Red Apple Technologies is a Crooked Company

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.

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.
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.
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.
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.

Rethinking Fruit

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.
This is based on a highly researched conclusion.
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.
2.     No study demonstrates that consumption of healthy food, including so called “super” foods, somehow neutralizes your consumption of unhealthy foods.
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.)
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.
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.
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
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.
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.

Who Are You?

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.

However, on a biological level, there's a much more complicated answer.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Why You Can't Judge A Chocolate By Its Color

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:

Ingredient Declaration:

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.

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.
Here was Dove's response in its entirety:
"Dear Steven:

Thank you for your email regarding DOVE®.
We are sorry to hear you are disappointed with the ingredients used in DOVE® PROMISES® Dark Chocolate with Almonds.
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.

Have a great day!

Your Friends at Mars Chocolate North America
Case ID 40245829"
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.
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
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.

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

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.

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."
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.""

Back in July 2013, I also posted a summary blog about the nature and healthiness of eating chocolate.
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
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.

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.

As for DOVE®, I say shame on it for misleading me and I suspect many others, and refusing to do anything about it.

168

Do you know what 168 stands for?
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?
Drum-roll, please.
168 represents the number of hours in a week.
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.
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.
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.
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.
I suggest you do your own tally and figure out how you spend each week.
Why bother?
Two reasons.
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.
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.
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.
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)
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.)
So what's my point here?
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.
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.
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.
Finally, always find a reason to get out of bed every day. It sure beats the alternative.

No Really, It's All About You.

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.
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.
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.)
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.
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.
Those clues include family history, genetic testing, blood work, the mirror, how you feel, etc.
None of these clues in and of themselves carry absolute weight.
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.
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.
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.
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.
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.
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.
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
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.
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).
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.

Next Stop: Stanford University

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.
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.
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.
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. 
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.