Please read the article I wrote for The Atlantic magazine at http://www.theatlantic.com/health/archive/2014/01/why-i-had-to-close-my-preventive-healthcare-clinic/282929/
Steven 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.
Monday, January 13, 2014
Friday, January 10, 2014
Can Dr. Oz Be Trusted?
On an episode of The Dr. Oz Show this week, one of Oz's guests endorsed several name brand products. I found that odd because of the following statement I found today on Dr. Oz's website www.droz.com.
link: http://www.doctoroz.com/blog/mehmet-oz-md/my-name-profit-not-anymore (here's the link)
Under the heading of "My Name for Profit? Not Anymore. by Mehmet Oz, MD," it reads
"I am not and have never been a paid spokesperson for any particular brand, supplement or product. I’ve even decided to no longer use brand names on The Doctor Oz Show."
Not only were brand name products specifically displayed and discussed on the show this week, here is a list of some of them from his website:
link: http://www.doctoroz.com/blog/mehmet-oz-md/my-name-profit-not-anymore (here's the link)
Under the heading of "My Name for Profit? Not Anymore. by Mehmet Oz, MD," it reads
"I am not and have never been a paid spokesperson for any particular brand, supplement or product. I’ve even decided to no longer use brand names on The Doctor Oz Show."
Not only were brand name products specifically displayed and discussed on the show this week, here is a list of some of them from his website:
http://www.doctoroz.com/videos/packaged-food-shopping-list
Frozen Food Meal
Helen’s Kitchen Fiesta Black Bean Burrito Bowl
Soup
Amy’s Organic Light in Sodium Lentil Vegetable
Energy Drink
GT’S Synergy Gingerberry Kombucha Tea
Vitalicious Vitabrownie Deep & Velvety Chocolate
Helen’s Kitchen Fiesta Black Bean Burrito Bowl
Soup
Amy’s Organic Light in Sodium Lentil Vegetable
Energy Drink
GT’S Synergy Gingerberry Kombucha Tea
Vitalicious Vitabrownie Deep & Velvety Chocolate
So you may say these are food products, not dietary supplements. Has he endorsed any brand name pills? Yes. On another episode this very week titled, Whole-Body Anti-Aging Guide 2014, he displays specific brand name pills from companies like Life Extension Foundation (LEF) and Swanson. One pill product called Lipowheat was recommended to remove facial wrinkles. (There were several other products also endorsed.) Now why would Oz specifically recommend a product from a company like LEF? Could it be because they sell his book on their website? Or because they have written very positive stories about him and his wife in their magazine? Is helping Dr. Oz market his brand or sell his book a type of compensation for his endorsements? Would that make him a paid spokesperson, which he claims he has never been?
(Below are relevant links supporting my assertions:
http://www.lef.org/search/?q=mehmet)
I thought Oz's words above that "he would no longer use brand names" were perfectly clear. Am I missing something? You tell me. Can he be trusted?
(Below are relevant links supporting my assertions:
http://www.lef.org/search/?q=mehmet)
I thought Oz's words above that "he would no longer use brand names" were perfectly clear. Am I missing something? You tell me. Can he be trusted?
Tuesday, January 7, 2014
The Pill Pushing Dr. Oz: His New Diet; Melatonin and DGL Licorice for Heartburn
I truly thought I was done critiquing the good Dr. Oz, but here I go again. Looking for something to watch as I mounted my elliptical, I fancied upon his show yesterday titled Dr. Oz's Two-Week Rapid Weight-Loss Diet. Now don't even get me going on the concepts of "rapid weight loss" and "diet," let alone something meaningful and lasting that is suppose to happen in two weeks. (See my previous blog on "Stop The Weight Loss Madness.") But the show started innocently enough with Dr Oz telling the audience that if they cut out all dairy (other than Greek yogurt), all bread and wheat based products (yes, that includes pasta), all sugar (including all alcohol), all artificial sweeteners, and all coffee, they could lose on average nine pounds over two weeks like his audience did. Now who can argue that cutting out many of the foods that cause weight gain may result in weight loss? I can't. (I'm not a fan of these quick weight loss schemes and a recent study shows the more often you try a new way to lose weight, the harder it gets. http://care.diabetesjournals.org/content/36/1/34.full) I think its disingenuous for Oz to claim that its something new or easily doable. Changing one's diet is at the crux of successful weight loss and it's just a big tease to throw this out at people. Either way, if he stopped with his diet suggestions, all would have been fine.
But of course, my pill-pushing friend couldn't help himself. After discussing this "new" diet, he recommended that people take a multivitamin and probiotics. Why? Just to play it safe. Are lean protein like fish and chicken, unlimited (that's his words) vegetables, nuts, Greek yogurt, fruits, unsweetened almond milk, and flaxseed not a good enough source of vitamins (other than Vitamin D)? If so, why should everyone take a multivitamin? From my perspective, it's because he's a pill-meister; a pill pimp, a pill-monger. You get the point, he's addicted to pushing pills. Could it be because the pill companies advertise on his show and websites? I don't know nor do I care. I just wish he would stop confusing people. Of course, he didn't describe the potency and bacterial strains that the probiotics should contain, which can make a difference between a complete waste of money for everyone versus some possible effect for some people. Should you take 100 million or ten billion? Two strains or ten? Which strains? What's the point of making a recommendation without being specific and explaining why? (See my blogs about probiotics.)
So somewhat bemused that he was up to his old tricks, I hoped he was done, but expected no such outcome. He did not disappoint.
The third segment on the show was about natural ways to treat heartburn. For that, he recommended 3 mg of melatonin each night for 4 weeks and a herb called DGL licorice, which he recommended before every meal. Unfamiliar with either of these recommendation and always willing to explore alternatives to prescription pills, I went to work to try and validate his assertions.
Let's start with the DGL licorice. The only double-blind randomized controlled study appears to have been done in 1973 (http://www.ncbi.nlm.nih.gov/pubmed/4584640) and showed no benefit over placebo. I also searched the naturalstandard.com database, which gave it a letter grade of "D," which means there is "negative scientific evidence"-- the evidence stacks against its effectiveness. It just doesn't work.
For melatonin, which is naturally produced by both your pineal gland and in your gut, and is also a by-product of sun exposure to your skin and associated with Vitamin D production, there was one small study that involved only sixty people that showed some benefit. However, the study used more than a 50% larger dose of 5 mg versus the 3 mg he recommended. (http://www.ncbi.nlm.nih.gov/pubmed/17426465?dopt=Abstract.) I couldn't find a study at 3 mg. Nevertheless, one study should never form the basis of a recommendation. Studies are often flawed and that's why good science requires validation. That's how naturalstandard.com grades different substances; it bases the grade on the body of evidence. It gave melatonin a "C" for effectiveness against gastrointestinal issues such as heartburn, which means the science is inconclusive. Besides, the explanation Oz offered for why he thinks melatonin even works on heartburn was not consistent with the human scientific literature. It's believed to be a completely different mechanism, unrelated to the pyloric sphincter he claimed was involved.
Finally, as melatonin is often used as a sleep aid, taking such a pill when you don't have a sleep problem, can alter your sleep.
It's very clear to me that Dr. Oz has little regard for making recommendations without proper vetting. If you know someone foolish enough to take advice from this man in regards to supplements, please show him or her this blog and the several dozen others I've written that point out the danger of such advice.
Shame on you, Dr. Oz, again.
But of course, my pill-pushing friend couldn't help himself. After discussing this "new" diet, he recommended that people take a multivitamin and probiotics. Why? Just to play it safe. Are lean protein like fish and chicken, unlimited (that's his words) vegetables, nuts, Greek yogurt, fruits, unsweetened almond milk, and flaxseed not a good enough source of vitamins (other than Vitamin D)? If so, why should everyone take a multivitamin? From my perspective, it's because he's a pill-meister; a pill pimp, a pill-monger. You get the point, he's addicted to pushing pills. Could it be because the pill companies advertise on his show and websites? I don't know nor do I care. I just wish he would stop confusing people. Of course, he didn't describe the potency and bacterial strains that the probiotics should contain, which can make a difference between a complete waste of money for everyone versus some possible effect for some people. Should you take 100 million or ten billion? Two strains or ten? Which strains? What's the point of making a recommendation without being specific and explaining why? (See my blogs about probiotics.)
So somewhat bemused that he was up to his old tricks, I hoped he was done, but expected no such outcome. He did not disappoint.
The third segment on the show was about natural ways to treat heartburn. For that, he recommended 3 mg of melatonin each night for 4 weeks and a herb called DGL licorice, which he recommended before every meal. Unfamiliar with either of these recommendation and always willing to explore alternatives to prescription pills, I went to work to try and validate his assertions.
Let's start with the DGL licorice. The only double-blind randomized controlled study appears to have been done in 1973 (http://www.ncbi.nlm.nih.gov/pubmed/4584640) and showed no benefit over placebo. I also searched the naturalstandard.com database, which gave it a letter grade of "D," which means there is "negative scientific evidence"-- the evidence stacks against its effectiveness. It just doesn't work.
For melatonin, which is naturally produced by both your pineal gland and in your gut, and is also a by-product of sun exposure to your skin and associated with Vitamin D production, there was one small study that involved only sixty people that showed some benefit. However, the study used more than a 50% larger dose of 5 mg versus the 3 mg he recommended. (http://www.ncbi.nlm.nih.gov/pubmed/17426465?dopt=Abstract.) I couldn't find a study at 3 mg. Nevertheless, one study should never form the basis of a recommendation. Studies are often flawed and that's why good science requires validation. That's how naturalstandard.com grades different substances; it bases the grade on the body of evidence. It gave melatonin a "C" for effectiveness against gastrointestinal issues such as heartburn, which means the science is inconclusive. Besides, the explanation Oz offered for why he thinks melatonin even works on heartburn was not consistent with the human scientific literature. It's believed to be a completely different mechanism, unrelated to the pyloric sphincter he claimed was involved.
Finally, as melatonin is often used as a sleep aid, taking such a pill when you don't have a sleep problem, can alter your sleep.
It's very clear to me that Dr. Oz has little regard for making recommendations without proper vetting. If you know someone foolish enough to take advice from this man in regards to supplements, please show him or her this blog and the several dozen others I've written that point out the danger of such advice.
Shame on you, Dr. Oz, again.
Sunday, December 22, 2013
A Final Word (At Least For Now) On Eating Healthy
As I get ready to hang up my stethoscope again, and ponder the over one-thousand conversations I've had with patients and others over the past three years about eating for health, one theme repeatedly comes to mind: despite their belief to the contrary, most people don't truly understand what it means to eat healthy. They are also confused about the value of eating healthy when the diet still includes plenty of unhealthy foods. Healthy foods, no matter how much you eat, do not neutralize the ill effects of unhealthy foods.
As a service to all, here is a brief synopsis of the elements of a healthy diet. It's little technical at first, but I get down to a basic list at the end.
First, let's take a quick look at what are called the essential nutrients, of which there are six categories, that all humans basically need to survive. By essential, we mean that the human body cannot produce these on its own without outside help.
There are:
13 essential vitamins
water
air
Some also think that choline, once thought a vitamin, is also an essential nutrient.
There are also other amino acids and fatty acids, and many other compounds in foods, such as antioxidants, enzymes, etc. that are metabolically active but are not essential to the diet as the human body can function without them.
Okay, so what are you supposed to do with all this detail. Nothing really other than eat foods that contain them.
For example, 11 of the vitamins can be obtained from eating fruits and vegetables.
One, vitamin D, can be made by sun exposure or found in foods like unsweetened almond milk.
The other Vitamin, B12, can be found in fish, chicken and meat. I'll come back to these later.
The minerals can be found in vegetables, fruits, nuts, beans whole grains, and seeds.
The amino acids and choline can be found in nuts, whole grains, beans, eggs, fish, chicken and meat.
The fatty acids, or their derivatives, can be found in seeds like chia and flax, as well as healthy wild fish like Alaskan Salmon.
So what does a healthy diet look like?
It contains daily raw fruits and vegetables, fresh or frozen. Fruits must include berries, banana, citrus, apples, and melons. Other fruits are optional. Vegetables must contain leafy green vegetables, collards, onions, tomatoes, carrots, onions, garlic, and mushrooms.
It contains raw whole nuts (includes pecans, almonds, pistachio, Brazil nuts, and macadamia- at least twenty a day except for Brazil nuts-limit to two a day), cooked beans (limit soybean but some okay), raw seeds (chia and flax best, but limit), and minimally processed whole grains like steel cut oatmeal with no preservatives nor genetically modified grains (non-GMO).
It contains wild fatty fish like wild salmon, herring, sardines, cod, halibut, etc. (3-4 times a week)
It contains free range chicken once a week, free range eggs twice a week, and lean antibiotic meat every other week as a side dish.
It includes dark chocolate(for the polyphenols) of at least 70% cacao with less than 5 grams of sugar per serving with a serving size equal to at least a third of the bar.
It contains unsweetened almond milk.
A very little olive or safflower oil.
It contains sun exposure and at least 50 ounces of fluids a day.
Of course, even a good thing in excess is harmful. So eat these foods in moderation, eat mindfully, and remember what the Okinawans say before every meal: Hora Hachi Bu (eat until your 80% full)
A healthy diet does not contain dairy of any kind (after infancy), yogurt included, and definitely not dairy that contains added hormones such as Bovine Recombinant Growth Hormone (which is part of all non-organic dairy), artificial sweeteners or added sugars, processed breads with added sugar, pastas whole grain or otherwise, ketchup with high fructose corn syrup (most), chips, processed snacks, pretzels, crackers, cold cut meats, processed meats, processed cereals like Cheerios and Kashi made from genetically modified grains (also don't be fooled by the label Organic: read the label and watch for added sugar greater than 4 grams per serving-if so, avoid), sweetened drinks or bottled fruit juices, health bars, protein touring products -- including bars, drinks, shakes or any other product touting protein, any supplements (unless prescribed by a knowledgeable physician), any multivitamins (unless pregnant), fried foods, burnt or charred foods, any food with partially hydrogenated on its ingredient list (even if label states no trans-fats), non-sun dried fruit (even if sun-dried eat in moderation), no foods or drinks whatsoever with preservatives added including nitrates and sulfites in particular, too many smoothies even if all raw ingredients--too many calories involved, farm-raised fish, especially tilapia and salmon, more than once a week tuna, non-organic apples, corn or potatoes, movie theater and microwave popcorn, too many oils including coconut, olive, sunflower, and safflower oils, too many starchy vegetables, candies with sugar and chemicals, foods with added dyes, non-organic soy-based products, and more food than you need to live-which is not really all that much after you meet the essential requirements.
I hope this information has been helpful and I wish you all Bon Appetite. If you have any questions, please feel free to write me at steven.charlap.md@mdprevent.net for at least the next six months.
As a service to all, here is a brief synopsis of the elements of a healthy diet. It's little technical at first, but I get down to a basic list at the end.
First, let's take a quick look at what are called the essential nutrients, of which there are six categories, that all humans basically need to survive. By essential, we mean that the human body cannot produce these on its own without outside help.
There are:
13 essential vitamins
- Vitamin A
- Vitamin C
- Vitamin D
- Vitamin E
- Vitamin K
- Vitamin B1 (thiamine)
- Vitamin B2 (riboflavin)
- Vitamin B3 (niacin)
- Pantothenic acid
- Biotin
- Vitamin B6
- Vitamin B12
- Folate (folic acid)
- Fat-soluble vitamins are stored in the body's fatty tissue. The four fat-soluble vitamins are vitamins A, D, E, and K.
- There are nine water-soluble vitamins. The body must use water-soluble vitamins right away. Any left over water-soluble vitamins leave the body through the urine. Vitamin B12 is the only water-soluble vitamin that can be stored in the liver for many years.
- Calcium (Ca)
- Chloride (Cl−)
- Chromium (Cr)[5]
- Cobalt (Co) (as part of Vitamin B12)
- Copper (Cu)
Main article: Copper in health
- Iodine (I)
- Iron (Fe)
- Magnesium (Mg)
- Manganese (Mn)
- Molybdenum (Mo)
- Phosphorus (P)
- Potassium (K)
- Selenium (Se)
- Sodium (Na)
- Zinc (Zn)
- histidine,
- isoleucine,
- leucine,
- lysine,
- methionine,
- phenylalanine,
- threonine,
- tryptophan
- valine.
- alpha linolenic acid
- linoleic acid
water
air
Some also think that choline, once thought a vitamin, is also an essential nutrient.
There are also other amino acids and fatty acids, and many other compounds in foods, such as antioxidants, enzymes, etc. that are metabolically active but are not essential to the diet as the human body can function without them.
Okay, so what are you supposed to do with all this detail. Nothing really other than eat foods that contain them.
For example, 11 of the vitamins can be obtained from eating fruits and vegetables.
One, vitamin D, can be made by sun exposure or found in foods like unsweetened almond milk.
The other Vitamin, B12, can be found in fish, chicken and meat. I'll come back to these later.
The minerals can be found in vegetables, fruits, nuts, beans whole grains, and seeds.
The amino acids and choline can be found in nuts, whole grains, beans, eggs, fish, chicken and meat.
The fatty acids, or their derivatives, can be found in seeds like chia and flax, as well as healthy wild fish like Alaskan Salmon.
So what does a healthy diet look like?
It contains daily raw fruits and vegetables, fresh or frozen. Fruits must include berries, banana, citrus, apples, and melons. Other fruits are optional. Vegetables must contain leafy green vegetables, collards, onions, tomatoes, carrots, onions, garlic, and mushrooms.
It contains raw whole nuts (includes pecans, almonds, pistachio, Brazil nuts, and macadamia- at least twenty a day except for Brazil nuts-limit to two a day), cooked beans (limit soybean but some okay), raw seeds (chia and flax best, but limit), and minimally processed whole grains like steel cut oatmeal with no preservatives nor genetically modified grains (non-GMO).
It contains wild fatty fish like wild salmon, herring, sardines, cod, halibut, etc. (3-4 times a week)
It contains free range chicken once a week, free range eggs twice a week, and lean antibiotic meat every other week as a side dish.
It includes dark chocolate(for the polyphenols) of at least 70% cacao with less than 5 grams of sugar per serving with a serving size equal to at least a third of the bar.
It contains unsweetened almond milk.
A very little olive or safflower oil.
It contains sun exposure and at least 50 ounces of fluids a day.
Of course, even a good thing in excess is harmful. So eat these foods in moderation, eat mindfully, and remember what the Okinawans say before every meal: Hora Hachi Bu (eat until your 80% full)
A healthy diet does not contain dairy of any kind (after infancy), yogurt included, and definitely not dairy that contains added hormones such as Bovine Recombinant Growth Hormone (which is part of all non-organic dairy), artificial sweeteners or added sugars, processed breads with added sugar, pastas whole grain or otherwise, ketchup with high fructose corn syrup (most), chips, processed snacks, pretzels, crackers, cold cut meats, processed meats, processed cereals like Cheerios and Kashi made from genetically modified grains (also don't be fooled by the label Organic: read the label and watch for added sugar greater than 4 grams per serving-if so, avoid), sweetened drinks or bottled fruit juices, health bars, protein touring products -- including bars, drinks, shakes or any other product touting protein, any supplements (unless prescribed by a knowledgeable physician), any multivitamins (unless pregnant), fried foods, burnt or charred foods, any food with partially hydrogenated on its ingredient list (even if label states no trans-fats), non-sun dried fruit (even if sun-dried eat in moderation), no foods or drinks whatsoever with preservatives added including nitrates and sulfites in particular, too many smoothies even if all raw ingredients--too many calories involved, farm-raised fish, especially tilapia and salmon, more than once a week tuna, non-organic apples, corn or potatoes, movie theater and microwave popcorn, too many oils including coconut, olive, sunflower, and safflower oils, too many starchy vegetables, candies with sugar and chemicals, foods with added dyes, non-organic soy-based products, and more food than you need to live-which is not really all that much after you meet the essential requirements.
I hope this information has been helpful and I wish you all Bon Appetite. If you have any questions, please feel free to write me at steven.charlap.md@mdprevent.net for at least the next six months.
Wednesday, November 27, 2013
See You Later, Brother
On November 19, 2013, my middle brother Shlomo (I am the youngest of three boys) passed away at the age of 59, after a valiant 14 month struggle against kidney cancer. Below, please find the eulogy I delivered at his funeral.
Shlomo always began all his simcha (happy occasion) speeches
with the words, “what can a father say to his child on the occasion of....” In respect, I will begin
my comments with “what can a brother say to a brother’s friends and family.”
I have always found it amazing that people seem to be their
best at their bar/bas mitzvah and at their funeral. That’s the time when we
sing their praise and highlight all the wonderful things about them. The rest
of the time, as we all know, everyone is not quite so perfect. So I’m sure you
will all expect me to say how wonderful Shlomo was and I will not
disappoint. But I think that those of us
here who really knew Shlomo, will know that I am not exaggerating such words of
praise.
Shlomo, or Eba, as I affectionately called him when I could
barely speak, was truly the perfect older brother in every sense of the word. I
can remember as a small child Shlomo always offering me his lap on long car
trips, no matter how hot or uncomfortable the trip may have been. With my head
nestled in his lap, he gave me a sense of security and warmth. Shlomo and I shared a bedroom for most of our
childhood and Shlomo would often tell me bedtime stories. We would play
baseball together in our small room using a rolled up sock. On my birthday, I
remember one year Shlomo purchasing me two small racing cars that he knew I so
terribly wanted. How he paid for them, I will never know because he had little
money of his own to speak of. When I was entering college after having taken
high school for granted, it was both my older brothers, Yehuda and Shlomo, who
inspired me to work hard. It was Shlomo, in particular, who changed my life by making success in
college a reality. In fact, I remember clearly as if he just said it, “It is
possible to get an A in every class you take in college. You just have to work hard” And I believed him.
When I complained during a lifeguard instructors course that
I could not perform a necessary skill, it was Shlomo who immediately chastened
me with a much needed and well-timed sharp rebuke of “stop it already, of
course you can do it.” This much-needed verbal blow compelled me to stop wallowing in self-pity and get
it right.
Shlomo’s favorite words to me that always got me motivated
to work hard and stay the course, whether in school or otherwise, was always
"bust, bust, bust." It meant to just keep going hard towards any goal and I say
to Aliza, Esti, Avivi, and Donny, as well as Dov, Neil, and Eitan, that
if your father and father-in-law was here today, I am sure that he would say to
you that when confronted with any of life’s challenges, the answer is always to
bust, bust, bust.
Shlomo’s thoughts were always about everyone but himself. He
has been the dutiful son that took care of our parents by always having them
live nearby, helping them with medical problems, and always welcoming them to
his home. When our father, z”l (of blessed memory) passed seven years ago,
Shlomo became the doting son to our mother who continued to live nearby. And
Shlomo and Meryl always warmly welcomed her to their home every Shabbat and yom-tov
(holiday). I know that Shlomo would want you Ema to take good care of yourself
even now that he is gone. Of course, Shlomo was also grateful for your Herculean
efforts to feed him well to keep his cancer at bay. He appreciated the never-ending
flow of fresh fruits and vegetables smoothies, which was your labor of love for
him, and all the time you spent at his bedside.
Shlomo also always saw himself as a problem solver, often
offering advice on how to reconcile differences between family members and he
was a big believer in always doing the right thing. One day, a few weeks ago, after I changed his bedpan, Shlomo
turned to me and said it is good you are doing this. I asked “why is that?” He
answered because it will make you feel better after I am gone. That’s the way Shlomo
was; always thinking about how some action would have a positive or negative
influence on somebody’s wellbeing.
This concern for the welfare of others extended to his medical practice as an internist and cardiologist. Working to ten or eleven at night was a constant for him and that is why his patients loved him and thought so warmly of him. (In fact, during the shiva (mourning period), dozens of his patients came to his house to express how much they loved him as their doctor, particularly how he made each of them feel like he or she was his only patient. Many also claimed that he had saved their lives with his medical care.) Everything I know about how to make a patient feel special, I learned from him.
A few weeks ago, Shlomo decided to make a farewell video to
his family, which I will share with them in the very near future. When he finished
the part about his kids, I said to Shlomo that all he said to each kid was how
great he thought they were and didn’t distinguish between them. He immediately
answered that it was true that he thought that each of his kids were truly
amazing and he was so proud of each of them. He also thought he was the
luckiest father-in-law in the world that each of his three girls had met and
married such incredible and loving sons-in-law, Dov, Neil and Eitan, who were
welcome additions to the family.
For Meryl, however, he had no shortage of words of praise of
what an amazing wife she had been to him, particularly during the last few
months. I often tell patients to print
out the serenity prayer and keep it by their bed side. Meryl epitomized this prayer.
She had the serenity to accept the things she could not change such as at the
end the inevitability of Shlomo’s passing. But she also had the courage to work
hard to keep him alive when we all thought that was still possible. And in the
end, she showed the wisdom in knowing the difference between the two. As a
first-hand witness, I cannot imagine a wife showing more grace and poise during
the most difficult of times, who never wavered for a moment in her love for her
husband of 35 years, who spent her every moment at his beck and call, sleeping
by his side every evening, even if it meant sleeping in a chair in a cramped
hospital room. And did all of this with
the most optimistic and positive countenance at all times.
So I say to Meryl and all the kids and sons-in-laws, from Ema,
Yehuda, Yael, Danielle, Justin, Nicole, and I, thank you for being such a
wonderful wife and children to the brother I loved so much and who was truly a
tzadik (man of virtue) and a wonderful person. My brother could not have had a
better family than you and I know he always felt lucky and grateful for having
all of you in his life. With Shlomo gone to Olem Habah (heaven), a place I am
sure he has earned, I hope that all of you will look to Yael and I as someone
you can rely upon and that from this point on we celebrate many simchahs
together, which I am sure will make Shlomo extremely happy as family meant everything to him. as he looks upon us
from high above.
I love you Shlomo, I will miss you, I will miss your bust,
bust, bust, and I hope to see you again after meah v’esrim (120 years).
Sunday, November 17, 2013
Stop The Weight Loss Madness
This past week, I saw no less than ten patients who wanted to lose weight. Each described in their own unique way how the extra weight was contributing to some perceived problem they had with the weight's effect on their image, energy level, health, etc.
To each patient, I said the same thing. Stop focusing on losing weight and start focusing on what you can and cannot do to your body to help it function at its optimal level. To each, I conveyed how the human body was developed over millions of years, with its most latest form, homo sapiens being around two hundred thousand years old. Over this period of time, human biology has evolved a full host of protective mechanisms to ward off disease. Of course, we all know these mechanisms sometimes fail miserably. It is very unfortunate when it does, and my heart goes out to those who suffer seemingly happenstance illness. Nevertheless, these mechanisms work for most and that is why the human body can usually protect itself fairly well against poor eating, lack of exercise, inadequate sleep, mounting stress, etc. for at least the first five or six decades of life. It's not that damage isn't being done, it's just that the damage isn't always so obvious until later.
I often share with patients the story of the my growing up in Brooklyn, NY and how one day the red lights turned on in on the dashboard of my father's old car. I share how my father drove it to a nearby gas station and spoke to the attendant and asked if he could help with the red light, to which he replied, "yes, I can disconnect it." Now even to a young boy that was a ridiculous statement. Little did I realize that during medical school and my residency, my teachers and mentors would primarily educate me on how to turn off patients' red lights. As doctors have become successful in eliminating symptoms without addressing the underlying problem, akin to turning off a red light warning of problems, patients have been confused into thinking they don't really have a problem. A case in point is a patient this week telling me that he was very healthy with normal blood sugar despite the fact that he was a diabetic on high blood sugar medication and nearly morbidly obese.
For some reason, Americans seem to disassociate the reasons they gained the weight with the effects such reasons have on their health beyond the number on a weight scale. They gain weight because they ate too much, they ate the wrong food, they barely moved, they slept poorly and were always hungry, etc. That is why I tell people to stop worrying about the numbers on the scale and to start paying close attention to the details of their lives. Although there is no perfect plan for staying healthy as the old Yiddish saying goes, mensch tracht un Got laft, men plan and G-d laughs, it still pays to plan. Therefore, by focusing on those elements of your life that you do have control over, you can shift the odds of staying and getting healthy in your favor. By doing so, one of the benefits is usually weight loss.
I have always believed that for virtually all problems, there are solutions. Over the past three years, by investing the time and listening carefully to what patients are telling me, in partnership with them, I have helped them identify such problems and come up with workable solutions. It has been a three year whirlwind and I am so grateful that I had the opportunity to so positively effect so many lives. However, as clinically successful and emotionally rewarding this endeavor has been, the time has come for me to move on to my next challenge. I will always be grateful for all that my patients have taught me and the wonderful personal stories they shared.
I know that those who embraced my philosophy about taking care of the one body they had by eating healthy foods in moderation, avoiding unhealthy foods altogether to the extent possible, physically staying active over the course of a day as much as possible beyond simply going to a gym for a specified work-out, improving sleeping habits, managing stress more effectively with good meditation and relaxation techniques, nurturing relationships and being grateful for the good things in life, have and will continue to reap great benefits from developing such good health habits.
To the rest of you I say, while good health is never guaranteed, a healthy lifestyle can shift the odds in your favor. Choices do have consequences so please choose wisely. Stop chasing weight loss like a lost puppy and focus on what really matters--your overall well-being.
To each patient, I said the same thing. Stop focusing on losing weight and start focusing on what you can and cannot do to your body to help it function at its optimal level. To each, I conveyed how the human body was developed over millions of years, with its most latest form, homo sapiens being around two hundred thousand years old. Over this period of time, human biology has evolved a full host of protective mechanisms to ward off disease. Of course, we all know these mechanisms sometimes fail miserably. It is very unfortunate when it does, and my heart goes out to those who suffer seemingly happenstance illness. Nevertheless, these mechanisms work for most and that is why the human body can usually protect itself fairly well against poor eating, lack of exercise, inadequate sleep, mounting stress, etc. for at least the first five or six decades of life. It's not that damage isn't being done, it's just that the damage isn't always so obvious until later.
I often share with patients the story of the my growing up in Brooklyn, NY and how one day the red lights turned on in on the dashboard of my father's old car. I share how my father drove it to a nearby gas station and spoke to the attendant and asked if he could help with the red light, to which he replied, "yes, I can disconnect it." Now even to a young boy that was a ridiculous statement. Little did I realize that during medical school and my residency, my teachers and mentors would primarily educate me on how to turn off patients' red lights. As doctors have become successful in eliminating symptoms without addressing the underlying problem, akin to turning off a red light warning of problems, patients have been confused into thinking they don't really have a problem. A case in point is a patient this week telling me that he was very healthy with normal blood sugar despite the fact that he was a diabetic on high blood sugar medication and nearly morbidly obese.
For some reason, Americans seem to disassociate the reasons they gained the weight with the effects such reasons have on their health beyond the number on a weight scale. They gain weight because they ate too much, they ate the wrong food, they barely moved, they slept poorly and were always hungry, etc. That is why I tell people to stop worrying about the numbers on the scale and to start paying close attention to the details of their lives. Although there is no perfect plan for staying healthy as the old Yiddish saying goes, mensch tracht un Got laft, men plan and G-d laughs, it still pays to plan. Therefore, by focusing on those elements of your life that you do have control over, you can shift the odds of staying and getting healthy in your favor. By doing so, one of the benefits is usually weight loss.
I have always believed that for virtually all problems, there are solutions. Over the past three years, by investing the time and listening carefully to what patients are telling me, in partnership with them, I have helped them identify such problems and come up with workable solutions. It has been a three year whirlwind and I am so grateful that I had the opportunity to so positively effect so many lives. However, as clinically successful and emotionally rewarding this endeavor has been, the time has come for me to move on to my next challenge. I will always be grateful for all that my patients have taught me and the wonderful personal stories they shared.
I know that those who embraced my philosophy about taking care of the one body they had by eating healthy foods in moderation, avoiding unhealthy foods altogether to the extent possible, physically staying active over the course of a day as much as possible beyond simply going to a gym for a specified work-out, improving sleeping habits, managing stress more effectively with good meditation and relaxation techniques, nurturing relationships and being grateful for the good things in life, have and will continue to reap great benefits from developing such good health habits.
To the rest of you I say, while good health is never guaranteed, a healthy lifestyle can shift the odds in your favor. Choices do have consequences so please choose wisely. Stop chasing weight loss like a lost puppy and focus on what really matters--your overall well-being.
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