• Apr17

    Two views of why heart disease prevention does not work well: one, personal responsibility is not given the attention it deserves.

    And two, physicians are not trained or incentivized to advise patients to stop smoking, improve their diet and become fit…maybe because people don’t think they can make a real difference in their own health. Which is wrong: it is *never* too late to start.

    Both of these commentaries are tragic.

    People need skills they don’t have, and don’t have easy access to: preparing, choosing and shopping for food well, improving mindset, productivity and sleep, and optimizing the home, work and mobile environments for the best lifestyle choices.

    Health care begins at home…not in the doctor’s office. Too often, it ends in the hospital, where we manage disease intensively. At which hospitals excel.

    What I want to do professionally over the next 5 years is help people like those in these videos—people at risk for or with chronic disease (heart, stroke, Alzheimer’s, diabetes, arthritis, hypertension, many cancers)–avoid the hospital. And avoid the Heart Attack Grill.

    The key is to make caring for yourself–and lifestyle–as fun as a vacation. My first step: helping men, and the women who love them Refuel.

     
  • Jun15

    If the US had the obesity rate it had in 2000 (not 2009), we might prevent 111,206 total knee replacements.

    If you have arthritis, you are twice as likely to be obese than if you don’t. About 50 million adults (22% of the US population) has arthritis—principally osteoarthritis, or wear and tear arthritis. Joint pain is the most common symptom.

    2000 median obesity among adults with arthritis: 33.2% (range 25.1% in Colorado to 40.1% in Ohio).
    2009 median obesity among adults with arthritis: 35.2% (range 26.9% in Colorado to 43.5% in Louisiana).

    Why do arthritic knees hurt? Is it because the knee bears 4# of stress for every pound of body weight? Is it inflammatory cytokines and adipokines that degrade cartilage? Is it something else?

    I’ve long been interested in improving quality of life in arthritis. A RC trial of omega-3s helped arthritic and neck pain; extra virgin olive oil has ibuprofen-like activity.

    Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year, but the real, human cost which cannot be quantified is much greater.

    A systematic, careful, personal approach which looks at drugs and side effects, as well as diet and lifestyle, is what I recommend for my own patients.

     
  • May7

    Last year, my Mom had her first operation: a total knee replacement.

    Active and curious, and having recently celebrated her 29th birthday again, her mother was turning 100 shortly and needed assistance.  Mom wasn’t able to get around well enough to help, with her osteoarthritis and pain.

    A month before the operation she asked me, “What can I eat to heal and recover from the surgery?”

    It turns out that there’s a good answer to this. It can be divided into wound healing, building bone, rebuilding muscle and guarding against weight gain.

    A blog is too short to cover each category in depth, but fortunately, there is a largely untapped literature about nutrition and post-operative care.

    The key: wounds heal from the inside out. Many patients need additional arginine and vitamin C, just to name two nutrients, pre-operatively and post operatively.  Lowering oxidative stress improves healing.  The peri-operative period is the most critical.

    Building bone is a function of vitamin D, calcium and magnesium, and the right hormones.  Smoking prevents bone from being built. And food can facilitate it.

    Rebuilding muscle is something that has nutrition, and dietary protein, at the center. I often encourage my patients to have a little protein-rich food at every meal, especially breakfast.  Omega-3 fatty acids, especially DHA (almost solely from fish and from algae, which is where fish get their DHA) improve muscle building post-op.  My Mom took them.

    Recent data have shown that total knee patients gain an average of 14 pounds post-op, and it’s not all muscle.  Gaining that much weight post-op delays recovery and increases instability.

    Post-op patients need satisfying, lower calorie recipes written on prescription slips: high calorie, high sugar foods that are highly processed should never appear, and would never be reimbursed.  But strategic nutrition can improve strength, healing, flexibility and stamina. And should.

    Although my grandmother passed away just after reaching 100,  my Mom has recently returned from Hawaii, Carmel, New York City and points unknown, without a cane or a pain pill, nearly as good as new.  In fact, better.

     
  • Jun8

    Prescriptions and palates can go together: drug-food interactions are a common reason for consultation. But some people would rather not eat, and purchase the medicine they need. The best site for free medicines we know of www.needymeds.com. Read More

     
  • Jun8

    Vitamin A is fat soluble, and to be absorbed, must be taken with a little fat.  Vitamin A is also stored in the body in fat: too much Vitamin A can be toxic, and cause birth defects in babies, and neurologic problems in adults. Vitamin A helps create vision and cell growth. Read More