Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

When More Choices Are Bad...

When comparing over-indulgent Americans to the more svelte (perhaps not for long) Europeans, it is often said that we "live to eat" while they "eat to live." This may explain why we have among the highest rates of obesity in the world, but it doesn't necessarily explain why our appetites have evolved so differently.

A new study out of Italy may shed some light on this phenomenon. Quoting from Medscape, "Scientists from three academic labs in Italy found that levels of ghrelin, [...a hormone that stimulates appetite] rose substantially in eight healthy volunteers -- who had already eaten a full meal -- when they were allowed to eat as much as they wanted of their favorite food. No such increase was seen when, under the same conditions, the same volunteers were told to eat foods they didn't like but that had the same calorie content." In layman's terms, our brains respond positively to foods we like to eat and therefore we are able to keep eating such food even when we are not hungry.

Another popular belief is that Europeans are more sophisticated eaters than Americans and relish their food more than we do. Indirectly, this Italian study would appear to support that contention. When it comes to food, most Americans are not very discriminating. Exposed to many foods from many different cultures, we seem to like the variety, and so we develop a wide range of tastes. The panoply of food choices available to us at any given time stimulates our appetite as we seek to determine what we will choose next. The Italian study therefore demonstrates why we may over-eat. The more foods we like, the more foods we eat. The more we eat, the heavier we get.

There is a concept called habituation that explains this phenomenon from another angle. Habituation means that we become accustomed to our foods. The less types of foods we eat, the less of that food we need to be satiated. In light of the Italian studies, this makes sense. The more foods we like, the more foods we eat. The fewer types of food we regularly consume, the less of it we hunger for.

On a personal level, this has worked for me. At 50, I was diagnosed with calcification around the heart, a sign of impending disaster. I was overweight, popped pills every day for reflux and irritable bowel syndrome, was on a statin for cholesterol near 300, and couldn't run 50 feet without limping the rest of the day.  I was your typical middle-aged American male. When I began to pursue MDPrevent in 2010, I was exposed to the science that changed my life. I learned that changing one's lifestyle, particularly how you eat, can change your life trajectory.

I now religiously eat the same breakfast and lunch every day. Breakfast is comprised of sliced bananas, blueberries, Bob's Red Mill Muesli, an organic cereal like Ezekiel Almond or Nature's Path Flax, and a glass of Blue Diamond Vanilla Unsweetened Almond Milk. I eat in a small bowl and I am NEVER hungry before lunch. For lunch, I eat hummus on Arnold's Whole Wheat Thins (has preservatives) or Ezekiel bread (no preservatives - found in freezer section), topped with spinach and sometimes olives, and over the next or so hour afterwards, I snack on sliced apples, a small bag of carrots, and a bag of mixed nuts. Again, I am NEVER hungry before dinner and I am not even famished by dinner time. For dinner, I try to eat wild fish like salmon or cod, with quinoa and mixed vegetables and for dessert, I enjoy sliced melon.

This food routine has allowed me to shed 20+ pounds, eliminate my reflux, my irritable bowel syndrome, stop my statin and still reduce my cholesterol to less than 150, move out of the pre-diabetic range, and also practically eliminate my hip osteoarthritis, which allows me to run for longer distances than I have in 20 years.

I am not saying that one has to eat exactly what I eat, but the facts remain that the less variety of foods I eat, the less I crave.

So if you want to stay healthy, get healthy, and keep the grim reaper waiting, consider narrowing down your food choices to a select group of healthier foods because the less foods you choose from, the less of those foods you will need to be satiated, and therefore, the less of those foods you will eat. Become a more discriminating eater and you will most likely also become a healthier one as well.

Help Needed!

You may think I spend a lot of time thinking about wellness and prevention. The truth be told, I spend almost all my time in such contemplation. First, I think about my health and that of my family. But most of the time, I think about my patients and our community at large.  I access on a daily basis multiple health information sources including new medical studies, medical journals, mass media, and websites. I am constantly searching for some valuable new piece of information, some innovation I haven't heard of, something worthwhile that I can incorporate into my daily medical practice that will help my patients.  To make a difference, I know you sometimes need to think not outside the box, but like there is no box at all.

King Solomon is credited as having written in The Book of Ecclesiastes that there is nothing new under the sun. This is widely understood to mean that everything that happens on earth is futile and we should therefore put our faith in G-d and direct all our attention to his service. Although I am a G-d fearing man, I have a different take on this interpretation. First, I believe that we serve G-d by our daily efforts to lead good, wholesome, ethical lives and also by helping others in need. Second, I believe that G-d helps those that help themselves.


When things have gone wrong for me as they do for everyone at some point, I try not to dwell on my misfortune but to rise above it. I may wallow in self-pity for a short time, but I know that I can ill afford to linger and that it will will do me no good to retain that state of mind for long. I always believe that a solution can be found if I look hard enough for it and don't give up. Fall down seven times, get up eight is my motto. When it comes to others, I know that they too can find solutions but that they need to pursue them with all due vigor.

It's said that in regards to health and longevity, genetics loads the gun and lifestyle factors pull the trigger. My goal in creating MDPrevent, was to metaphorically disarm people. If we can just take the guns out of their hands, they will be less likely to do themselves harm. And by guns, I mean all the things they do on a daily basis that are rife with health risks and dangers.  Information brings knowledge, knowledge brings reason, reason brings motive, and motive brings action.

Nothing in life has ever frustrated me more than seeing something bad happen that could have been avoided by practical and reasonable action. It breaks my heart to see friends, family, patients, and even strangers pursue courses of action that can only lead to dire consequences. Sometimes it is as simple as constantly eating the wrong foods and shunning any physical activity, and sometimes its far more complicated. Yet, in all circumstances, it is painful to watch, knowing what comes next.

My adult life has been dedicated to the service of others. I believe that it is my sacred mission to help others help themselves. Everything I read and encounter is processed through the filter of how this information may be applied on a grander scale to the masses.  My pursuit of a MBA was driven by a desire to do something across a broader platform than what an individual doctor can do for his patients.

I am writing today because I seek insight from those who may perchance read this blog.  My thoughts keep returning to a health fair I attended last week. At the fair, you may remember that I queried passerbys with "Would you like to add more good years to your life?"  Many responded "No."

I am not strictly looking for reasons why anyone would answer in such a manner. My suspicions that people's reasons for shutting me down range from not wanting to be bothered by a man posing a question with an obvious answer to a belief that it is futile and/or worthless to seek such a goal so why even bother. I am sure there are many other reasons, both simple and complicated. I am, however, trying to figure out what to do about it. Nothing, is not an acceptable answer. I fear that for many Henry David Thoreau's utterance, "Most men lead lives of quiet desperation and go to the grave with the song still in them" may be in play. This would be tragic and most assuredly avoidable.


So dear reader, how do I get through to the masses that they can take control of their lives and find improved health and increased wellbeing? How do we empower the various generations to pay closer attention to their health and keep chronic disease at bay? How we help others lead lives of satisfaction instead of desperation? What messaging, medium, or context must be deployed for the message to resonate that good things can emerge from purposeful action?


I await your suggestions. Please write me at steven.charlap.md@mdprevent.net.

Look In The Mirror. Part 2. Better To Buy A Bike!

Yesterday, I wrote about the dangers of using the services of a mobile testing company. As fate would have it, after writing my piece, I received a solicitation from one such company.

The solicitation included a marketing flyer, which on one side was titled, "6 Reasons for Regular Screening." Let's analyze their reasoning.

1. Your health changes over time.

Based on this logic, we should be doing all sorts of testing all the time because we never know when our health changes.  Applying this principle, this should include blood tests, ekgs, x-rays, CT scans, MRIs, PET scans, ultrasounds, cardiac-stress tests, spinal-taps, endoscopies, etc. If you agree with their thought process, why exclude more elaborate tests that are better detectors of problems. The answer is because most of the tests they do are unnecessary, because the tests are not free, because you can't obsess about your health by constant testing (a little neuroticsm is ok), and most importantly, because you are likely to get many false positives that will lead to further stress and unnecessary testing.

2. Your physician usually cannot order these screenings unless symptoms are present.

That's an easy one. Good physicians don't go on wild goose chases looking for problems. When they hear hoof-beats, they think of horses, not zebras, and they use the proper tools to diagnose the problem(s) the patient shares with them.

That said, certain medical tests are covered and recommended in the absence of symptoms because the evidence for thier prospective use has been carefully evaluated by the United States Preventive Sevices Task Force (USPSTF) and determined to be of good use. However, these tests are generally covered by insurance and can be ordered by your doctor.

3. Your previous results may have revealed important risk factors.

This is a doozey. It reminds me of my experience with the pre-diabetes. Do they think (or hope) you ignored the previous abnormal results, did not bother to consult a medical professional, and should now return for another test only to keep repeating the process of excluding a medical consultation?  Apparently so. Testing in the absence of follow-up is dangerous. Do not be a doctient, a person who thinks he is both a patient and a doctor and can self diagnose and treat.

4. Screenings can help prevent stroke.

Screenings do not help prevent stroke. They may detect your increased risk for stroke after which you can consult a doctor for preventive measures. The issue here is that in the absence of sign and symptoms of stroke related disease, such as heart disease, diabetes, obesity, high blood pressure, high cholesterol, atrial fibrillation, etc., the probability of having a stroke is extremely low. If you have these medical issues, you are at higher risk for a stroke and you don't need a test to confirm the risk. You should take action immediately to decrease your risk by changing your lifestyle and seeing your physician for medical intervention.

5. Screenings can detect serious risk factors in just minutes.

If you have nothing better to do with your life, then by all means go for these unnecessary tests in the absence of sign and symptoms because maybe, just maybe they may find some abnormality that requires action you should have already taken anyway. But don't worry, they will confuse you fast.

6. You may suffer from Peripheral Arterial Disease (PAD).

That's a true statement. You may suffer from hardening of the arteries and about a thousand other diseases. Again, PAD itself is associated with heart disease, diabetes, obesity, high blood pressure, and high cholesterol. If you eat what you want and barely exercise, there is a high probability you will develop PAD at some point in life. You don't need this test, and in the absence of signs and symptoms, that is why it is not covered by insurance.

Many insurances today, including Medicare, offer a full range of preventive benefits, including screening tests, that have, based on the scientific evidence, been to be found worthwhile. Don't succumb to fancy marketing and be sucked into getting unnecessary testing.

If you have any concerns about your health, speak to your medical provider as soon as possible.

One final note, a study just published in the American Journal of Cardiology, focused on men who had at least one parent who'd had a heart attack before the age of 55. The study found that despite this apparent gentic predisposition to heart disease, those men with a healthier lifestyle were less likely to develop heart failure over two decades.

"Healthy habits included not smoking, exercising regularly, keeping a normal weight and drinking alcohol in moderation."

Many screening companies use your family history to scare you into unnecessary testing. The bottom-line remains that testing doesn't prevent disease--you do by the lifestyle you live. Save your money on testing and buy a bicycle or some other piece of exercise equipment. It will do you more good.

Just Look In the Mirror

I read an interesting article yesterday on the Fox Business website titled DIY health care: The trouble with direct-to-consumer health screenings. DIY stands for Do It Yourself.

The gist of the article describes the dangers associated with participating in unsolicited screening tests offered by commercial, usually mobile, companies. The article states that if "you get a letter in the mail inviting you to participate in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other scary stuff, you should probably toss it out with the rest of the junk mail."

The article gives several reasons. One reason is the perils of self-diagnosis. (See my blog from March 14 titled, Are You A Doctient?) The article states, "People might buy direct-to-consumer health screenings for their own self-diagnosis and self-treatment for symptoms of disease. "It's difficult for the lay public to really appreciate the nuances and wholly understand the difference between screening and diagnostic testing. Many patients seek screening tests for symptom diagnosis. These patients can be dangerously falsely reassured by normal results if they have chosen the wrong test, or even led in the wrong direction with abnormal results."

The article adds, "Additionally, many of the medical screening tests are not supported by evidence-based guidelines and therefore expose patients to tremendous and unnecessary harm. "The data has shown that many of these tests [when used for disease screening] will produce far more harm than benefit for most patients." (See my blog on April 5 about unnecessary tests).  

One more consideration. According to Linda Sherry, director of national priorities for Consumer Action, agrees. "These tests have limited or no diagnostic value and may trigger stress [and] fear, and encourage further, more expensive testing to rule out false positives. Insurance won't pay for them unless they are ordered by a doctor for diagnostic reasons, not preventive reasons."

If you're looking to save money, "you can take your own blood pressure at most pharmacy chains and many communities have health screening days designed to educate people about symptoms that might require follow-up," says Sherry.

Read more: http://www.foxbusiness.com/personal-finance/2012/05/02/diy-health-care-trouble-with-direct-to-consumer-health-screenings/#ixzz1toa6ivop

On a personal note, I participated in such a screening program about a year ago offered by Lifeline Screening. I went for the whole megilla. I did so as part research and part curiosity. A routine blood sugar measurement revealed that I had a 105 level. Such a level is construed as elevated. (by the way, I noticed the tech eating a fruit shortly before th test and contact witht eh fruit could have skewed my result.) 

When sharing the blood results with me, the concerned technician told me that I was pre-diabetic and I should "watch" my number. The absurdity of the statement struck me immediately. What did "watch" my number even mean? He didn't tell me to consult with a physician. He just told me to "watch." Did he mean for me to use his services again to see how the number changed? He didn't say, but I suspect as much. Being pre-diabetic is a warning sign that requires intervention before you progress to full blown diabetes. Telling me to "watch" my number was worthless.

So what's a person to do?  I say instead of relying on marketing solicitations for tests that you probably don't need and should generally only be ordered by a physician when you do need them, let me offer some practical alternatives.

First get on a scale. Then calculate your BMI. Here's a good site to calculate it:

http://www.nhlbisupport.com/bmi/  

If your BMI is over 25, you are in unhealthy territory. Over 30 you are in a real danger zone. Over 40, start saying your goodbyes if you don't do something immediately about it.

Next measure your waist circumference. If you have a bulge around your waste, that typically means you are accumulating the unhealthy type of fat cells called white fat cells. They predict problems and just like with an elevated BMI, you should initiate changes to your lifestyle to improve your health prospects.  I recommend starting with a physician consultation and then moving on to a nutritionist and fitness instructor. If stress and/or sleep are a problem, consult a psychologist as well.

Finally, take a long, hard look at your naked self in the mirror. Do you see a healthy, vibrant, relaxed, age appropriate person in the mirror or a tired, slumped, over- or under-weight, stressed-out individual? Be honest with yourself. If you look good, you probably feel good and you are probably doing well. But if you look worn-out, haggard, depressed, older than your age, I think it's time to get serious about your health and to develop a personal wellness plan.By the way, while you are looking, check for any abnormal growths on any aspect of your body front and back, top and bottom.

Try doing this once a month to take stock of your life and health. It's free, it's easy and it will provide much valuable information that will not lead to unnecessary and expensive testing. So the next time you get a solicitation from a testing company, try making an airplane out of it for fun. Nevertheless, listen to your body and if you have any concerns, consult a physician.

Longevity and Weight: What's the connection?

For the past year, I have been meeting with, treating, and lecturing to over a thousand seniors. Although this is not a scientific conclusion, I notice that people in their late 80s and above are never markedly overweight and those who are markedly overweight often look older than they are. This is consistent with a study of Jews of Eastern European descent that are believed to have a longevity gene that confers the potential to live into their 90s and above. The study showed that despite sometimes living unhealthy lifestyles, none of those living into their 90s were overweight.

A study reported today further supports this conclusion.

First, let's review what is the Body Mass Index (BMI).  BMI is a measurement of weight classification calculated by factoring in your weight and height. It is an imperfect measurement because it doesn't differentiate between high body fat and muscle content. BMI has been used by the World Health Organization as the standard for recording obesity statistics since the early 1980s. (The formula is pasted at the end of the blog.) Here in the U.S., it is also the most commonly used measurement to determine underweight, normal weight, overweight, and obesity.

Generally a BMI below 18.5 is considered underweight, 18.5-25 is considered normal, above 25 to 30 is overweight, 30 to 35 moderately obese, 35 to 40 severely obese, and above 40 very severely or morbidly obese.  (It is used differently for children but I won't discuss that here. Write me for more information.)

In a new study,  Nicholas J. Timpson, PhD, of the University of Bristol, in England, and colleagues found that for every .8 (point eight)  increase in BMI, ischemic heart disease risk rose 52%.

 "These data add evidence to support a causal link between increased BMI and ischemic heart disease risk, though the mechanism may ultimately be through intermediate factors like hypertension, dyslipidemia, and type 2 diabetes," the group wrote in the May issue of PLoS Medicine."

Furthermore, they explained that "Observational studies, both prospective and retrospective, consistently link higher BMI to heart risks across different populations, but haven't convincingly demonstrated causality because of the possibility of confounding, reverse causation, and bias."


Everyone knows that being overweight is often associated with developing chronic diseases like heart disease, diabetes, stroke, cancer and dementia. However, this study is a big deal because it shows a direct correlation between weight and heart disease risks.

So it turns out that what I have been noting empirically, is in fact, scientifically grounded. The heavier you are over a BMI of 25 the more likely you are to die prematurely from ischemic heart disease, and I suspect, from other diseases as well.

At a health fair on Monday, I greeted passersbys with "How would you like to add more healthy years to your life?"  I thought this question will receive a resounding yes every time asked and it would allow me to engage the person in a meaningful conversation regarding the benefits of taking advantage of Medicare's smorgasbord of wellness and preventive services. I was wrong.

At least a quarter of the people said they were not interested. Perhaps it was my delivery or they were wary of what I was offering as too good to be true.  I really don't know the reason, but it amazed me anyway that anyone could answer that question negatively. I shouldn't be surprised.  Since the introduction of new wellness and preventive benefits in January 2011, less than 94% of eligible seniors nationwide have taken advantage of over $1,000 worth of these life-enhancing benefits. These services were implemented by Medicare to help seniors avoid chronic disease, prevent heart attacks, lose weight, and allow for early disease detection. Yet, few doctors are providing the service and few seniors are receiving them. What gives? Do they not know of the benefits or are they simply not interested?

I can't profess to know exactly what goes through seniors minds (even though in my past work experience I led an organization that cared for 5 million seniors), as I am a generation younger, but it still breaks my heart that they are not all willing to do whatever they can to live longer, healthier lives.

I can only imagine the fears they have of doing so-fears of developing dementia, fears of running out of money, fears of being institutionalized, or being left alone with the passage of friends and family. These can be legitimate fears as they can and do happen, but early planning can make a difference and I know plenty of seniors who continue to enjoy life into their 90s and beyond. I recently presented to three centenarians, the oldest 103. They all peppered me with questions.

Many seniors don't realize that the longer they live, the more good years they have enjoyed. A researcher at Albert Einstein College of Medicine also concluded that the longer you live, the less you spend on medical care. That may not make sense at first pass, but when you think about it, it begins to resonate. Living longer typically means you have less sick days and that means less visits to doctors, etc. Medical costs are a huge drain as we age and avoiding such expenses preserves our capital.

The bottom line is whether you do it for yourself, for some member of your family, or for any reason that motivates you, take care of your health (and weight) so that you can enjoy a long, healthy life.

BMI formula:

Facts versus. Fiction: Which are which?

This morning I received the letter below from a reader of my newsletter. It is presented in its entirety.

"Dear Dr. Charlap:

Thanks for E-mailing me your newsletters as I enjoy keeping up with different points of view regarding health care.  However, as you probably know, I disagree with you on the subject of vitamin supplements and natural remedies.  The following is an article I came across that is only one example of how vitamin supplementation is helpful to health.  I take supplements to help with several health problems of my own.  I'd much rather do this than be dependent on drugs when that can be avoided.  As far as I can see, it is drugs in many instances that are harmful to health, not vitamin supplements.  So, maybe we can agree to disagree.  There are many good things offered by MDPrevent, and perhaps in the future I may look into some of them. 

XXXX

Dr. Blaylock

Daily Supplements Save Lives Thursday, April 19, 2012 8:14 AM One never knows when tragedy will strike, but those who are well-prepared are more likely to survive and have a good recovery. Since many patients with life-threatening conditions receive substandard treatment in hospitals — mainly critical care units — you should supplement with essential vitamins, minerals, and other nutrients long before such an event occurs. This will give your body time to maximize its antioxidant system, boost immunity, and reduce inflammation. It also strengthens your tissues, cells, and organs so they can better withstand disease or injury. Daily supplementation with highly absorbable, buffered or lipsomal vitamin C (1,000 mg three times a day, between meals) can protect against death following a flu infection, no matter how severe it is. We know this from studies of poor populations in Africa and Australia — mortality is directly proportional to one’s nutritional status. Adding vitamin E offers even more protection. (Read my special report "Key Vitamins that Save Your Heart, Prevent Cancer and Keep You Living Long") for more details. Antioxidants such as vitamin C and vitamin E work as a system — that is, they need to all be present in sufficient amounts. The risk of death from infections, especially the flu, is directly proportional to a person’s vitamin D3 levels. This vitamin stimulates the body to produce special, very powerful antibacterial and antiviral proteins (antimicrobial peptides). A physician in my area recently measured the vitamin D3 levels in his patients and found that virtually all were deficient, and many were extremely deficient. Combine this with a low vitamin C level and you have a prescription for a severe reaction to infections. To learn more about vitamin D3, read my special report "Vitamin D's Hidden Role in Your Health." There is no question that vitamin C plays a major role in protecting the brain from free radicals and lipid peroxidation products, and helps the body fight infections. In fact, in high doses it can perform miracles. © 2012 Newsmax. All rights reserved. Here was my response:   "Dear XXXX, Instead of simply agreeing to disagree, let's take a moment to review the article you sent. First, let's focus on Dr. Russell Blaylock. Here are some excerpts I quickly gleaned from the internet. Do you take the flu vaccination? He is against it. According to these websites he sells supplements. Here's the link. http://www.newportnutritionals.com/  Yet, on the site linked to the article, it states he makes no money from supplements. I maintain that you cannot take supplement advice from someone who sells them because of the inherent conflict of interest. That is why MDPrevent got rid of every last supplement in our offices. Here are some additional articles about him. Although I cannot verify everything being written about him, it gives me pause for thought and I trust it will do the same for you. http://www.skepdic.com/blaylock.html http://en.wikipedia.org/wiki/Russell_Blaylock http://scienceblogs.com/whitecoatunderground/2009/11/what_do_we_need_most_during_a.php http://lowellhubbs.blogspot.com/2011/06/quack-of-day-dr-russell-blaylock.html http://rationalwiki.org/wiki/Russell_Blaylock Here's a question and answer from a blog on the web about him. Again, I did not verify the veracity of the statements. "Can anyone tell me about Dr. Russell Blaylock? I've googled him and have a general idea of his credentials, but outside of a lot of articles and books he has written, I can't get a feel for if he is credible or wacky. My mother has been getting his Blaylock Wellness Report and while a lot of what he writes makes sense and is relatively mainstream, some of what he writes seems a little wacky. I've never heard of him before, so I took a look at his website. I'm extremely unimpressed. When you have to pump up your background by spinning being chief resident in his final year of residency into "I ran the neurology unit for a year", something's wrong. And when he boasts of publishing a variety of papers in peer-reviewed journals--and it turns out, after I typed his name into PubMed that he hasn't published a blessed thing since 1981, so ALL of the peer-reviewed stuff was during medical school and residency.... And then after holding up his "peer-review journals" publishing history, in the material pumping up his newsletter he has the nerve to claim that he won't have anything to do with the major journals because they're shills of big pharma! He says he had a private practice in nutrition, but doesn't say a thing about what got him interested in that, how he educated himself, etc. And he doesn't write that newsletter, he merely edits it for the company that puts it out." Second, he makes a claim about high dose Vitamin C protecting against after-flu death.  I will wager that there is no such scientifically valid study published in a peer reviewed journal in existence. Such as study, at best, cannot be a double-blind randomized controlled study, which is the gold standard of studies. There is no way researchers gave 1,000 mg of Vitamin C to study participants, then exposed them or wiated to see who got exposed to the flu, and then watched to see how many stayed alive and how many died.  At best, such a study could have been an observational study which is highly unreliable. As you know, I am not a fan of artificial sweeteners. However, Blaylock makes multiple adverse health claims about such products that have simply not panned out in numerous reliable studies. If you want to see such studies, I will get them for you. Finally, in the article you sent me, Blaylock masterfully blends facts and fiction. Vitamins, by their definition, are essential to our health. There is no disagreement on that point. Also, you need all of them and so, yes, your body works better when they are all present together. Also, many people do have Vitamin D deficiencies because they have little sun exposure which is required for the body to naturally produce Vitamin D.  However, a recent study was halted because of high doasgeVitamin E increasing cancer rates and in a Sloan Kettering Cancer Center Study, Vitamin C pills were found to protect cancer cells as well as normal cells. Most importantly, while Vitamins are very important, how you get them is more important. When sold in pill form, what you get is the vitamin in isolation. Chemically, it is identical to the same vitamin as it exists in its natural state in a fruit or vegetable. However, in a fruit and vegetable, the vitamin is surrounded by enzymes, co-enzymes, activators, precursors, antioxidants, and other synergistic nutrients.  Our gut bacterial determine how we process the foods we eat and for hundreds of thousands if not millions of years, man and his predecessors have been consuming and processing natural foods. Only since the 1934, when Carl Rehnborg sold the first vitamin (and he sold ground up vegetables, not isolated vitamins), have these ageless bacteria even been exposed to vitamins in isolation. So in conclusion, if you feel strongly about supplements, which apparently you do, I think it would be prudent to make sure that you are relying on accurate and reliable information. My major opposition to supplements is that they are generally a poor substitute for real food. I continue to caution you against making the mistake of choosing them over more valuable alternatives. I welcome your feedback. To your health, Steve" Addendum: "By the way, for reliable people who are not fans of supplements, here are two names.  They are the professors that head up the prevention departments at Harvard (Brigham's and Women's Hospital),  Dr. Joann Manson and at Yale, Dr. David Katz.  Both decry the use of most supplements and multi-vitamins except in specific circumstances like Folate for pregnant women." In conclusion, when comparing facts versus fiction, it is good to know which is which. ·               ·