Paging Dr La Puma

May5

Week 1: Med Student Culinary Medicine Clinical Elective (First!)

Posted in: Aging and Costs of Aging, Common Conditions, Environmental Health, Obesity and Weight Loss, Wellness and Health

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 College 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.

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).

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

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Apr17

How to Prevent Heart Attacks

Posted in: Arthritis, Diabetes, High Cholesterol, Hypertension, Obesity and Weight Loss, Refuel, Stroke, Wellness and Health

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.

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Mar24

Obesity and Hunger: 2 Sides Same Coin: Same Solution?

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

Hunger in America is largely hidden, yet Feeding America’s 200+ foodbanks feed one out of 6 Americans. The USDA reports that in 2011, 46.7 million Americans—or roughly one of four adults — received food assistance from one of 15 federal programs. Here is the meal map.

This is amazing in so many ways: because when you have little money and less time, the cheapest, quickest thing to eat seems like the best.

Yet we know where highly processed food has taken the U.S. and Australia, and soon Mexico, Western Europe, and then South America, Asia, India and China: to insulin resistance, obesity, metabolic syndrome, pre-diabetes and diabetes. Not to mention heart disease and breast cancer and colon cancer.

It’s a fact that some food–starchy, sugary, high glycemic index food makes you hungrier–in adolescents and adults. But millions of people have survived on soda and white bread and instant noodles and donuts. And when you’re hungry and have no time, other facts seem less relevant.

It may seem bizarre that obesity and its medical problems are so intimately related to hunger and food insecurity: that obesity and hunger are two sides of the same coin. And the global health burden from obesity is now greater than the global health burden from hunger, according to a huge Lancet study.

But there is a direct relationship: less money, less time, cheaper, lower quality food: more hunger, more highly processed food, more inflammatory food, more obesity.

The solution, as Jeff Bridges says above, and his wife Susan Bridges demonstrates in a video we shot for the FoodBank of Santa Barbara, is not just charity. It’s education, training and skill development. How to plant and maintain a household garden. How to cook what you get out of it. How to plan ahead for day-to-day food security.

And at a larger scale: how to link Foodbanks and health care organizations. How to create partnerships with clinics, pharmacies, health care systems. How to conduct simple health care screenings at food distribution sites, and offer healthier, non-disease-causing food for pickup and purchase.

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Jan21

Osteoporosis – The Silent Disease

Posted in: Aging and Costs of Aging, Obesity and Weight Loss, Wellness and Health

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.

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Jan14

Heavy Blues: Weight and Depression

Posted in: Aging and Costs of Aging, Common Conditions, Obesity and Weight Loss
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.

Testosterone 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.

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