<br />
<br />
Not surprisingly, Steve Mister, President of the Council for Responsible
Nutrition, the main trade association for the dietary supplement industry, went
on record by stating that "we reviewed the literature and came to the
opposite decision" as his organization found the same studies showing that
multivitamins now "had the potential for additional benefits." That
response was mild when compared to other pro-supplement pundits that labeled
the Annals' conclusions "bunk right off the bat," "garbage in
garbage out" and "highly premature and unscientific." The
rhetoric on the internet got so heated that it nearly dared comparison to the
controversy surrounding the cartoon depictions of Islam's revered founder
several years back. <span style="mso-spacerun: yes;"> </span>Challenges to faith
always stir emotions.<br />
<br />
As with most of the major religions, <i>Supplementiasm</i> offers its devout
many places of worship from small health food storefronts on the internet to
corporate retail megastores and many venues in between. <i>Supplementiasm</i>
also has it religious leaders like Doctors Mehmet Oz and Andrew Weil, who spread
its gospel with almost missionary zeal. In response to the Annals controversy,
the Dr. Oz Show devoted two segments during different episodes to reaffirming Oz's
personal faith in multivitamins, going so far as to declare that he and other
members of his family take them at home. Of course, with Walgreen's Pharmacies,
significant sellers of dietary supplements, and Schiff Vitamins, manufacturers
of the same, listed as "Trusted Partners" on his show, it was not
surprising that Oz came to their defense. In fact, many in the supplement
industry credit Oz's regular pro-supplement pronouncements as the basis for
their growing popularity.<br />
<br />
Another common factor among major religions is the splintering of groups. For
example, Christians, have Catholics, Baptists, Protestants, etc. Jews have
Orthodox, Conservative, Reform, etc. and Muslims, have Sunnis and
Shiites. Similarly with <i>Supplementiasm</i>, one can find segmentation
among the highest devotees to dietary supplements, with membership in various
sects such as Vegans, Vegetarians, Juicers, Calorie Restrictors, Anti-Agers, etc.<br />
<br />
While <i>Supplementiasm</i> may have fervent followers, I do not count myself
among them. In fact, you could label my beliefs as agnostic, as I am full of
doubts and questions. You see I've been down this path before. I was
raised in a religious household, was schooled through college in religion-based
institutions, and grew up with the expectation that I would take the leap of
faith in embracing my religion's core belief system; I understand what it means
to make religion part of one's life; I also appreciate that the absence of or
ability to appreciate the available evidence that supports religious belief
does not always represent evidence of absence.<span style="mso-spacerun: yes;">
</span>In other words, I may not be able to prove there is a G-d, but I can
still put my full faith in one.<span style="mso-spacerun: yes;"> </span></div>
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<br />
In addition, my mother was an early devotee of dietary supplements as she
zealously read Prevention Magazine as early as the 1960s. Based on her early
readings, she had me eating calf liver as often as I can remember to ensure an
adequate iron supply. Every breakfast throughout elementary school
consisted of a mixed bowl of cottage cheese (my daily needs), fresh squeezed
orange juice (my vitamin C), fresh ground apple sauce (other vitamins and
nutrients), and wheat germ (the B vitamins). By the way, yes, it tasted like
you think. <span style="mso-spacerun: yes;"> </span>Nevertheless, it was served
and eaten religiously every day. For lunch, to make sure I got enough protein, my
mom would wake early to make fresh fried chicken cutlets. (I must admit I
appreciated her daily effort and they tasted quite good, unlike the breakfast
bowl.)<br />
<br />
For a number of years, my mother-imposed imposed routine also included daily
spoonfuls of cod liver oil (my omega-3s). In later years, her preaching
included carrots for beta-carotene, and multivitamins and fish oil pills. Even
in my 40s, she was pounding the pulpit in favor of supplementing with folate, a
B vitamin. <span style="mso-spacerun: yes;"> </span>Don't get me wrong. My mother
is a smart lady who wanted what was best for her family. But her reacting to
the latest "science" was misguided—a lesson she eventually learned on
her own. I also don't think that Prevention Magazine meant any harm. It
was only reporting on the latest studies. I'm not sure my mother could have
ever imagined how fast such beliefs would eventually spread and how much of it
was plain wrong and potentially harmful, with calf-liver being a prime example
(now thought to contain too much iron for men and too much saturated fat for
others). My mother, a religious woman also by upbringing, just wanted to do
right by her family. <span style="mso-spacerun: yes;"> </span>As she already believed
in one faith based system, it wasn’t much of a stretch to believe in another.<br />
<br />
So given my religious proclivities, one might think that I would have a
penchant for Supplementiasm. Well, I did until about three years ago. In 2011,
I opened a primary care and preventive medicine practice and one of my first
actions was to purchase five thousand dollars’ worth of dietary supplements for
sale to patients. My initial list of dozens of products was whittled down to
about thirty products, including calcium, Vitamin D, melatonin, fish oil,
alpha-lipoic acid, etc. as initial research indicated they were the most
reliable products to offer. Then I started intensively reading the scientific
literature by securing a paid subscription to the Natural Standard database of
dietary supplements and herbs and reviewing the clinical literature on my own,
and as I read more, the more my faith waned. I developed a decided bias against
the bulk of dietary supplements.<br />
<br />
After reading over 40,000 studies and abstracts found on the government's
website of published clinical literature called Pubmed and other online
databases, one thing was clear. Dietary supplements were not the panacea their
manufacturers claimed they were. In many cases, they were a waste of money, and
at times even posed a real harm. Based on my collected data, I developed
a lecture titled Why Dietary Supplements Are Usually a Waste of Money and May
Be Harmful that was delivered dozens of times to thousands of people across
Southeast Florida, including through TV and radio appearances. At some of
these forums, the <i>Supplementiasm</i> adherents pushed back--the old adage of
not discussing religion and politics with strangers proved true. Sometimes
it felt as if I was insulting their G-d, while all I was asking for was the
evidence upon which they were relying. Some of these pill-pushing disciples
included licensed and practicing physicians hawking unproven, often very
expensive products. My words often made no impact as far as I could tell
and when they were pressed to produce their holy scripture upon which they
relied, they often stumbled and fumbled in their failure to produce anything resembling
good science.<br />
<br />
So at this point, you may think me atheistic about <i>Supplementiasm</i>, but
that would not be true. The search for the truth and to try and differentiate
between the science and pseudo-science continues. I am not prepared to reject dietary
supplements completely out of hand (as I do believe in certain supplements like
Vitamin D and calcium in certain cases; though, I always prefer food over pills
for nutrition) but my concerns are many and growing (particularly as the
industry also continues to expand rapidly). Based on my accumulated knowledge,
I feel very few Americans should be taking any dietary supplements without
physician guidance, including multivitamins, and most clinical thought leaders,
in the dietetics and medical fields agree with me.<br />
<br />
However, like any true theologians, the disciples of <i>Supplēmentiasm</i> hold
steadfast in their beliefs and cannot be easily dissuaded.<i> </i>An
anecdote bears proof. The supplements mentioned earlier that were purchased for
my practice came from a company I came across at a medical conference that
seemed reputable. When I decided to no longer include supplements in the practice,
it meant no further purchases from the company and this displeased the sales
representative. In response, the representative asked if the company
could check my blood to see if I have any vitamin deficiencies because they are
sure everyone does. Wow, I thought. The representative had really
drunk the Kool-Aid. By the way, my blood tests were normal. Another
company had me test my antioxidant levels on their patented scanner, which many
revere as one of the sacraments of <i>Supplēmentiasm. </i>The scanner scored me
in the highest echelons of carotenoids, an antioxidant whose measured levels
are thought to be indicative of total antioxidant activity in the human
body.<span style="mso-spacerun: yes;"> </span>I scored extremely high despite my
lack of supplementation; rather, I imagine, because I eat several servings of
fruits and vegetables every day. It was a waste of a test. But that's not even
what disturbed me. The representatives, when confronted with the results, always
argue that I am the exception.<br />
<br />
An even bigger concern is the degree of sacrosanct belief that so many, sellers
and consumers of such products (I suspect she's a user), harbor about
supplementation. For millions of years, men and women and their predecessors
lived off the land and somehow that no long suffices. The supplement marketers
propagate stories about soil depletion creating nutrient poor fruits and
vegetables. My review of over a 100 studies of nutrient depleted soil showed
that in 100% of the cases, the produce failed to grow properly and were not
edible. Yes, soil may be depleted, but the studies show that fruits and
vegetables that actually grow and make it to our hands still have plenty of
nutrition.<br />
<br />
Furthermore, despite the fact that not a single valid human study has ever
demonstrated an extension of a single day of human life from supplementation in
the absence of deficiency, nearly $30 billion was spent last year on these
products. My own experience with attempts to talk some patients off of taking
supplements got the nastiest looks imaginable. Sometimes successful, some
patients would return to tell me how much better they felt having stopped the
pills. My response was that what they were experiencing was a placebo effect
because the supplements had no effect on them while they were taking them.<span style="mso-spacerun: yes;"> </span>For those who wouldn’t stop, it was clear
that they were believers that their products were sacrosanct. They believe
despite the absence of any tangible evidence; their beliefs are as strong as
any religious faith. <br />
<br />
However, my greatest concern is that this growing dependence on dietary supplements
increasingly may strip people of any responsibility for their lifestyle
choices. Pop a pill or two or twenty and you are all set. Nothing to worry
about. This is a very dangerous thought process.<span style="mso-spacerun: yes;"> </span>The same can be said for prescription
pills.<span style="mso-spacerun: yes;"> </span>Most prescription pills treat
symptoms, not the underlying disease. There are far too many prescriptions
written unnecessarily in this country. Proponents of supplements often point to
the fact that prescriptions kill over 100,000 per year while there are no harms
associated with supplements. The facts are that the 100,000 was an estimated and
extrapolated number that appeared in one paper that also described that most of
the deaths were attributable to oxycodone overdoses.<span style="mso-spacerun: yes;"> </span>There have been numerous reports of health
issues caused by supplements and many issues probably go unreported because patients
often fail to tell their physicians and physicians often fail to ask if patients
are taking such pills. <br />
<br />
I am respectful of all religions. However, I must confess that I wish this <i>Supplēmentiasm,
</i>with over 55,000 products now on sale, would be exposed for the chicanery
that it mostly represents.<i> </i>While there are many wonderful attributes to
religion, and to religious belief and practice, the facts remain that religious
extremists have been responsible for many destructive and irresponsible actions
over the centuries. Let's hope that <i>Supplēmentiasm's </i>leaders<i> </i>do
not yet prove to do the most harm.<br />
<br />
As to the supplements I bought for my practice, I gave a few for free to a
handful of patients that I thought would benefit, gave the more scientifically
supported pills to a nearby homeless shelter, and discarded the rest. I had
learned an expensive lesson, but my religious sensibilities to do the right
thing were well served.<i> </i>I pray that one day the disciples of <i>Supplementiasm</i>
will come to the same conclusion, but I have little faith that day will come
soon.<br />
<br />
<i>This parody is not meant to insult any religion or any person of religious
faith. It is provided for thought and discussion purposes only.</i></div>
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com5tag:blogger.com,1999:blog-3836609211397742247.post-3217077460586566382014-02-14T10:32:00.003-08:002014-02-17T12:33:09.413-08:00Dr. Oz's Claims on Turmeric: Does He Just Make Things Up?<div dir="ltr" style="text-align: left;" trbidi="on">
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On an episode of the Dr. Oz Show this week, Oz claimed that a new study was recently released that showed that Turmeric, an Indian spice, is useful in the treatment of irritable bowel syndrome. He recommended a dosage of 500 mg.<br />
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<b>Is There Such A Human Study?</b><br />
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<a href="http://t2.gstatic.com/images?q=tbn:ANd9GcSI6_btDiM7QxBagGQUEjQku8_1SDCSPuujZ2v-nxKK_acpvd0Jug" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" class="irc_mut" src="http://t2.gstatic.com/images?q=tbn:ANd9GcSI6_btDiM7QxBagGQUEjQku8_1SDCSPuujZ2v-nxKK_acpvd0Jug" height="239" style="margin-top: 0px;" width="320" /></a></div>
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After searching for such a recent (last few years) study, I couldn't find any. In fact, a study by the title of<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"> Curcumin (Turmeric) in the
Treatment of Irritable Bowel Syndrome: A Randomized-Controlled Trial (CuTIBS) was initiated in 2007, completed in 2009, and updated in 2011, but the results were never published. (see:</span><span style="font-family: ""serif"","serif"; mso-bidi-font-weight: bold; mso-font-kerning: 18.0pt;"><a href="http://clinicaltrials.gov/ct2/show/results/NCT00779493"><span style="font-family: "Times New Roman","serif";"> </span>http://clinicaltrials.gov/ct2/show/results/NCT00779493</a></span>). Since that time, pubmed.com, the database of clinical studies, does not identify any other such studies. Unpublished results usually mean worthless results. </div>
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A pilot study done ten years ago in 2004, contained no control group that was given a placebo for comparison purposes. (See: <span style="font-family: ""serif"","serif"; mso-bidi-font-weight: bold; mso-font-kerning: 18.0pt;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/15673996?dopt=Abstract">http://www.ncbi.nlm.nih.gov/pubmed/15673996?dopt=Abstract</a></span>)
Instead of a control group, it had two study groups, with one group taking one pill and the other group taking two pills. Both groups showed some improvement of IBS symptoms. However, it's important to remember that a study for IBS showed that a group that was told it was being given a placebo still showed improvement with IBS. Either way, non-blinded, non-randomized studies are of little clinical value. They definitely don't rise to the level of deserving national pronouncements.</div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><br /></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Is Turmeric Really That Helpful?</span></b><br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">What is interesting about Turmeric is that it is a plant that is consumed mostly as an ingredient of local ethnic foods, primarily by natives of India, particularly in Southeast India, where it grows. It is claimed to have ant-cancer, anti-inflammatory, anti-dementia, anti-infectious, and anti-oxidant properties. With all these health benefits, one would expect that natives of Southeast India would have longer life expectancies. One would be very wrong and disappointed as India has one of the lowest rates of life expectancy anywhere in the world. (See: </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><!--[if gte mso 9]><xml>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><span style="font-family: ""serif"","serif"; mso-bidi-font-weight: bold; mso-font-kerning: 18.0pt;"><a href="http://www.oecd-ilibrary.org/docserver/download/8112131ec004.pdf?expires=1392400784&id=id&accname=guest&checksum=1561729FC56D11AD485B50AD61D1404A">http://www.oecd-ilibrary.org/docserver/download/8112131ec004.pdf?expires=1392400784&id=id&accname=guest&checksum=1561729FC56D11AD485B50AD61D1404A</a></span>). Ouch.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><br /></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;"><b>Harms of Turmeric </b></span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Faithful readers of this blog may remember a few years back my writing about the recommendation I received from Michael Roizen, a partner with Dr. Oz on several books, who highly recommended that I consume turmeric for its multiple health benefits, including dementia prevention. (Here's an excerpt from that blog almost three years ago: </span><br />
<br />
<a href="http://www.mnn.com/sites/default/files/Turmeric_main_0127.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" class="irc_mut" src="http://www.mnn.com/sites/default/files/Turmeric_main_0127.jpg" height="180" id="irc_mi" style="margin-top: 59px;" width="320" /></a>"Dr. Roizen told me that turmeric prevents Alzheimer's and is good for
brain health. Based on Dr. Roizen's suggestion that day (and my hearing
him repeat the same advice a few days later on the Retirement Living TV
channel), I naively purchased turmeric and began to add it regularly to
my food.<br />
<br />
Unfortunately, the highly staining substance
turned my teeth bright yellow. After this disconcerting turn of events,
I began intensively researching turmeric and discovered two disturbing
facts. First, tumeric has little validated science to support its use
for the indications Dr. Roizen asserted. Second, I discovered that in
the absence of a black pepper called piperine, turmeric is very poorly
absorbed by normal ingestion and so adding it to my food was an effort
in futility, except if turning my teeth yellow was my endgame. (By the
way, I had to go to a dentist to get rid of the stain.)"<br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">It was that incident, by the way, that really started me on the path of trying to verify positive statements made about any dietary supplement.</span><br />
<br />
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Final (For Now) Word on Turmeric</span></b><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">As an aside, I am not against turmeric, or its derivative curcumin, as an ingredient in meals. There is just no real good proof that it has a very positive effect on any major human health factor. According to naturalstandard.com, it doesn't get higher than a grade of C, for inconclusive evidence, for any clinical indication. </span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">So once again, Dr. Oz recommends a product that lacks the scientific support he claims. He even goes so far as to give a specific untested dosage of 500 mg. </span><br />
<br />
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-font-kerning: 18.0pt;">Did he just make it up? You know the answer.</span></div>
<br /></div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com19tag:blogger.com,1999:blog-3836609211397742247.post-88725339796691355272014-02-13T11:34:00.000-08:002014-02-14T07:40:33.537-08:00Is Dr. Oz A Paid Spokesperson For Products? Want To Be His Trusted Partner?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-size: 12.0pt;">Before I answer the questions in the title above, I'd like to address why I keep writing about Dr. Oz. The basic reason is because people follow his advice, which I believe can be detrimental to their health, if not a waste of their money. If he stuck to topics in which he either had expertise or acknowledged lack of certain knowledge thereof, I would never write about him again. But as long as he keeps misleading people with misinformation under the pretense of good science, I will keep pointing it out.</span></div>
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<span style="font-size: 12.0pt;">People often wonder if Dr. Oz is paid for promoting products. On his show's website,
under the heading of "<b>My Name for Profit? Not Anymore. by Mehmet
Oz, MD</b>," it reads</span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"> "I am not and have never been a paid spokesperson for any
particular brand, supplement or product." That would seem to be a definitive answer.</span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">However, if one digs a little deeper, one will find the following companies and products, among others, listed below, that are included in his website as "Trusted Partners" under a banner that reads "OZ WATCH, INTEGRITY & ACTION: </span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" src="http://s.doctoroz.com/sites/default/files/im_uploads/schiff_logo_0.jpg" height="81" width="105" /></span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" src="http://s.doctoroz.com/sites/default/files/im_uploads/walgreens-logo_1.jpg" height="65" width="105" /></span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" src="http://s.doctoroz.com/sites/default/files/im_uploads/metamucil_logo_0.jpg" height="81" width="105" /></span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" src="http://s.doctoroz.com/sites/default/files/im_uploads/generalmills_logo_1.jpg" height="60" width="105" /></span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" src="http://s.doctoroz.com/sites/default/files/im_uploads/eucerin_logo_1.jpg" height="77" width="105" /></span><span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;"><img class="mceItem" height="74" src="http://s.doctoroz.com/sites/default/files/im_uploads/omron_logo_0.jpg" width="105" /> </span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">One note of interest--there is only one company within each category of retail product listed as a trusted partner. For example, there is Walgreens, but not CVS. Schiff but not LEF. </span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">Nevertheless, I wondered how one becomes a Dr. Oz Show "Trusted Partner?" So I wrote the show to ask, and alas, three weeks later, I have yet to receive a response.</span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">Although, I cannot say for certain whether or not Dr. Oz is paid directly by any of these companies to represent them on the show, I have both seen them mentioned on the show and watched advertisements for them during commercials. In fact, an Omron product was featured on today's episode with the company name clearly displayed and there was a commercial for Eucerin today as well.</span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">Would indirect payments make him a paid spokesperson? Is there a criteria we can use to define what is considered paid? I like to use the Federal Law kickback criteria that states that compensation is considered if it is direct, or indirect, cash or in kind. In other words, there are different ways to get paid, but in the end, no matter how you get rewarded, its still the same. If it quacks like a duck...</span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">Dr. Oz is paid to appear on his show. The money to pay him presumably comes from revenue the show generates. Revenue comes from both paid commercials and other sources. Based on prudent principles of economics, I believe, but cannot say for certain, that a company pays or gives some other form of inducement to be a "Trusted Partner" on a nationally televised daily show.</span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">Therefore, would you agree that it is reasonable to conclude that Dr. Oz is being disingenuous to claim that he is not a paid spokesperson or does not endorse brand products through his show when they are clearly displayed on his website? </span></div>
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<span style="font-size: 12.0pt; mso-fareast-font-family: Calibri;">I wonder what it takes to become a trusted partner? I hope it's worth it. </span><span style="font-size: 12.0pt;"></span></div>
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com1tag:blogger.com,1999:blog-3836609211397742247.post-20557016106494223012014-02-12T08:14:00.004-08:002014-02-17T13:57:19.036-08:00Is There Any Harm In Eating Lots of Vegetables?<div dir="ltr" style="text-align: left;" trbidi="on">
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" style="margin-top: 0px;" width="320" /></a><span style="color: #1f497d; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">I recently made a statement to a colleague that eating an
excessive number of vegetables could be harmful. He asked for supporting
documentation to back up my comment. As my statement was based on previous
readings, I sought out the clinical literature that associated too many vegetables
consumed with what I believed to be the following seven potential problems. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Certain vegetables, such as cassava, are goitrogenic, which means they
cause goiter, a thyroid condition that results in an enlarged thyroid that may
or may not impair function.</span><span style="font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Certain vegetables, such as kale, are rich in purine, which can possibly
lead to the build up of uric acid in joints, a painful condition known as gout. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Certain vegetables, such as carrots, are rich in beta-carotene, an
anti-oxidant, which can lead to carotenosis, a benign condition in which the
skin turns orange. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">The fiber, particularly insoluble fiber, in vegetables
can cause intestinal blockage, gas, and bloating if over consumed. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Minerals in vegetables, such as potassium and phosphorus,
can be difficult for the kidney to process in high amounts if the kidney is not
working properly such as in certain people with high blood pressure. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Excessive vegetables can lead to hypervitaminosis, which
means too much vitamin, such as excessive Vitamin A, which can be harmful to
the body. </span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: .25in; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -.25in;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-themecolor: dark2;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Certain vegetables, </span><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;"><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">such as
potatoes and corn,</span> contain high calories from starch that can contribute to weight gain if eaten excessively.</span><br />
<br />
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">8. Certain vegetables, such as spinach, can interfere with calcium absorption.</span><br />
<br />
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">9. Certain vegetables, such as tomatoes, contain oxalates which can bind to calcium to form calculi of calcium oxalate. Calcium oxalate build-up can lead to kidney stones. </span></div>
<div class="MsoNormalCxSpFirst" style="line-height: normal; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">So are the statements above true? Even
though in making my statement I relied on my previous recollections, the question asked deserved
specific citations of valid clinical studies. However, after spending three
hours searching the literature for supporting documentation, I was disappointed
to discover that the literature I could find showed limited support.<span style="mso-spacerun: yes;"> </span>I went as far back as the 1950s and still could find
almost nothing on the topic. Based on this search, It appears that there do not
exist any reliable studies demonstrating harms associated with excessive
vegetable consumption, other than for reported individual case reports of reactions to
specific high intakes.<span style="mso-spacerun: yes;"> </span>The goiter
and gout arguments had the weakest supporting evidence.<span style="mso-spacerun: yes;"> The oxalate, a little stronger. </span></span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<a href="http://lhonakerrsj.files.wordpress.com/2013/11/cbeyl09-18-11.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" class="irc_mut" src="http://lhonakerrsj.files.wordpress.com/2013/11/cbeyl09-18-11.jpg" height="270" id="irc_mi" style="margin-top: 0px;" width="320" /></a><span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">Therefore,
after reviewing the literature, I have to modify my statement about vegetables
to say it is inconclusive if eating too many assorted vegetables for people
without underlying medical conditions, such as kidney or liver disease,
Chrohn’s disease, irritable bowel syndrome, etc. is necessarily harmful,
particularly as it appears that most people would have difficulty eating <i>too
many</i> vegetables due to the high fiber content. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">That
said, I still think that even vegetables should only be eaten in moderation
because there are no good studies to show what happens when they are eaten in
excess. The absence of evidence is not always evidence of absence.
Sometimes it is, but I prefer not to speculate in this case having already made
one misstatement. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">The
lesson here for me is what I always say: Caveat lector--let the reader beware.
Don't trust what you read unless there is good science to support it.</span><br />
<br />
<span style="color: #1f497d; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-themecolor: dark2;">I'm glad I was asked to support with proof my inaccurate statement. </span></div>
</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com5tag:blogger.com,1999:blog-3836609211397742247.post-37659799001037403712014-02-01T16:28:00.001-08:002014-02-02T08:44:22.467-08:00The Case For and Against Fruits: Are Fruits Healthy? Are They Good for a Diet? Is There A Best Time To Eat Them?<div dir="ltr" style="text-align: left;" trbidi="on">
Fruits have been around a really long time. Most anthropologists and evolutionary biologists believe that the diet of early man consisted mainly of fruit, until such time when we diversified our food consumption by becoming hunter-gatherers and then eventually farmers. Even as access to fruits sometimes became limited due to climate change, it never completely disappeared from the human diet. But some people now argue that it should.<br />
<br />
The anti-fruit crowd highlight four major arguments against fruits available today.<br />
<br />
<b>Argument 1: Fruits are contaminated and nutritionally depleted. </b><br />
<br />
<a href="http://www.rodalenews.com/files/images/slideshow2/gmo-cartoons-gmo-fruit-fly-101.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" class="irc_mut" src="http://www.rodalenews.com/files/images/slideshow2/gmo-cartoons-gmo-fruit-fly-101.jpg" height="320" id="irc_mi" style="margin-top: 0px;" width="288" /></a>First, they claim that fruits have been so genetically modified and tainted by man-made chemicals that they no longer contain sufficient nutrients to meet human needs for such nutrients or that you should only eat them if they are organic. These arguments are usually put forth by pill-pushers who want you take to a pill instead of, or in addition to eating fruits. To the former point, I say that my own extensive review of the scientific literature supports that fruits have been altered, but that they still contain more than sufficient nutrients to meet our daily needs, particularly if you eat even a few servings per day.<br />
<br />
As to the organic issue, it's really a question of money. No rational person can argue that there is something good to be gained from eating something that has been exposed to pesticides, herbicides, fungicides, and other man made chemicals, and/or has been genetically modified. Although the specific harms from these chemicals is still hotly debated, if you can afford to avoid them, you should surely do so, especially the Environmental Working Group's "Dirty Dozen." (See http://www.ewg.org/foodnews/) If not, then rinse very carefully. I tend to rinse my blueberries at least three times under pressure before having them for breakfast.<br />
<br />
<br />
<b>Argument 2: Fruits are high in a sugar called fructose and that is not good for your liver, lipid levels, and diabetes</b><br />
<br />
The next reason often given for avoiding fruits is their high fructose content. First of all, not all fruits have the same amount of fructose (For a more detailed description of how the body processes fructose, please read the American Journal of Clinical Nutrition primer found at <!--[if gte mso 9]><xml>
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<a href="http://ajcn.nutrition.org/content/86/4/895.full">http://ajcn.nutrition.org/content/86/4/895.full</a>)</div>
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<br />
To summarize the primer, the pancreas doesn't react to fructose until is is metabolized like it does to sucrose and glucose. Moreover, we don't need any dietary fructose to function. However, even though fruits have fructose, the fructose is interwoven with the fruits' fiber and is therefore digested more slowly than fructose from other sources. Please note, fructose and high fructose corn syrup are two completely different beats. The latter should be viewed as extremely harmful like a man with a loaded gun.<br />
<br />
<a href="http://paleoaholic.com/wp-content/uploads/2013/10/fresh-fruits-vegetables-2419.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" class="irc_mut" src="http://paleoaholic.com/wp-content/uploads/2013/10/fresh-fruits-vegetables-2419.jpg" height="238" id="irc_mi" style="margin-top: 0px;" width="320" /></a>Therefore, contrary to the advice of pundits that state you can eat all the fruits you want because of the robust
nutrient content including various vitamins, minerals, antioxidants and
other synergistic nutrients, fruits should be a staple of a healthy diet, but only eaten in moderation. Weight Watchers is simply wrong to assign fruits '0' points, In fact, type two diabetics are told to limit their fruit intake to no more than 15 grams at a sitting because more than that <i>may</i> be problematic. (That's a whole other topic for another day.)<br />
<a href="http://www.eworldsms.net/wp-content/uploads/2013/01/funny1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" class="irc_mut" src="http://www.eworldsms.net/wp-content/uploads/2013/01/funny1.jpg" height="230" id="irc_mi" style="margin-top: 76px;" width="400" /></a><br />
Nevertheless, fruits have plenty to offer, particularly in regards to antioxidants, but do note, that many, if not most, of the same healthy nutrients found in fruits can also be found in vegetables. For examples, the beta-carotene in melons can be found in carrots and yams; lycopene in watermelon can be found in tomatoes (although technically a fruit because it grows on trees,); anthocyanins in blueberries can be found in eggplant; phytosterols and polyphenols can be found dispersed in both groups. The list goes on.<br />
<br />
Fruit skins can be good sources of insoluble fiber, helping move things along in the gastrointestinal track and can also contain flavonoids, which are plant secondary metabolites that have antioxidant capabilities that may diminish inflammation. Fruits are also contain other not as fully studied nutrients, like pectins, B-Cryptoxanthin, and A-carotene, which can be in apples. As with other nutrients, they also occur in vegetables. One area of limited research is the synergistic affects of all the different nutrients found in all the different fruits. Either way, fruits are a tasty and sweet alternative to less desirable man-sweetened foods.<br />
<br />
<b>Argument 3: Fruit calories add to weight gain </b><br />
<br />
The final argument against fruits is the calories they contain. It's true, virtually everything we eat contains calories and fruits are no exception. Even though the theorem of calories in/caloires out is not perfect because not all calories are processed the same because of the fiber content of the food they come from, it is true that fruits, if eaten in large quantities can contribute to weight gain. It's not the fruits themselves that are causing the weight gain; its the totality of what you are eating. So as long as you go easy on other foods, your weight loss plans can easily accommodate some measured amount of fruit calories.<br />
<br />
<b>Argument 4: They can only be eaten before meals as they will ferment in your intestinal tract after meals</b><br />
<b><br /></b>
It is simply a myth that you can't eat fruit
after meals. You can. The fermentation arguments are pue rubbish. I
searched the entire clinical study database back to the 1950s and
couldn't find a single valid study to support such nonsense.<br />
(Don't take my word for it. Read this from the University of Missouri: <br />
<br />
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<br />
<br />
<b>The flip-side: Eat only fruits </b><br />
<br />
Some people have gone to the other extreme and have taken to a mostly fruit diet. Steve Jobs tried and failed to cure his cancer with a mostly fruit only diet. (See my previous blog on fruits and cancer prevention, which can be found at http://mdprevent.blogspot.com/2012/11/do-fruits-and-vegatables-prevent-cancer.html)<br />
<br />
These fruit obsessed dieters claim they possess more energy and feel healthier. This is not surprising because the fructose in fruit is a carbohydrate that fuels energy. But as I wrote above, too much fructose is not a good thing as it can overwhelm the liver and eventually raise blood glucose to levels that precipitate large amounts of insulin release that can predispose to diabetes. Fructose breaks down to substances that can lead to glucose or blood sugar production.<br />
<br />
<b>My four golden rules of eating healthy </b><br />
<br />
So in summation, let me finish with my four golden rules of eating healthy.<br />
<br />
1. Don't eat more than you need to feel reasonably full.<br />
2. Make sure that the combination of foods eaten over a course of a week contain all the essential nutrients your body needs to function properly.<br />
3. Avoid or severely limit exposure to chemicals and highly processed ingredients stripped of most nutrients, and definitely avoid products that contain many of such ingredients rolled into one.<br />
4. Loosely monitor your total salt, fat, sugar of any kind including fructose, and calorie intake to levels that work for your body. If you are not sure what those levels are, discuss them with your physician.<br />
<b><br /></b>
<b>The final analysis</b><br />
<br />
<a href="http://www.gaspirtz.com/images/photo-cartoons/orange-juice.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" class="irc_mut" src="http://www.gaspirtz.com/images/photo-cartoons/orange-juice.jpg" height="320" id="irc_mi" style="margin-top: 0px;" width="276" /></a>Fruits have been a staple of the human and pre-human diet for time immemorial. Yes, its true that fruits may not be of the same nature and quality than they were tens or hundreds of thousands of years ago, but they are still awfully darn good. They offer many key essential nutrients, but as with most foods, you can overdue eating them. They are a good part of a comprehensive approach to healthy eating.<br />
<br />
By the way, do avoid fruit juices that are robbed of most of the fruits' fiber and have concentrated fructose. However, contrary to the popular belief, the reason to avoid fruit juices is not because fruit lose most of their nutritional value during the juicing process. (See <!--[if gte mso 9]><xml>
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<![endif]--><span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/9806122">http://www.ncbi.nlm.nih.gov/pubmed/9806122</a>) </span><br />
<br />
So now that you know the facts, you can figure out when and how much to eat, and enjoy fruit on your own. Bon Appetite.</div>
Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com2tag:blogger.com,1999:blog-3836609211397742247.post-80636542545530864642014-01-31T09:57:00.001-08:002014-01-31T10:09:24.512-08:00Is it safe to take advice from the Dr. Oz Show? Judge says it's at your own risk. <div dir="ltr" style="text-align: left;" trbidi="on">
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<u><b><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">America's Doctor?</span></b></u><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Since his
earliest appearances on The Oprah Winfrey Show, Dr. Mehmet Oz is often referred to in the
media as America's Doctor. With his weekday daytime TV show reaching an
estimated hundreds of thousands of households (although reported to be dwindling), a significant number of
Americans have come to take advice from him as if he was their personal doctor.
They have opened their hearts and minds to him as if he were the doctor who examined
them, knows their medical history, overall lifestyle, and daily psycho-social
challenges, and has assumed responsibility for their health; a doctor who only
has their best interests at heart. In an era of ubiquitous health advice found
on the web, in print media, and TV, and an increasing reliance on such advice
by the general populace, it would not seem to be too far-fetched to take
medical advice from Oz, a licensed and practicing physician who can legally
dispense such advice. Or would it be?</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"></span><br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"><u><b><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">My Doctor Said...</span></b></u></span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">One
gentleman named Frank Dietl, 76, who lives in Southampton, New Jersey, thought it was safe to take such advice. Not a good move. Here’s what happened to Frank after watching the April 17, 2012, episode of the
NBC show titled "Dr. Oz's 24-Hour Ultimate Energy Boost Plan," during
which Oz offered advice on what he called "my night sleep
special." </span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Oz’s advice
centered on a "Knapsack Heated Rice Footsie," a pair of socks with
uncooked rice -- "just enough to fill the toe of the sock" -- and
heated in a microwave oven. He told his audience to "put this in the microwave
until it's warm [and then]…put the socks on your feet and go to bed.”<span style="mso-spacerun: yes;"> </span>According to Oz, "when you do this
and lie for about 20 minutes with those socks on in bed, the heat will divert
blood to your feet to your heat" and "when your feet get hot, guess
what happens to your body. It gets cold. Your body will automatically adjust
its core temperature and as it gets cooler, you're going to be able to sleep
better because your body has to be cold in order to be sleepy. He recommended
this in combination with a cup of Rooibos Tea to reduce "tensions,
headaches and irritability," would help facilitate sleep. He went on to
add that "If you can do this the right way, you're going to be
thanking me for years to come." </span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Dietl, a diabetic
with peripheral neuropathy in his feet, which means he has loss of sensation,
followed Oz's advice thinking it applied to him because Oz made no verbal
disclaimers (discussion ahead on Oz's written disclaimers). The result was that
due to Dietl's inability to feel that the socks were too hot, he suffered third
degree (the worse type of) burns. He sued Dr. Oz and his producers
and distributors -- including co-defendants NBC, Sony Pictures Television, ZoCo
Productions and Oprah Winfrey's Harpo Productions-- claiming that Oz
neglected his "duty and obligation to warn viewing audience as to the
possible effects of following the advice offered" and "to warn
against certain effects of said medical advice as to those persons suffering
from other additional medical conditions."</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Specifically, the
civil lawsuit filed in a New York State court stated that "Dietl was
severely injured, bruised, and wounded, suffered, still suffers and will
continue to suffer for some time physical pain and bodily injuries and became
sick, sore, lame and disabled and so remained for a considerable length of
time." </span><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"><br />
<u><b>Oz Is Not Your Doctor</b></u></span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;">Six months later, in October 2013, Oz deservedly had the lawsuit against him
dismissed because the judge in the case felt that no doctor-patient
relationship existed between Dr. Oz and his studio audience. According to
Judge Saliann Scarpulla who wrote in a brief decision dismissing the claim, the
plaintiff, "Dietl has pointed to no authority that would lead this court
to find a duty of care between a television talk-show host and his vast
home-viewing audience, and Dietl fails to convince this court that creating
such a duty would be sound public policy."</span><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"></span><br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: Arial; mso-hansi-theme-font: minor-latin;"><br /></span>
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">At the hearing, Dietl's attorney told the
judge that what the plaintiff was arguing was not a "quasi
physician-patient relationship" but that Oz still breached a duty of care
by providing negligent medical advice. Specifically, Dietl believes that Oz
should have warned the audience of the dangers related to the at-home remedy if
not properly prepared as well as the dangers if the audience had prior medical
conditions.</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The judge, however, still believed this
argument amounts to one of a physician-patient relationship and was unwilling
to accept a legal theory that would create a duty of care just because a
physician looks into a camera and addresses an unseen audience.</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">For once, I have to side with Dr. Oz and agree
with the judge. </span><br />
<br />
<u><b><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">The Oz Disclaimers</span></b></u><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I think Dietl's first mistake was not heeding
the fine print on the disclaimer that flashes on the screen at the end of each
Dr. Oz Show episode. Here's the disclaimer:</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">“Please note: This show is only intended to
provide general information and is not specific medical advice. You
should consult with your own healthcare professional before altering or
beginning any course of treatment. ZoCo is not responsible for any
losses, damages or claims that may result from your medical decisions and you
are strongly encouraged to do your own research prior to any medical decisions
you make." </span><br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><br /></span>
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">On Oz's website, which contains summaries of
his shows plus other info, the disclaimer goes even further, when it states
"This website is for informational and entertainment purposes only and is
not a substitute for medical advice, diagnosis or treatment."</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Now try to imagine your reaction if your own
doctor made such statements to you. Some people may say that these disclaimers
are merely a protection against lawsuits in a highly litigious society and Dr.
Oz really does want you to take his advice--given all the research he claims
has been done by his "team" in vetting such advice--without
consulting anyone else. If you’ve watched his show then you heard him say words
like "I'm telling you what to do." </span><br />
<br />
<u><b><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Should You Take Medical Advice From the Dr. Oz Show?</span></b></u><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Nevertheless, a judge says the Dr. Oz Show does not have a doctor-patient relationship with you. The disclaimers on the show and website state that Oz and his guests don't expect
you to take their medical advice without first consulting a legitimate source.
The disclaimer states don't just take their word on anything, do your own
research. </span><br />
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</span><br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Dietl’s second mistake was taking medical
advice from a TV show that offers such advice for “entertainment purposes
only” and may not care what happens to you if you take such advice because if
it did, the show would otherwise explain the associated dangers like you may burn
yourself. Or when Oz says everyone should take a baby aspirin, he would warn
about possible bleeding and other horrible side effects (like one I got).</span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I think the facts are clear. The Dr. Oz Show
is pure entertainment and as the show displays on its own, the info provided “is
not specific medical advice” and “you are strongly encouraged to do your own
research prior to any medical decisions you make <span style="mso-spacerun: yes;"> </span></span><br />
<br />
<span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Finally, really good advice from the Dr. Oz Show.</span><br />
<br />
<br />
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Anonymoushttp://www.blogger.com/profile/09559738574907672604noreply@blogger.com0tag:blogger.com,1999:blog-3836609211397742247.post-89473986928114469102014-01-28T08:43:00.000-08:002014-05-20T08:01:55.443-07:00The Longevity Paradox: Why Is Living to 100 Easier for Some People Than Living to 90 is For Most?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Are you curious to know the 'absolute rules'
that if followed will always add many more years to your life? </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">If you are reading this expecting me
to provide you with such rules, let me apologize in advance. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">I have searched
for them for the past three years by speaking with over 1,000 senior citizen patients, including
several over one-hundred years old, and by reading over 50 books, 40,000
clinical studies/abstracts, and countless online articles, and I am sorry to say that I
don't believe they exist. Among books like The Blue Zones, The Longevity
Project, Successful Aging, The Art of Living Long, A History of the Human Body,
etc., I just can’t find any clearly proven advice. I’ve studied material from
the Okinawa, New England, and Albert Einstein College of Medicine Centenarian
studies, read publications from the SENS Research Foundation and available
proceedings from International Longevity conferences. </span></div>
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<br /></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The reason there
doesn’t seem to be
any absolute right answer is because when it comes to living fifteen or
more
years beyond the average life expectancy there appears to be a paradox.
(In fact, in the late 90s, a compendium of studies was published with
the title, The Paradoxes of Longevity.)</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Take smoking for example. There is
no question regarding the association of cigarette smoking with lung cancer.
Cigarettes are considered dangerous and responsible for producing debilitating
lung diseases, which can sometimes—but not always--be lethal. Not every
cigarette smoker develops lung cancer, and for that matter, not every lung
cancer patient previously smoked or had major exposure to second-hand fumes or
other chemicals. </span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In Daniel Buetner's book The Blue
Zones, he reveals five places, such as Sardinia, Italy and Nicoya, Costa Rica,
scattered around the globe that harbor relatively high concentrations of
centenarians, people aged over 100. He ascribes their longevity to living a
certain healthy lifestyle. It often comes down to the food they eat, the
physical activity they do, their attitude towards life and family, etc.
However, in these same areas there are plenty of friends, family, and neighbors
who lived remarkably similar lives and yet died much earlier. Not surprisingly,
in searching out the life expectancy for these ‘Blue Zone’ areas, I found that
they are for the most part only a few years higher than life expectancies in
other parts of the world with far fewer centenarians and that’s after you
average in the centenarians. </span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Yet, books and articles are
published incessantly offering the ‘secrets’ and ‘keys’ to living to 100 if you
follow a few similar rules such as eating properly, being physically active,
getting the right amount of sleep, managing stress well, being social, etc. But
do these actions always matter? If you lived the optimal life, will you add
many more years to your life? The answer is complicated.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">For some people, living a
sub-optimal life may result in premature death such as in the case of the
morbidly obese person who develops heart disease and type 2 diabetes, and succumbs
early. Commonsense and plenty of supporting science affirms the notion that
certain lifestyle activities, such as a sedentary life and poor eating habits
may lead to premature chronic diseases such as diabetes, heart disease and
cancer. But, ‘may’ is not always. </span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">To prove my point, let me share my
own recently completed informal, admittedly unscientific, but revealing
research project. The project involved accumulating all the stories about centenarians
published online in 2013. Most of the stories were identified through a Google
alert email for the keyword "longevity." After identifying over 50
stories, I searched each story for the centenarians' 'secret' or 'key' to
longevity. I created a chart of the first 50 individuals I randomly came across
that offered a reason for the centenarian's extended longevity.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Here are the results. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The oldest centenarian was 114, with
many having turned 100 just last year. 35 were women and 15 were men.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Here are the reasons they gave. It
adds up to 50+ reasons because some offered more than one: </span></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="mso-cellspacing: 0in; mso-padding-alt: 0in 0in 0in 0in; mso-table-layout-alt: fixed; mso-yfti-tbllook: 1184; width: 1074px;">
<tbody>
<tr style="height: 28.5pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 533.7pt;" width="1067">
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="mso-cellspacing: 0in; mso-padding-alt: 0in 0in 0in 0in; mso-table-layout-alt: fixed; mso-yfti-tbllook: 1184; width: 1206px;">
<tbody>
<tr style="height: 28.5pt; mso-row-margin-right: 132.4pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 470.6pt;" width="941">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">18 attribute it to (hard) work
and physical activity</span></div>
</td>
<td colspan="27" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="265"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 131.4pt; mso-yfti-irow: 1;">
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 470.6pt;" width="941">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">10 attribute it to regular
alcohol consumption</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="26" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="263"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 121.8pt; mso-yfti-irow: 2;">
<td colspan="5" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 473.2pt;" width="946">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6 attribute it to strictly never
drinking or smoking</span></div>
</td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td colspan="5" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.0pt;" width="12"><br /></td>
<td colspan="17" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="244"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 3;">
<td colspan="5" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 473.2pt;" width="946">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">14 attribute it to a good
attitude towards life and/or to their faith</span></div>
</td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-yfti-irow: 4;">
<td colspan="15" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 587.8pt;" width="1176">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to Anacin pills</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: .05in;" width="7"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 5;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to love of roller coasters</span></div>
</td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: .05in;" width="7"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 6;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to good doctors</span></div>
</td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: .05in;" width="7"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 7;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to cafe lattes (long before
they became popular)</span></div>
</td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: .05in;" width="7"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 8;">
<td colspan="5" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 473.2pt;" width="946">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to marrying a man thirty years
younger</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 1.0pt; mso-yfti-irow: 9;">
<td colspan="15" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 587.8pt;" width="1176">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to eating bacon</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="2"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 10;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to eating Italian food</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 11;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 to eating junk food</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 12;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 6.5in;" width="936">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1 credited cigarettes and
1 credited cigars (and yet, no lung cancer)</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="3" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.6pt;" width="5"><br /></td>
<td colspan="2" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 2.0pt;" width="4"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
<td colspan="15" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="240"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 119.8pt; mso-yfti-irow: 13; mso-yfti-lastrow: yes;">
<td colspan="5" style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 473.2pt;" width="946">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2 claimed no explanation</span></div>
</td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.0pt;" width="2"><br /></td>
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<br /></div>
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<td style="border: none;" width="936"><br /></td>
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<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.1pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.1pt;" width="2"><br /></td>
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 1.1pt;" width="2"><br /></td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 60.0pt; mso-yfti-irow: 1;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 477.0pt;" width="954">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Since I put this chart together, I
came across four more stories for 100, 104, 108 and 109 year </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">olds. The 100
year old claimed his longevity was due to eating lots of strawberry ice
cream, </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">just like his father did, who lived to 104. The 104 year old credited
her longevity to her love </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">of eating chocolate and drinking hot
chocolate. The 108 year old stated that it was in part </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">due to never
marrying and avoiding the accompanying decades of stress. The 109 gave her
</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">key to longevity as not eating a lot and never between meals.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
</td>
<td colspan="4" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="120"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 60.0pt; mso-yfti-irow: 2;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 477.0pt;" width="954">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Now as you review this list, it
should be clear that there were no absolute reliable and </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">consistent reasons
as to why any of them lived past 100. In fact, scientists at Albert Einstein
</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">College of Medicine and at Boston University, who have been studying
centenarians for many </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">years, concur that there is no single absolute
explanation for centenarian longevity. The current</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> thinking is these
longevity winners possess a number of small genetic variations that work
</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> together as a group to confer benefit to them. According to Thomas Perls, a
Boston University</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> professor of medicine and director of the New England
Centenarian Study, "Twenty percent of </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">the population has the genetic
wherewithal to get to be 100."</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
</td>
<td colspan="4" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="120"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 60.0pt; mso-yfti-irow: 3;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 477.0pt;" width="954">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">So what does that mean for the
eighty percent that represent the rest of us who may not enjoy</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> such gene
variations? Should we even bother to engage in a healthy lifestyle if there
are no </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">guarantees or absolutes? Why deny ourselves that piece of chocolate
cake or bother to get out </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">of our chairs and move at all if good health and
longevity simply come down to winning the </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">gene lottery?</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
</td>
<td colspan="4" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="120"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 60.0pt; mso-yfti-irow: 4;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 477.0pt;" width="954">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The answer is that even though
there are no absolutes when it comes to your health, there are </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">probabilities
and possibilities.</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
</td>
<td colspan="4" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="120"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr style="height: 28.5pt; mso-row-margin-right: 60.0pt; mso-yfti-irow: 5; mso-yfti-lastrow: yes;">
<td style="height: 28.5pt; padding: 0in 0in 0in 0in; width: 477.0pt;" width="954">
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">A healthy lifestyle increases the
probability of a healthy life even as the possibility for poor </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">health, like
the inexplicable cancer, still exists. An unhealthy lifestyle increases the
probability</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"> for poor health like heart disease and cancer, even though the
possibility does exist that you </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">will escape such devastating illnesses and
still live to 100 like the few who did in the review </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">cited above. On this
point, the preponderance of scientific evidence is clear, although not
</span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">absolute. For me it all comes down to what Louis Pasteur once said, which is
that "Chance </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">favors the prepared mind." In other words, sometimes
we make our own luck. </span></div>
</td>
<td colspan="4" style="border: none; mso-cell-special: placeholder; padding: 0in 0in 0in 0in;" width="120"><div class="MsoNormal">
<br /></div>
</td>
</tr>
<tr height="0">
<td style="border: none;" width="1093"><br /></td><td style="border: none;" width="113"><br /></td><td style="border: none;" width="1"><br /></td><td style="border: none;" width="1"><br /></td><td style="border: none;" width="1"><br /></td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">So the
next time you read an article claiming that one thing or another is the
absolute way to good health and extended longevity or books like Grain Brain or
Wheat Belly that claim that certain foods are absolutely bad for you, you
should realize that such absolutes simply don't exist (although I can't only
say that with absolute certainty).</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";">So beware
of people claiming they have absolute answers for you. They can't be certain;
no one can today, although the future may tell a different story (See my previous post about the inevitability of death).</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The old adage that one man's poison
may be another man's food should come to mind. What works for one person, may
not work for another. You may still live to 100 by eating junk food, smoking,
and never exercising. You won’t be the first and probably not the last. You
could also win the next Powerball lottery. But if I were you, I wouldn't place
all my bets on it, especially, when it's your life and health at stake. </span></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>I can’t tell you if that’s an absolute lesson
worth learning, but it’s pretty darn close.</span></div>
<table border="0" cellpadding="0" cellspacing="0" style="width: 537px;"><tbody>
<tr height="38" style="height: 28.5pt;"><td class="xl63" height="38" style="height: 28.5pt; width: 136pt;" width="181"><br /></td><td class="xl63" style="width: 48pt;" width="64"><br /></td><td style="width: 48pt;" width="64"><br /></td><td style="width: 171pt;" width="228"><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" height="38" style="height: 28.5pt;"><br /></td><td class="xl63"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="3" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" height="38" style="height: 28.5pt;"><br /></td><td class="xl63"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" height="38" style="height: 28.5pt;"><br /></td><td class="xl63"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="2" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td><td><br /></td><td><br /></td></tr>
<tr height="38" style="height: 28.5pt;"><td class="xl63" colspan="4" height="38" style="height: 28.5pt; mso-ignore: colspan;"><br /></td>
</tr>
</tbody></table>
</div>
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