• May5

    This week I have been teaching the first week of the first clinical elective in culinary medicine in a U.S. Medical School (in Santa Barbara: I love it when students create special circumstances outside of their curriculum). Michael Roizen and I taught the first clinical cooking and nutrition 2 week course onsite at SUNY-Upstate, in winter, and we might have called it culinary medicine, but didn’t. What a blast!

    Other than Des Moines University School of Osteopathic Medicine, I think only Tulane offers an elective in culinary medicine (to first and second year students: they have a super well-endowed teaching kitchen and a supportive dean…so glad they’re doing it.) My alma mater Baylor ColleDay 1 culinary medicine curriculumge of Medicine offers a CHEF elective (a series of cooking classes) to basic science students, as has the University of Maryland, the University of Massachusetts and Vanderbilt. There’s even been a culinary competition at Stanford among med students.

    Culinary medicine means blending the art of cooking and the culinary arts with the science and practice of medicine, and aims to offer delicious menus, recipes, habits and research findings which prevent and treat disease.

    So we’ve spent this week reviewing its basic culinary applications (cooking, shopping, eating, menu design, recipe planning, gardening and eating) with basic medical science (nutrition, physiology, chemistry…and plant and animal nutrition, physiology and chemistry, and their interactions).

    We also looked at the impact of hunger in the community, and efforts to combat hunger, obesity, and their derivative illnesses, especially in underpriviliged and medically indigent populations. We’re using my ChefMD’s Big Book of Culinary Medicine as a primary text, and supplementing with many peer-reviewed articles, websites and recommended apps. I’d like to offer the latter on prescription slips for clinicians, if there is interest.

    Here for example is Day 1: it started with Alice Waters giving a talk on the importance of integration of culinary skill at all levels (I moderated the dialogue afterwards, at UCSB’s Campbell Hall: also a blast); and then, as you can see from my day 1 handwritten curriculum, we moved to scientific paper and book analyses, seeing patients, and visiting the hospital gift shop, where we found food for sale.

    Hospital Gift Shop Food for Sale, Cash Regiester

    We then met up with the hospital’s culinary director (with whom I arranged a rotation, to see what really goes on in a conscious hospital’s kitchen), and mentioned the treats, left: rice krispies, brownies, more.

    They’re working on getting healthier food all around, he said, but people like them…he only had so much say-so.  (Really?  I thought)(The hospital has come a long way in a short time)(It used to offer cheeseburgers after coronary bypass)(Next month, maybe).

    We then cooked for a full day, working on knife skills, the relationship between the garden, orchard, apiary and the kitchen, and creating an entire menu of beverage, appetizer and entree, largely from onsite organic produce.  Below is the Rincon Hass Guacamole with Pink Lemonade Zest and Wild Radish Flowers (below, right).

    Culinary Medicine Guacamole: Senior Elective

    There were no lacerations, I’m happy to report, and we’re entering week 2: stay tuned!

    Balancing flavor in a dish; roasting, steaming and grilling; appropriate communication techniques with patients aiming to solve common problems such as obesity and hypertension; and  an extensive farmer’s market tour with teaching about nutritional content are upcoming.

    Now it’s off to speak to the Next Generation Summit on “The Biology of Weight and Why Women are the Key”: looking forward to these bright entrepreneurs and their ideas.

    This short talk is a tad longer than my The Biology of Weight: What Men Need to Lose the Gut at SXSW which I gave in March.

    I focus both of these talks down into a simple get strong and healthy plan for men in “Refuel”, coming at the end of the year: sneak peek: http://RefuelMen.com

     

     

     

     

     

     

     

     

     

     

     
  • Jan21

    Osteoporosis is thought of as a women’s disease, but osteoporosis in men can be even more dangerous.

    Men are at greater risk of complication and death when they fracture their hip than are women: men are twice as likely to die as women after a fracture.

    Up to 25% of men over the age of 50 will break a bone due to osteoporosis or because of low bone mass, and about 80,000 men break their hips each year. Bone is constantly changing and old bone is replaced by new bone.  But that’s not the way you want to remodel your bones.

    Osteoporosis, courtesy of Health News Updates

    As we age though, the rate of change of bone remodeling declines.

    Men in their 50s experience less bone loss than women of the same age. Somewhere between the ages of 65 and 70, the playing field is leveled and men lose just as much of their bone density as women, which makes them more prone to debilitating fractures.

    This is where healthy weight loss and muscle gain come into play.

    Being obese or overweight will put extra stress on your bones, but losing weight rapidly puts you in a position of greater risk for osteoporosis.

    When you drop weight rapidly, you lose important minerals and hormones such as testosterone.  A low testosterone level is one culprit behind osteoporosis in men. Too much alcohol, long term steroid use, smoking, and a low vitamin D level are four others.

    One way men can increase testosterone levels is by working out. Lifting weights twice a week will help your upper body, and a brisk walk for 30 minutes daily will begin to fortify your hip bones. Not only will exercising build your muscle mass and strength, but it will also help to increase your bone density, which will put you one step closer to preventing osteoporosis.

    Changing your diet will also help you lose weight and prevent osteoporosis. I suggest at least 600 IU of Vitamin D3, and up to 1000 (measure your level!)  and no supplement of calcium: you don’t need it if you get enough greens and dairy.

    Start with a gradual change in exercise and diet to give you a head start on preventing osteoporosis. See your doctor if you have any questions or want a bone density evaluation: if you have osteoporosis, and you’re over 40 and you’re a man, you need a testosterone level check.

     
  • Jan14

    Problems with weight control can be an issue for your health, but did you know overweight could also be causing depression?

    When a man gains those extra pounds around his waist, which is where men do, his testosterone levels may be reduced.

    DepressionTestosterone affects a man’s mood and outlook on life. It also helps build stamina, and increases sex drive, energy, and motivation. Testosterone levels in men commonly fall naturally over time through aging, though they don’t have to: testosterone decline is not necesarily part of normal aging.  Being overweight in the middle, with visceral fat, can also significantly decrease those levels. That can lead to depressed mood, irritability, a loss of vitality, and poor sex drive. And performance, not just in bed, but at work.

    A man as little as 30 pounds overweight can be affected. Studies have shown that if a man who is 6’1” gains 30 pounds he will suffer a drop in testosterone equivalent to adding 10 years to his current age.

    A male who displays any of the following behavior may be showing symptoms of undiagnosed depression.

    • Anger issues
    • Regular substance abuse
    • Constant controlling or violent behavior
    • Being overly involved in work or sports
    • Infidelity
    • Hazardous behavior or unnecessary risks

     
    I’d like to use this space on my Paging Dr. La Puma blog to let you know that depression can be treated. Drugs do help some people who are seriously ill, but for most people, there are reasons to consider food, fitness, sleep and mindset measures first.

    Try adding these foods to your diet to help give your mood a boost; walnuts, fish, dark chocolate, saffron, lentils, and chilies. An easy meal to help combat depression and is also easy on the waistline would be my Saffron Scallop, Shrimp, and Chickpea Paella recipe.

    Depression in males often goes undiagnosed. Anyone with symptoms is urged to seek out help, especially if you’re considering hurting yourself. If you’re depressed, need help and your doctor is unavailable, call the USA Depression Hotline- 630-482-9696

     

    Araujo, A. B., Travison, T. G., Bhasin, S., Esche, G., Williams, R., Clark, R., &     McKinlay, J., (2008, November). Association of Testosterone and Estradiol with Age-Related Declines in Physical Function in a Diverse Sample of Men. J Am Geriatr Soc.56(11), 2000-2008.

     
  • Oct17

    I believe there is a national movement to help you get stronger, leaner and healthier with what you eat.  Knowing what’s in your food, and how it can help you get well or make you sick are the most important steps you can take to transform your life.

    So it was my recent experience in New York City, with Dr. Oz: there, in 3 TV segments over 25 minutes (it airs 10.18.12) and is online. I demonstrated and described the medical magic of

    a. chicken, antibiotic free
    b. oyster sauce
    c. arugula
    d. lime
    e. pumpkin, both fresh and canned
    f.  bulgur
    g. black pepper and oregano
    h. concord grapes
    i. red wine

    I also described how and why hospital food has to change to prevent disease instead of cause it, and medical education as well, and gave my simple acronym of BITES™ of foods you should eat every week. The Little Bites part of my ChefMD book is everyone’s favorite part.

    Boosting immunity and reducing risk for cancer with what you eat is powerful. Obesity is probably the most important cause of cancer, equivalent now with smoking.

    So is the idea that you can do this by choosing the right foods for you that work for you, because of how they work and how they make you feel. I’ll do two up-to-30-minute public tweet-ups about this and the show, 10.18.12 at 4pm EST and 4pm PST with the hashtag #DrJLPapproved: I’m at http://twitter.com/johnlapuma. Please join!

    We used culinary medical tools on the Show: a blender (VitaMix!), a microplane zester (essential creating zest and capturing the phytonutrients in the skin) and a wine aerator (to bring up flavor and aroma in red wines, regardless of price point).  Plus my great Santoku knife for opening and roasting that pumpkin.

    Finally, we made a simple, marinated-for-a-moment (Chris Kimball is right: short marinades of very lean meats especially are as effective as long ones) anxiety-reducing, easy recipe: Honeyed Chinese Chicken.

    You can get the recipe, free, when you sign up for my still-free newsletter, sent once or twice a month, full of information, recommended products and tips, exclusive subscriber benefits, plus more on BITES™.

    Lab and human studies show reduction in cortisol levels (the stress hormone) with chicken essence and bonito broth consumption, and this anxiety-reducing recipe has both.

    But it might actually reduce anxiety because it is so easy and quick, tastes even better the next day and because you can make it in quantity and save it.

    This week and next I teach two nutrition and cooking classes at the Santa Barbara Healing Sanctuary–a beautiful residential wellness retreat for those trying to make sense of how their bodies work and can work better–even heal.

    Yesterday I taught knife skills: I love doing this, and everyone practiced well. (Btw, the best chef’s knife for most people is a smaller, well-made, easy to use and a Santoku, and a paired, greater hardness steel: my favorite Victorinox here, on Amazon).

    I lead a tour of sustainably grown citrus trees: mandarins, lemons and navel oranges, and looked at leaves, trunk and fruit; the processes of growth in these trees all parallel the human body. How they ripen and protect fruit, fight off invaders, and sustain growth. I love doing this too.

    We tasted a tangerine and a lemon, and interestingly, the people with GERD felt better (interesting, as acidic foods have been shown to be alkalinizing in the body).

    We discussed each person’s experience with food and their health conditions, and they varied widely, from thinking it was everything, to loving to cook, to hating it, to not thinking much about it or its relevance.

    We touched on supplements, as multivitamins reduce total cancer in men, especially those with a parental history of cancer, and magnesium is a mineral most people are deficient in, is critical to normal muscle, nerve and cardiac function and regulates normal blood sugar, blood pressure and immune function.

    Everyone had questions, including a recommended multivitamin.

    Cooking and choosing well are fun, but they are also work–fabulous, life-filling work that is rewarded not only by dinner, but by the feeling that you can be in control of your life and health.

    And in an era in which the wrong food or medicine can make you sick in hidden ways, that’s life-changing.

     
  • Sep20

    JAMA’s new theme issue on obesity (linked table of contents below) has a point counter point in a network TV new report on the male boomer interest in testosterone.

    Visceral fat in men converts testosterone into estrogen. That causes or exacerbates dulled sex drive, poor energy, irritability, insomnia, erectile dysfunction, loss of muscle mass and more.  All from belly fat.

    In this new ABC clip, a 57 year old uses T for an edge in work, and proudly shows off his biceps.  He’s lost 30# and feels great (stopping the estrogen conversion helps).

    But could have he done this without the injections? It doesn’t appear that his level was clinically low.

    Unacknowledged: manly eating.  There are natural ways to boost testosterone, lose the gut, improve sex drive and build muscle. Diane Sawyer looks concerned.  Are you?

    Read the JAMA pieces below for current mainstream medical thought on the epidemic…minus testosterone.

    Viewpoint

    The Role of Government in Preventing Excess Calorie Consumption:  The Example of New York City
    Thomas A. Farley, MD, MPH
    JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623

    The Next Generation of Obesity Research:  No Time to Waste
    Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
    JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853

    FDA Approval of Obesity Drugs:  A Difference in Risk-Benefit Perceptions
    Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
    JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007

    Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
    William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
    JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931

    Original Contribution

    Exercise Dose and Diabetes Risk in Overweight and Obese Children:  A Randomized Controlled Trial
    Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
    JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762

    Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
    Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
    JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461

    Health Benefits of Gastric Bypass Surgery After 6 Years
    Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
    JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164

    Health Care Use During 20 Years Following Bariatric Surgery
    Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
    JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792

    Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea:  A Randomized Controlled Trial
    John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
    JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580

    Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
    Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
    JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132

    Editorial

    Progress in Filling the Gaps in Bariatric Surgery
    Anita P. Courcoulas, MD, MPH
    JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337

    Progress in Obesity Research:  Reasons for Optimism
    Edward H. Livingston, MD; Jody W. Zylke, MD
    JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203