If It Doesn't Make Sense...

I often like to say that "If it doesn't make sense, it doesn't make sense." Now this may not strike you as the most pithy of sayings, but I find it to be astoundingly profound for its accuracy.  Basically, it means that if you hear something that doesn't make sense, then it usually means you didn't hear it right or it isn't true. This has been a long-standing belief of mine since high school. A few anecdotes may explain why.

When I was in high school, Jeff, a close friend of mine often did well on tests.  I thought like me that he didn't really study so he did well because he was simply smarter than me and absorbed the material in class better than I did.  I was convinced of this until one day when I was at his home the night before a history examination.  While I watched the Yankees play ball, he repeatedly snuck away for some reason. Finally, I followed him only to discover that he was studying the history book for the upcoming test. I realized then that in general, one can't do well for a test unless one prepares. This may have been obvious to others, but it took this incident for this reality to resonate with me. (What can I tell you, I was a slow starter.)

When my children would tell me that their friends were doing well on tests without studying, I would often respond that I was sure this was not true. Inevitably they would discover the truth. When I built my national health care practice, my fervent belief in things needing to make sense saved me from making many mistakes.  Whenever I heard something that didn't make sense, rather than reacting to the information, I would first search out the facts. Inevitably, they either told a different story or there was more information that offered clarity to the situation.

In my current medical practice, the constant search for things to make sense continues to serve me well. Two recent incidents are excellent cases in point. The first involves a patient who said he lost 35 pounds by limiting his salt intake and consuming a lower fat diet.  While there are mechanisms to explain how both of these may contribute to some weight loss, in and of themselves, they are not sufficient enough factors to result in major weight loss.  Why? Low fat diets often result in greater consumption of high carbohydrate foods that are major weight gain culprits.  Although the patient insisted that switching from dark chicken to white chicken were among the major changes he made to lose weight, I knew that it didn't make sense, and upon further questioning, it became readily apparent that simultaneously with decreasing the fat and salt content of his food, he had likewise decreased his carbohydrate intake. Now it made sense.

Another recent situation involves a patient who admits to being an alcoholic. She asked me innocently enough why she was suffering from the ravages of alcoholism (multiple abnormal blood results) while those around her that drank with equal aplomb seemed to be spared from such consequences.  I assured her that this was simply not the case. Looking at her, you would not expect her to have anemia, blood in the urine, abnormal liver function tests, very high cholesterol, inflammation of the esophagus, etc. It is only because she admits her problem and sought the care of a doctor that her issues were identified. My rule that things make sense guides me in telling her that her friends will also suffer, if they aren't already, the consequences of alcoholism sooner or later.

I have numerous other examples that I won't bore you with the details. The bottom line is we live in a world where most things make sense (except maybe liposuction) even if we don't agree with them. One of the most sensible things is that taking care of your health yields great benefits under almost any circumstances. Yet, book after book gets published and people pay good money to hear the same advice over and over again. On the surface, this would seem nonsensical. Why don't people get it?  It seems to be simple enough. Avoid processed foods and eat mostly unprocessed foods. Yet, so many people are overweight and suffer from poor food choices. It's a huge problem and may seem like it doesn't make sense.

The problem is it actually makes sense. We know sugar and trans-fats are bad for us, sometimes even vowing to avoid them, yet the moment someone puts a piece of creamy 'Midnight Dark Chocolate Belgium Chocolate Cake' in front of us we throw caution to the wind and disavow any previous resolutions.

It actually makes sense because the lure of such a treat overpowers even the best of us. For some, it's not chocolate cake but ice cream, hot dogs, french fries, movie theater popcorn, pizza, pasta, etc. The list is endless and each of us knows our poison -- the devilish food we can't resist. So what's a reasonable person to do in a world that forever tempts us to corrupt healthy eating?

The answer is planning. If you have unhealthy food at home, expect that you will eat it. If you go hungry to a restaurant and do not know what's on the menu in advance, expect to choose poorly. If you go to a friend's house and haven't explained to your friend what you are trying to accomplish with your eating, expect things to go awry.

BUT...

If you plan out as many meals as possible in advance, then you are more likely to eat the right foods. If you eat some nuts before going out to a restaurant for dinner and check the menu on-line before the meal so you can pre-select your choice, you will be less likely to eat the bread and butter and choose the unhealthier fare off the menu. If you go grocery shopping when you are not starved and avoid impulse purchases along the aisles, you are more likely to choose wisely.

Willpower will fail you.  In an interesting study in which two groups were asked to eat foods at different rates, the group that ate slower were surveyed to be less hungry two hours later. However, when both groups were shown delicious deserts shortly thereafter, they ate the deserts in similar quantities. The researchers explained that our bodies' natural appetite stimulants allow us to eat favorite foods even when we are not hungry. 

Eating healthy takes effort and planning. It's not simple, but it's usually the only thing that works. It also makes sense. So the next time you hear something that doesn't make sense, remember that what you are hearing may be wrong or you may be hearing it wrong.

Super Immunity - Not!

When I hear the word "Super," my thoughts race back to my childhood and my dalliance with  Superman, the DC Comics superhero from the planet Krypton who gains super powers from exposure to our sun. We all know the old rephrase that he's "able to leap tall buildings in a single bound, faster than a speeding bullet, more powerful than a locomotive." We also all know that he's a fictional character and such powers simply do not exist. Yet, like my older brothers, I could not get enough of the comic books and TV shows featuring the super fellow and other super heroes.  Everyone loves the idea of something super.

During my residency, the word "super" took on new meaning. Whenever I needed a lab result right away, I would write that I needed it STAT. However, I found that since every resident would write STAT on every blood work request, the lab began to dismiss the qualification. It then became necessary to write "SUPER STAT" to try to differentiate my request from the others. Soon, all my fellow residents were equally connoting "SUPER STAT" on each request and that too lost significance. It then became a game of how many "SUPERs" you could add before STAT. It wasn't uncommon to see "SUPER SUPER SUPER SUPER SUPER SUPER STAT" on a lab slip. The lab techs, I am sure, got a good chuckle, from our efforts of one-upmanship.

Today, "super" seems to have a new affixation. People love to attach it to all sorts of concepts related to health and nutrition. Case in point is a new book just featured on The Dr. Oz Show (yes, he's back for a new season) titled Super Immunity by Dr. Joel Fuhrman. In general, I think Fuhrman is a highly reputable doctor who fully understands the value of healthy eating. Notwithstanding, I have to take exception to his, or anyone's, concept of super-immunity or super foods or super anything for that matter. The reason is that I can find no evidence whatsoever to support the concept of super immunity or super foods. From my perspective, a food is either health promoting or it is not. It either supports a healthy immune system or it does not. You get the drift.  I don't know about you, but I don't want my body to do anything but function properly and that includes my immune system. In fact, I love wild Salmon, but I would never call it a super food (because it's not--it's just a healthy source of protein, fatty acids, etc.).

You may think this is a question of semantics, but I think there is much more at stake here. Dr. Fuhrman would be the first to tell you that eating properly is not a question of adding healthy foods to your diet; rather, it is a matter of building a foundation of healthy foods. Yet, when you suggest to the public any suggestions of quick fixes, eg. super foods, you run the risk of people thinking that they can balance unhealthy foods with such super-foods. This is how people are confused into believing the popular adage that eating healthy means "eating in moderation." Bad foods will often neutralize the benefits of healthy foods, super or otherwise.  Moderation simply doesn't apply to certain foods like trans-fats, sucrose, high fructose corn syrup, etc.

A writer, speaker, or doctor must choose his or her words carefully as to not mislead the reader, listener, or patient. I know this from first-hand experience. Through my lecturing, I have learned the importance of choosing the right words so as to not lead listeners to wrong or invalid conclusions. For example, I can't make a general statement that medications are bad (although not a fan of many due to indiscriminate use, many medications serve useful purposes) for fear that someone may stop all their medications inappropriately. I know because this has happened. Nevertheless, I heard Dr. Fuhrman make such a statement on the Oz show. I also can't say that a little bit of neurosis about one's health can contribute to longevity because someone may take that as a reason to start obsessing about every facet of their health. I know that because unfortunately that also happened.

Some doctors may feel it is appropriate to take liberties with superlatives like "Super" to grab attention with the good intention to deliver important information. (Isn't the road to hell  paved with good intentions?) I feel it strains credibility and undermines the ultimate message.  Let's leave "Super" to Superheroes and let's stick to science instead of science-fiction when it comes to dispensing health advice. Otherwise, it won't be long before you see a book with the title SUPER SUPER SUPER SUPER SUPER IMMUNITY trying to grab your attention.

Want The Truth?

In a scene in the play and movie of the same title, A Few Good Men, written by Aaron Sorkin, there is the following scene involving the interrogation on the witness stand of a Colonel Jessep, played by Jack Nicholson in the movie, by a Lieutenant Kaffee, played by Tom Cruise in the same movie.

It goes like this:

Witness Jessep: You want answers?
Lawyer Kaffee: I think I'm entitled to them.
Witness Jessep: You want answers?
Lawyer Kaffee: I want the truth!
Witness Jessep: You can't handle the truth!

That line is considered one of the most notable movie lines of all times.  However, for me, it poses a much larger question. Do people always want the truth?

We know that in social situations, the truth may be best avoided. For example, if your friend just got a awful haircut or your spouse gained some weight, when asked, should you always be honest? Some may argue that one should always tell the truth, but I think we can mostly agree that a white lie such as expressing approval of someone's new clothing (that they are currently wearing and which you wouldn't be caught dead in) may be the right thing to do on the spot. Later on, may be a different story.

Nevertheless, when people come to a doctor they should always expect and always receive the most honest answer the doctor can provide. Quite frankly, it really doesn't matter if they can handle the truth, they are legally obligated to it and should expect no less. And by truth, I mean all the facts.

That's the way I feel about the preponderance of information disseminated by mass media to the unwary public. The media may believe that it is more important to create an emotional response than to give you the actual facts. A reporter who interviewed Dr. Oz conveyed to me that this was his belief. He thinks he should nudge people in the right direction rather than give them the facts. You may agree, but I am vehemently opposed.

Why? Since opening MDPrevent in 2010, I have encountered hundreds of patients who were not explained all of their previous blood results. Every time I see an old blood laboratory result, I query patients if the doctor who ordered the test ever discussed all the listed abnormalities. Unfortunately, most of the time the answer is no.

The most commonly ignored laboratory findings appear to be pre-diabetes and early signs of anemia.  The doctors are so busy turning off the red light (the reason the patient came to see them for in the first place) that they are essentially ignoring the yellow lights at risk of turning red.  When I ask other doctors why this is the case, I get the expected answer. There simply isn't enough time to address problems that haven't yet happened.

To that I say phooey!  Medicare and other insurances pays doctors more for the more time they spend with you. The doctor's first obligation is to the patient in front of him or her. If they need more time than scheduled, they should schedule another appointment. But there is no excuse not to review all your findings and discuss ways to avert greater problems.  An ounce of prevention may be worth a lot more than a pound of cure--it may be worth your overall health and life.

If you have had blood work in the past two years and there were any abnormalities (numbers out of range) noted on the results, I urge you to ask your doctor to explain what the results mean and if they indicate a potential longer-term problem. Such discussions are necessary. Trust a doctor when I tell you it is best to be aware of everything (not to obsess or get neurotic) even if action is unnecessary and imprudent.

From my perspective, an educated consumer is the best patient. You may sometimes have trouble handling the truth, but you are entitled to it, the truth and nothing but the whole truth, from your doctor.

Is Red Meat Intrinsically Bad?

One of the most common questions I am asked by my patients is if red meat is bad for them. The answer to this question could fill a book, but I will try to give a more concise and succinct answer here.

I will not address the moral issues associated with eating red meat; rather, I will only focus on the health consequences.

Here's what I have gleaned from my research.  From an evolutionary perspective, man's becoming a carnivore is what allowed the human brain to develop into its current form. Apparently, the addition of animal protein to early man's diet allowed the brain to further develop and evolve to its superiority in the animal kingdom.  At one point in evolution when meat became scarce, allegedly the human brain also degenerated. When the animal population regained its numbers and meat became more readily available, the brain regained its stature. Therefore, the immediate answer to the question above is that meat is not intrinsically unhealthy.

However, there is no question that the meat that was eaten by our ancestors is not the same meat we eat today and most likely not the same quantities. Today's meat is mass produced by feeding cows all sorts of additives such as hormones, antibiotics, corn feed, etc.  According to T. Colin Campbell, PhD, in his controversial book, The China Study, bovine (cow) meat and its byproducts such as milk and cheese are the root cause of most cancers and autoimmune diseases in the world.  (As an aside, every person I have met in my life who told me they had been diagnosed with Multiple Sclerosis (MS), a degenerative nerve disease, had a history of taking animal derived amino acid supplements and using protein powder products to build muscle. This is not a scientifically valid sample, but one hell of a coincidence. Of note, Campbell claims that MS is one of the consequences of using animal derived protein.)

The other problem with meat is the quantities we consume. Our forebearers had to hunt for their meat and so it was not as readily available as being on a supermarket shelf. It also had less saturated fat because the animals were leaner and more active than the pasture dwelling, sedentary, fattened cows from which we derive most of our meat today. 

The other problem with meat is how it is prepared. Processed meats like salami, bologna, pastrami, etc. have always been notoriously unhealthy because of added nitrites, a known carcinogen.

Furthermore, according to a new study involving more than 2,000 men performed by the University of Southern California and the Cancer Prevention Institute of California, pan-frying red meat may increase man's risk for prostate cancer by up to 40 percent.

"We found that men who ate more than 1.5 servings of pan-fried red meat per week increased their risk of advanced prostate cancer by 30 percent," study leader Mariana Stern, associate professor of preventive medicine at the Keck School of Medicine at USC, said in a university news release. "In addition, men who ate more than 2.5 servings of red meat cooked at high temperatures were 40 percent more likely to have advanced prostate cancer."

Hamburgers, an American favorite, in particular, were linked to an increased risk of prostate cancer, the study found. If people knew how most hamburger meat is prepared and processed here in the U.S., including the nature of fillers added, they would probably never eat a hamburger again. I know I've stopped eating hamburger's based on two videos I saw, one that dealt with the cardiovascular effects of the hamburger in regards to clotting arteries and another that demonstrated what is typically added to them such as other parts of the cow that should be discarded.

The reason for the increased rate of prostate cancer demonstrated by the USC study is not known and may have to do with the formation of DNA-damaging carcinogens -- known as heterocyclic amines -- during the cooking process.

So what's the bottom line?

In my study of longevity and the cultures that seem to enjoy the highest rates, one thing is certain. If they eat any meat at all, it is always as a side dish.

For the record, I am not a vegan and I have no plan anytime soon to become one. First, because as you know I am wild about wild salmon. Vegans don't eat any meat, fish, chicken or otherwise. Second, vegans need to supplement with Vitamin B12, which tells me that it's not natural for us to be vegans if we need a pill made in a plant to maintain our health. Third, because I'm not convinced that a bite here or there of some unprocessed red meat is the poison that some people would have you believe it is.  Fourth, most of the time I come across it when invited to a meal and I don't want to insult my hosts. Having a strong social network is more important to my overall good health and longevity that sticking to an uncompromising position on red meat.

For those looking for yet another reason to minimize red meat and/or have an ecological focus, scientists have calculated that reducing red meat consumption would decrease global warning. So if you've been keeping score, there are a lot more reasons to limit your red meat consumption than maintain it.

In conclusion, I don't think that the red meat we generally have available to us is too healthy from both a heart-wise and overall health perspective (and don't forget ecological). So if you insist on eating red meat, I suggest you think of it as a side dish.

Can You Trust Dr. David Williams?

My patients often share with me the myriad health newsletters to which they subscribe. Recently a patient gave me a newsletter written by Dr. David Williams. My first question before reading the newsletter was what kind of doctor is Dr. Williams? The patient responded I'm sure he's an MD. In fact, Dr. Williams is a chiropractor.  Now don't get me wrong. I have nothing against chiropractors as I've used them myself for strained backs and shoulders. Also, I have no problem with anyone writing about nutrition as long as they stick to scientifically validated facts.

However, I do have two major pet peeves. People who distort information, and people who try to confuse you with information so they can sell you something. The newsletter I was asked to read concerned the lost value of eating an entire chicken and all parts of animals (not at one sitting) because otherwise you don't get the gelatin contained in bone marrow, etc. The premise was, as is often the premise in such rubbish, is that the more recent trends not to eat the chitins (pig intestine), pancreas, etc. has led to diabetes, heart disease, obesity, etc. and if you eat them, all those problems may disappear.

The newsletter starts innocently enough like they all do with a pseudo-scientific explanation of the importance of gelatin to our health. But like most of these non-credible newsletters it veers off to the fantastic when it makes unsubstantiated health claims. Of course, the moment that starts I become suspicious if there's a sales pitch coming up. To Dr. William's credit, there was no pitch for selling his own gelatin, but there was reference to another commercial product, which I could not find for sale on his website. Nevertheless, Dr. Williams's website lists many products for sale of questionable value including the now highly disputed resveratrol (due to research improprieties).

The bottom line on Dr. Williams is that he has an actual degree and a license. He is more trustworthy than those PhDs from non-accredited schools that I've been writing about in previous blogs. Notwithstanding, when Dr. Williams makes preposterous claims about the all curative health benefits of a substance like gelatin, he throws his credibility into seriously questionable territory and by doing so undermines any good he may otherwise be capable of doing.

Facts and science matter and we have enough bad information already out there. We don't need more articles that tell us this may help us and this may hurt us.  It only adds to the confusion. I feel if you don't have something of value to say, stay quiet. As the old saying goes, "Better to keep your mouth closed and be thought a fool than open it and remove all doubt."

Ginkgo Biloba: Another Supplement Bites The Dust--Almost

One of the biggest fears among seniors is the development of dementia, particularly Alzheimer's, which comprises about 60% of dementia cases.  According to currently available statistics, about 1 out of 7 seniors over 65 develops dementia, as do about 3 out of 8 above 85.

Nevertheless, the moment many seniors experience any memory problems, the first thing they worry about is if they are developing dementia. On this point, I turn to my favorite quote source Mark Twain, who once wrote and I paraphrase, "I have spent most of my time worrying about things that never happened."  Clearly in most cases, dementia begins with memory problems, but not every memory problem is dementia, and forgetting something once in a while is not necessarily a sign of dementia. I write this not to discourage proper follow-up of increasing or sudden onset of significant memory problems, but to caution sanity when your mind doesn't seem to work as well as it once did and you forget a thing or two. There are many reasons one may forget something, the simplest being distraction and the most complicated being more than dementia.

Nevertheless, the business of helping people deal with memory issues is thriving.  There are books, games, programs, specialized exercise equipment, medical foods, and of course supplements that promise improvement in memory if you just use them. One of the foremost among them is Ginkgo Biloba. Skipping over the detailed specifics of its origins, it is best summarized as an extract of trees that typically grow in China. This extract has been purported to be used by the Chinese for centuries and studied extensively. Nevertheless, there is quite a bit of debate regarding its effectiveness in treating memory problems and preventing Alzheimer's.  European studies have shown more benefits than American studies for memory help.

One of the biggest problems with many medical studies is that they are paid for by the manufacturer of the product who controls what gets data released and this often creates a conflict of interest for the researcher. Therefore, one hardly ever sees a negative study paid for by the manufacturer.  Imagine my surprise and delight to learn about a new study about ginkgo biloba that was paid for by Ipsen, the producer of ginkgo biloba extract that had negative findings. And by negative, I mean the product did not do what the researchers had hoped it would do--stop the progression of Alzheimer's.

Here are the results of the study copied verbatim from the study itself:

Findings

Between March, 2002, and November, 2004, we enrolled and randomly allocated 2854 participants, of whom 1406 received at least one dose of ginkgo biloba extract and 1414 received at least one dose of placebo. By 5 years, 61 participants in the ginkgo group had been diagnosed with probable Alzheimer's disease (1·2 cases per 100 person-years) compared with 73 participants in the placebo group (1·4 cases per 100 person-years; hazard ratio [HR] 0·84, 95% CI 0·60—1·18; p=0·306), but the risk was not proportional over time. Incidence of adverse events was much the same between groups. 76 participants in the ginkgo group died compared with 82 participants in the placebo group (0·94, 0·69—1·28; p=0·68). 65 participants in the ginkgo group had a stroke compared with 60 participants in the placebo group (risk ratio 1·12, 95% CI 0·77—1·63; p=0·57). Incidence of other haemorrhagic or cardiovascular events also did not differ between groups.

Interpretation

Long-term use of standardized ginkgo biloba extract in this trial did not reduce the risk of progression to Alzheimer's disease compared with placebo.

This study performed by Bruno Vellas, MD, of Hopital Casselardit in Toulouse, France, and colleagues was reported in The Lancet Neurology.
According to the researchers, "Ginkgo has been used in some countries by patients with cognitive disorders, and its plausible mechanisms of action for brain benefits include antioxidant effects and potential inhibition of caspase-3 activation and amyloid-beta aggregation."

Quoting medscape.com, furthermore, the researchers noted, "Yet several studies -- including the Ginkgo Evaluation of Memory trial reported in 2008 -- haven't been able to demonstrate that the plant extract can prevent dementia. Indeed, the entire field of prevention of Alzheimer's disease is lacking, with little effects seen for various therapies including hormone replacement therapy, NSAIDs, vitamins, and cholinesterase inhibitors."


According to a Columbia University professor, this was a well constructed, if imperfect study. What makes it most noteworthy is that it was paid for by the manufacturer and did not get the desired results. That makes this study more reliable in my mind.

So there you have it. Another staple of the supplement industry bites the dust, at least as far as for Alzheimer's prevention value. It may still have some value in short term memory help, but that's a topic for another day.