• Archives

  • May13

    Feeding Tube Diet: Unhealthy or Usual Business?

    Posted in: Obesity and Weight Loss, Wellness and Health

    2 weeks after the New York Times broke this, it’s still here: covered on 20/20 Friday and Forbes still has it front and center (my comments are highlighted): 10 days of fat and protein or just protein, 800 calories, 24/7 insertion, $1500 (not including the “trade secret” formula) and bam- 20# off. Or your money not back.

    Only organized medicine seems uninterested, despite documented and numerous side effects (sinusitis, aspiration, misplacement, puncture) of this medical device.

    It’s easy to gasp at the expense, at the brazen short-cut, at the lack of interest in getting to the root cause, at the water weight loss, at the disassociation of bare nutrition from flavor (really!) and from legitimate medical uses. (I have taken care of many people with feeding tubes who wish they didn’t have to have them, and certainly did not seek one out).

    But it’s also easy to appreciate the pressure people feel to lose weight, to see that they are burning fat and do lose their appetite, to empathize with people who often wish for another life and see this as a way to gain access, to invest in the marketplace of weight loss commerce, to try something new. The diet/exercise as it is often pitched often fails, so if this fails, all you have lost is money, time, a little dignity.

    Is this worth standing up to and saying: why not just use a piece of duct tape?

    Or is it not worth getting worked up about?

     

  • Aug2

    Response to Bittman’s “Tax Bad Foods”

    Posted in: Aging and Costs of Aging, Diabetes, Food FAQ's, High Cholesterol, Obesity and Weight Loss, Wellness and Health

    As a physician and professionally trained chef, I write recipes on prescription slips. I try to practice what Mark Bittman of the New York Times eloquently preaches in Tax Soda, Subsidize Vegetables.

    Yet a healthy diet is like penicillin–simple, powerful, and with increasing rates of resistance, from physicians.

    Physicians are not trained to speak with patients about diet and nutrition, much less cooking and food shopping.

    Physicians are also better paid to prescribe medication and do procedures than to ask patients to switch from soda to water.

    Writing recipes on prescription slips changes this dynamic.

    Putting foods, recipes and meals in pharmacies and on managed care and hospital formularies might help patients get the food and health care they need, economically.

    Healthy hospital food, like that at Planetree’s New Milford Hospital is a good start.

     

  • Apr18

    Is Sugar Toxic? Gary Taubes’ Lab Reports

    Posted in: High Cholesterol, Obesity and Weight Loss, Wellness and Health

    Gary Taubes blew the top off the New York Times readership with his carefully researched “What if it’s all been a big fat lie?” about fat and heart disease in 2002 (translation: it’s the type of fat that matters, not total fat).Sugar through your life (NYTimes.com)

    He’s doing it again with “Is Sugar Toxic? (translation: yes, it’s poisoning you now).

    Now he posts his state-of-the-art lipid lab results (which I also order for patients) to prove his minimal heart disease risk. He eats primarily meat and eggs.

    Any of my patients would be proud: (except one thing: the CO2 of 19, which is probably because he’s often ketotic, and has to blow off CO2 to normalize his blood pH).

    Three questions:

    a. What is  the effect of sustained ketosis on heart disease risk?.

    Ketosis mimics starvation, pushing the body to burn fats rather than carbs (because there are no carbs!) for fuel. Fatty acids and ketones result.

    Ketogenic diets work in about 50% of kids with specific seizure conditions.  They reduce appetite but are difficult to sustain (Atkins is a modified ketogenic diet).  In a small study in kids, there were worrisome cardiac changes: I don’t know of adult cardiac data.

    b. What are the other heart disease risk factors? Smoking, high blood pressure, diabetes and pre-diabetes, sedentariness, family history of early heart disease, high waist-to-hip ratio.

    Let’s assume these are not a problem for Mr. Taubes. But not so for everyone else. Some of these have to do with food, and some not. Even if sugar is the problem.  And it might be.

    c. Is it practical?

    To eat without most carbs and sugar, especially fructose, is virtually impossible in the U.S. and even more so abroad.

    But Taubes’ idea that “we all respond to the carbohydrate/insulin effect differently”, and for weight loss “getting rid of all the grains and much or most of the fruit, and then eating more of whatever foods they happen to eat or like that provide protein and fat” deserve exploration.

    People with celiac disease learn to cook, to read labels, to avoid gluten, because it’s toxic to them.  Will we see the same for obesity, heart disease and sugar? Let’s hope so.

     

  • Nov9

    Writing a Best-Seller: Resources!

    Posted in: Uncategorized, Wellness and Health

    In Las Vegas last week, I gave a talk last week to 75 physicians on writing, publishing and marketing–specifically, how to write a New York Times Best-Seller (see previous post for strategies).

    I also love being with out-of-the-box people, who think beyond their training or degree, and are keenly interested in something else too.  That was the MedicalFusion conference.

    I prepared for the talk by researching the topic (there are real empiric data), and examining my own experiences.

    It turns out that as fast as publishing is changing, some of the old truths still hold.

    If you are swinging for the fences, you are best served by getting an agent, using a New York publisher, letting them amplify your message, and learning excellent media skills.  And there’s no substitute for practice.

    What put my last book (ChefMD) over the top was the NPR interview, confounding the conventional wisdom that only TV works to sell books.

    I prepared for the interview, like I prepare for all interviews: by reviewing my handwritten 4 x 6 or 8.5 x 11 cards.  I love high technology, but I have not transferred these to my phone, because the hands-on approach seems to work.

    Here are 8 recommended hands-on resources about writing a best-seller: Seth Godin, of course, and Tim Ferris of Four Hour Work Week, twice; Dan Poynter’s self-publishing guide with suppliers; authorhive.com for book marketing; and for self-publishing: lulu.com, createspace.com and authorsolutions.com.  See what you like!

     

  • Oct13

    What to Ask Your Doctor About Nutrition

    Posted in: Common Conditions, Environmental Health, Uncategorized, Wellness and Health

    I was interviewed last week by Oxygen Magazine about the New York Times coverage of nutrition in medical school (or rather, the declining hours given in U.S. medical schools to the subject: full scientific article here.)
    The questions were very good, and so I thought I’d offer my answers to you too.

    1. How important is food in preventing disease?

    Food is the most powerful clinical intervention against chronic disease doctors have.  We should be able to write recipes on prescription slips, just like prescription medication.  And every doctor should know how.

    2. Should people ask their doctor how they feel about nutrition? If so, what kind of question(s) should they ask?

    a. What should I eat for my (specific condition)? {By specific, I mean fill-in-the-blank: high blood pressure, diabetes, gout, arthritis, depression, optimal health}
    b. Where can I learn about what to eat for my (specific condition)?
    c. Where can I find easy, healthy recipes for my general health by someone you trust?

    and more generally

    d. Do you think nutrition and what I eat are important for my (specific condition)?

    If you get a “No” or “I doubt it” to question d, ask “Why”? There might be a good reason. But if there isn’t, consider looking for a doctor who says “Yes, I do.”

     
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