Sunday, December 22, 2013

A Final Word (At Least For Now) On Eating Healthy

As I get ready to hang up my stethoscope again, and ponder the over one-thousand conversations I've had with patients and others over the past three years about eating for health, one theme repeatedly comes to mind: despite their belief to the contrary, most people don't truly understand what it means to eat healthy. They are also confused about the value of eating healthy when the diet still includes plenty of unhealthy foods. Healthy foods, no matter how much you eat, do not neutralize the ill effects of unhealthy foods.

As a service to all, here is a brief synopsis of the elements of a healthy diet. It's little technical at first, but I get down to a basic list at the end.

First, let's take a quick look at what are called the essential nutrients, of which there are six categories, that all humans basically need to survive. By essential, we mean that the human body cannot produce these on its own without outside help.

There are:
13 essential vitamins
Vitamins are grouped into two categories:
  • Fat-soluble vitamins are stored in the body's fatty tissue. The four fat-soluble vitamins are vitamins A, D, E, and K.
  • There are nine water-soluble vitamins. The body must use water-soluble vitamins right away. Any left over water-soluble vitamins leave the body through the urine. Vitamin B12 is the only water-soluble vitamin that can be stored in the liver for many years.
There are 15 give or take essential minerals. There are also trace minerals not listed here.
There are 9 essential amino acids
  • histidine, 
  • isoleucine, 
  • leucine, 
  • lysine, 
  • methionine, 
  • phenylalanine, 
  • threonine,  
  • tryptophan
  • valine.
2 essential fatty acids
  • alpha linolenic acid
  • linoleic acid


Some also think that choline, once thought a vitamin, is also an essential nutrient.

There are also other amino acids and fatty acids, and many other compounds in foods, such as antioxidants, enzymes, etc. that are metabolically active but are not essential to the diet as the human body can function without them.

Okay, so what are you supposed to do with all this detail. Nothing really other than eat foods that contain them.

For example, 11 of the vitamins can be obtained from eating fruits and vegetables.

One, vitamin D, can be made by sun exposure or found in foods like unsweetened almond milk.

The other Vitamin, B12, can be found in fish, chicken and meat. I'll come back to these later.

The minerals can be found in vegetables, fruits, nuts, beans whole grains, and seeds.

The amino acids and choline can be found in nuts, whole grains, beans, eggs, fish, chicken and meat.

The fatty acids, or their derivatives, can be found in seeds like chia and flax, as well as healthy wild fish like Alaskan Salmon.

So what does a healthy diet look like?

It contains daily raw fruits and vegetables, fresh or frozen. Fruits must include berries, banana, citrus, apples, and melons. Other fruits are optional. Vegetables must contain leafy green vegetables, collards, onions, tomatoes, carrots, onions, garlic, and mushrooms.
It contains raw whole nuts (includes pecans, almonds, pistachio, Brazil nuts, and macadamia- at least twenty a day except for Brazil nuts-limit to two a day), cooked beans (limit soybean but some okay), raw seeds (chia and flax best, but limit), and minimally processed whole grains like steel cut oatmeal with no preservatives nor genetically modified grains (non-GMO).
It contains wild fatty fish like wild salmon, herring, sardines, cod, halibut, etc. (3-4 times a week)
It contains free range chicken once a week, free range eggs twice a week, and lean antibiotic meat every other week as a side dish.
It includes dark chocolate(for the polyphenols) of at least 70% cacao with less than 5 grams of sugar per serving with a serving size equal to at least a third of the bar.
It contains unsweetened almond milk.
A very little olive or safflower oil.
It contains sun exposure and at least 50 ounces of fluids a day.
Of course, even a good thing in excess is harmful. So eat these foods in moderation, eat mindfully, and remember what the Okinawans say before every meal: Hora Hachi Bu (eat until your 80% full)

A healthy diet does not contain dairy of any kind (after infancy), yogurt included, and definitely not dairy that contains added hormones such as Bovine Recombinant Growth Hormone (which is part of all non-organic dairy), artificial sweeteners or added sugars, processed breads with added sugar, pastas whole grain or otherwise, ketchup with high fructose corn syrup (most), chips, processed snacks, pretzels, crackers, cold cut meats, processed meats, processed cereals like Cheerios and Kashi made from genetically modified grains (also don't be fooled by the label Organic: read the label and watch for added sugar greater than 4 grams per serving-if so, avoid), sweetened drinks or bottled fruit juices, health bars, protein touring products -- including bars, drinks, shakes or any other product touting protein, any supplements (unless prescribed by a knowledgeable physician), any multivitamins (unless pregnant), fried foods, burnt or charred foods, any food with partially hydrogenated on its ingredient list (even if label states no trans-fats), non-sun dried fruit (even if sun-dried eat in moderation), no foods or drinks whatsoever with preservatives added including nitrates and sulfites in particular, too many smoothies even if all raw ingredients--too many calories involved, farm-raised fish, especially tilapia and salmon, more than once a week tuna, non-organic apples, corn or potatoes, movie theater and microwave popcorn, too many oils including coconut, olive, sunflower, and safflower oils, too many starchy vegetables, candies with sugar and chemicals, foods with added dyes, non-organic soy-based products, and more food than you need to live-which is not really all that much after you meet the essential requirements. 

I hope this information has been helpful and I wish you all Bon Appetite. If you have any questions, please feel free to write me at for at least the next six months.

Wednesday, November 27, 2013

See You Later, Brother

On November 19, 2013, my middle brother Shlomo (I am the youngest of three boys) passed away at the age of 59, after a valiant 14 month struggle against kidney cancer.  Below, please find the eulogy I delivered at his funeral.

Shlomo always began all his simcha (happy occasion) speeches with the words, “what can a father say to his child on the occasion of....” In respect, I will begin my comments with “what can a brother say to a brother’s friends and family.” 

I have always found it amazing that people seem to be their best at their bar/bas mitzvah and at their funeral. That’s the time when we sing their praise and highlight all the wonderful things about them. The rest of the time, as we all know, everyone is not quite so perfect. So I’m sure you will all expect me to say how wonderful Shlomo was and I will not disappoint.  But I think that those of us here who really knew Shlomo, will know that I am not exaggerating such words of praise.

Shlomo, or Eba, as I affectionately called him when I could barely speak, was truly the perfect older brother in every sense of the word. I can remember as a small child Shlomo always offering me his lap on long car trips, no matter how hot or uncomfortable the trip may have been. With my head nestled in his lap, he gave me a sense of security and warmth.  Shlomo and I shared a bedroom for most of our childhood and Shlomo would often tell me bedtime stories. We would play baseball together in our small room using a rolled up sock. On my birthday, I remember one year Shlomo purchasing me two small racing cars that he knew I so terribly wanted. How he paid for them, I will never know because he had little money of his own to speak of. When I was entering college after having taken high school for granted, it was both my older brothers, Yehuda and Shlomo, who inspired me to work hard. It was Shlomo, in particular, who changed my life by making success in college a reality. In fact, I remember clearly as if he just said it, “It is possible to get an A in every class you take in college. You just have to work hard” And I believed him.

When I complained during a lifeguard instructors course that I could not perform a necessary skill, it was Shlomo who immediately chastened me with a much needed and well-timed sharp rebuke of “stop it already, of course you can do it.” This much-needed verbal blow compelled me to stop wallowing in self-pity and get it right.

Shlomo’s favorite words to me that always got me motivated to work hard and stay the course, whether in school or otherwise, was always "bust, bust, bust." It meant to just keep going hard towards any goal and I say to Aliza, Esti, Avivi, and Donny, as well as Dov, Neil, and Eitan, that if your father and father-in-law was here today, I am sure that he would say to you that when confronted with any of life’s challenges, the answer is always to bust, bust, bust.

Shlomo’s thoughts were always about everyone but himself. He has been the dutiful son that took care of our parents by always having them live nearby, helping them with medical problems, and always welcoming them to his home. When our father, z”l (of blessed memory) passed seven years ago, Shlomo became the doting son to our mother who continued to live nearby. And Shlomo and Meryl always warmly welcomed her to their home every Shabbat and yom-tov (holiday). I know that Shlomo would want you Ema to take good care of yourself even now that he is gone. Of course, Shlomo was also grateful for your Herculean efforts to feed him well to keep his cancer at bay. He appreciated the never-ending flow of fresh fruits and vegetables smoothies, which was your labor of love for him, and all the time you spent at his bedside.

Shlomo also always saw himself as a problem solver, often offering advice on how to reconcile differences between family members and he was a big believer in always doing the right thing.  One day, a few weeks ago, after I changed his bedpan, Shlomo turned to me and said it is good you are doing this. I asked “why is that?” He answered because it will make you feel better after I am gone. That’s the way Shlomo was; always thinking about how some action would have a positive or negative influence on somebody’s wellbeing.

This concern for the welfare of others extended to his medical practice as an internist and cardiologist. Working to ten or eleven at night was a constant for him and that is why his patients loved him and thought so warmly of him. (In fact, during the shiva (mourning period), dozens of his patients came to his house to express how much they loved him as their doctor, particularly how he made each of them feel like he or she was his only patient. Many also claimed that he had saved their lives with his medical care.)  Everything I know about how to make a patient feel special, I learned from him.

A few weeks ago, Shlomo decided to make a farewell video to his family, which I will share with them in the very near future. When he finished the part about his kids, I said to Shlomo that all he said to each kid was how great he thought they were and didn’t distinguish between them. He immediately answered that it was true that he thought that each of his kids were truly amazing and he was so proud of each of them. He also thought he was the luckiest father-in-law in the world that each of his three girls had met and married such incredible and loving sons-in-law, Dov, Neil and Eitan, who were welcome additions to the family.

For Meryl, however, he had no shortage of words of praise of what an amazing wife she had been to him, particularly during the last few months.  I often tell patients to print out the serenity prayer and keep it by their bed side. Meryl epitomized this prayer. She had the serenity to accept the things she could not change such as at the end the inevitability of Shlomo’s passing. But she also had the courage to work hard to keep him alive when we all thought that was still possible. And in the end, she showed the wisdom in knowing the difference between the two. As a first-hand witness, I cannot imagine a wife showing more grace and poise during the most difficult of times, who never wavered for a moment in her love for her husband of 35 years, who spent her every moment at his beck and call, sleeping by his side every evening, even if it meant sleeping in a chair in a cramped hospital room.  And did all of this with the most optimistic and positive countenance at all times.

So I say to Meryl and all the kids and sons-in-laws, from Ema, Yehuda, Yael, Danielle, Justin, Nicole, and I, thank you for being such a wonderful wife and children to the brother I loved so much and who was truly a tzadik (man of virtue) and a wonderful person. My brother could not have had a better family than you and I know he always felt lucky and grateful for having all of you in his life. With Shlomo gone to Olem Habah (heaven), a place I am sure he has earned, I hope that all of you will look to Yael and I as someone you can rely upon and that from this point on we celebrate many simchahs together, which I am sure will make Shlomo extremely happy as family meant everything to him. as he looks upon us from high above.  

I love you Shlomo, I will miss you, I will miss your bust, bust, bust, and I hope to see you again after meah v’esrim (120 years).

Sunday, November 17, 2013

Stop The Weight Loss Madness

This past week, I saw no less than ten patients who wanted to lose weight. Each described in their own unique way how the extra weight was contributing to some perceived problem they had with the weight's effect on their image, energy level, health, etc.

To each patient, I said the same thing. Stop focusing on losing weight and start focusing on what you can and cannot do to your body to help it function at its optimal level.  To each, I conveyed how the human body was developed over millions of years, with its most latest form, homo sapiens being around two hundred thousand years old. Over this period of time, human biology has evolved a full host of protective mechanisms to ward off disease. Of course, we all know these mechanisms sometimes fail miserably. It is very unfortunate when it does, and my heart goes out to those who suffer seemingly happenstance illness. Nevertheless, these mechanisms work for most and that is why the human body can usually protect itself fairly well against poor eating, lack of exercise, inadequate sleep, mounting stress, etc. for at least the first five or six decades of life.  It's not that damage isn't being done, it's just that the damage isn't always so obvious until later.

I often share with patients the story of the my growing up in Brooklyn, NY and how one day the red lights turned on in on the dashboard of my father's old car.  I share how my father drove it to a nearby gas station and spoke to the attendant and asked if he could help with the red light, to which he replied, "yes, I can disconnect it."  Now even to a young boy that was a ridiculous statement. Little did I realize that during medical school and my residency, my teachers and mentors would primarily educate me on how to turn off patients' red lights. As doctors have become successful in eliminating symptoms without addressing the underlying problem, akin to turning off a red light warning of problems, patients have been confused into thinking they don't really have a problem. A case in point is a patient this week telling me that he was very healthy with normal blood sugar despite the fact that he was a diabetic on high blood sugar medication and nearly morbidly obese.

For some reason, Americans seem to disassociate the reasons they gained the weight with the effects such reasons have on their health beyond the number on a weight scale.  They gain weight because they ate too much, they ate the wrong food, they barely moved, they slept poorly and were always hungry, etc. That is why I tell people to stop worrying about the numbers on the scale and to start paying close attention to the details of their lives. Although there is no perfect plan for staying healthy as the old Yiddish saying goes, mensch tracht un Got laft, men plan and G-d laughs, it still pays to plan. Therefore, by focusing on those elements of your life that you do have control over, you can shift the odds of staying and getting healthy in your favor. By doing so, one of the benefits is usually weight loss.

I have always believed that for virtually all problems, there are solutions.  Over the past three years, by investing the time and listening carefully to what patients are telling me, in partnership with them, I have helped them identify such problems and come up with workable solutions.  It has been a three year whirlwind and I am so grateful that I had the opportunity to so positively effect so many lives.  However, as clinically successful and emotionally rewarding this endeavor has been, the time has come for me to move on to my next challenge. I will always be grateful for all that my patients have taught me and the wonderful personal stories they shared.

I know that those who embraced my philosophy about taking care of the one body they had by eating healthy foods in moderation, avoiding unhealthy foods altogether to the extent possible, physically staying  active over the course of a day as much as possible beyond simply going to a gym for a specified work-out, improving sleeping habits, managing stress more effectively with good meditation and relaxation techniques, nurturing relationships and being grateful for the good things in life, have and will continue to reap great benefits from developing such good health habits.

To the rest of you I say, while good health is never guaranteed, a healthy lifestyle can shift the odds in your favor. Choices do have consequences so please choose wisely. Stop chasing weight loss like a lost puppy and focus on what really matters--your overall well-being.

Tuesday, September 17, 2013

New Study May Have Discovered Real Anti-Aging Approach

Last week, an  obese senior patient with multiple medical problems asked me in earnest if changing her lifestyle would actually make a difference to her health after all the damage her body had already incurred.  My response included that at a minimum, changing her eating habits, moving more, and managing stress better would slow, perhaps even stop certain further damage.  I was not so brazen to state that actions taken late in life would actually reverse years of neglect. Even though some recent studies have shown that lifestyle changes can reverse type 2 diabetes and improve heart and vascular health, nevertheless, no one knows precisely when someone crosses the line of no return (of course unless they pass). As one who follows the evidence, I refuse to give patients false hopes and perpetuate unverified information. But, I have some good news.

For some time it's been known that a poor lifestyle and stress in particular are linked to accelerated shortening of telomeres.  The telomere is the tail section of our chromosomes. Every time a cell divides, the telomere naturally shortens. After a certain number of cell divisions, the telomere reaches a certain length which results in either cell death (apoptosis) or cell shutdown (senescence.)  When enough cells stop functioning, so do we. It is believed by scientists that telomere shortening may be one of the major factors in our aging and ultimate demise. Stress has been linked to speeding up the process and scientists have yet to discover a mechanism to stop this shortening... until now.

A new study from the University of California at San Francisco (UCSF) reveals something absolutely remarkable.  The study led by Dr. Dean Ornish and Dr. Elizabeth Blackburn, who won the Nobel prize for her work on telomeres, showed for the first time a connection between lifestyle and the actual lengthening of telomeres. It was a small study and it illustrated that those participants, all men, who embraced significant lifestyle change such as healthier eating which included low fat, low-carb meals, increased their physical activity, managed their stress better with meditation and other forms of relaxation, and improved their social contacts, actually saw a lengthening of their telomeres.  Aversely, the control group generally saw a decrease in telomere length.

Here is a quote from the study:

“Our findings are consistent with those of earlier studies, but to our knowledge this is the first study of any intervention that has shown a significant change in relative telomere length in human immune-system cells over time when compared with a non-intervention group. We noted a correlation between the degree of positive lifestyle change and increase in telomere length when all participants were assessed together, which supports the internal validity of this study. Although our sample size was small and all participants had early-stage cancer with low risk of metastasis, we believe large, randomized trials to test the validity and applicability of our results are warranted.”

The study, however, had a number of weaknesses, not the least of which it included a small sample size, it was not a randomized double-blind controlled study, it only included men with prostate cancer, and it had several variable lifestyle changes. Notwithstanding, the study holds out the tantalizing prospect that switching your lifestyle at any time can actually slow down or possibly even reverse aging.  There is much more research to be done, but the next time a patient asks me if it is possible to reverse years of damage, I will cite this study and future studies I'm hopeful will come that indicate that the answer may be yes.

In the interim, I don't know about you, but I will try to live a lifestyle linked to lengthening of telomeres and hope (and pray) for the best.

Friday, August 30, 2013

When It Comes to Longevity, To Live or Not Live Long, Is Hardly The Question

The recent Pew Research Center Survey that revealed that Americans do not want to live past 100 continues to generate much fanfare. When I read the survey, I was hardly surprised that the average responder chose ninety as their ideal final age. With articles like, “Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too” that appeared two years ago in New York magazine, and the similarly timed “How to Die...What I Learned from the Last Days of My Mom and Dad” that was published in Time magazine, it shouldn't come as a surprise to anyone else. Both articles poignantly described how difficult the end of live is when you are among the oldest old and near death. They reaffirmed for most people a misguided view of aging in America. Fortunately, for those among you who aren't quite ready to set a deadline for your demise, both authors' circumstances were the exception to the rule and the benefits of living long outweigh the negatives.  More about that later.

Centenarians Among Us
Meanwhile, hardly a week goes by these days without some small town newspaper featuring a story about a local centenarian (no wonder, their ranks are swelling). Almost in lockstep, each story describes some secret longevity sauce uniquely offered by their age-wizened seer.  Most of us read such stories with a "that's nice," but don't otherwise think twice about it.  These centenarians are aberrations to most of us, something to be admired from afar, but not worthy of our aspirations. We may be intrigued by them, but most of us don't want to be them.  In addition, our society, unlike many others, has little reverence for the most aged among us. Why grow so old, we think to ourselves, to only feel neglected or unwanted?  Though we may be momentarily entertained by stories about the athletic triumphs of ninety-plus year olds like the recent article in the Wall Street Journal, most Americans prefer not to outlive their vitality, and apparently believe that means passing by age ninety.

Average Americans
As fate would have it, one of my patients last week when asked specifically how long he wanted to live answered without hesitation that ninety would suit him fine. Bemused, I thought to myself, "hello average American." When questioned what sway ninety held, he almost robotically responded that ninety was the age that he thought he would stop fully functioning and was prepared to move on. With all due respect to this patient and all the others who were surveyed by Pew and answered similarly, they may be wrong to choose ninety as their final age.  By the time we finished our visit, my patient agreed. Please let me tell you why.

The Race
I like to use analogies. In this instance, I used a racing analogy. When one races towards a finish line, the goal is to cross it, not reach it. Imagine, if the goal was to simply reach it. Given the momentum, the runner would have to slow done long before the goal in order to come to a complete stop at the goal. Similarly, to desire to die at ninety basically means that we choose to lose our vitality in our eighties. Vice a versa, if we wish to live to one hundred, it means that we are seeking to remain very vibrant in our eighties and early to mid-nineties.  Is that reasonable? Does it really make a difference what we think? It turns out yes. As gleaned from my extensive readings about centenarians, in most cases, the centenarians, and even super centenarians (over 110), expected to live long with many expecting to living even longer than they actually did. Attitude really does matter. It's not enough to simply expect to live long. Lifestyle and genetics play a role, but hoping to die by a certain age has consequences. 

Did You Ever Get An A?
Here's another, perhaps more pertinent, analogy.  Remember those school days you may wish to forget? Do you recall ever studying for a test in the hope of getting an A? If so, did you study 'just enough' to get an A or did you study all the material in the hope that would get you an A. Unless you are one of those geniuses of whom my children always claim never have to study to get an A, I posit that you reviewed all the material in an exhaustive fashion in the hope that you had done enough to get such A. Trying to do 'just enough' to get an A is highly unlikely to work because it isn't a complete approach. The same applies to healthy longevity.  If you simply aim to live to age ninety, you are assuming that unhealthy behaviors that may prevent you from living past ninety will also not impact your health pre-ninety. They will, and aiming for ninety is being shortsighted. 

The Facts About Longevity
So let's go back to the premise of the two articles that claimed that dying at an older age has serious drawbacks. The facts are that such conclusions are simply inaccurate. According to research conducted at the New England Centenarian Study (NECS) affiliated with Boston University, "90% of all of the centenarians [they studied] were still independently functioning at the average age of 93 years. Somehow, despite the presence of diseases, people who become centenarians don’t die from those diseases, but rather they are able to deal with them much better than other people and remain independently functioning more than 30 years beyond the age of 60." 

Compression of Morbidity
Furthermore, the NECS research reveals that when compared to controls, "nonagenarians (subjects in their nineties), centenarians (ages 100-104), semi-supercentenarians (ages 105-109) and supercentenarians(ages 110+)...had...progressively shorter periods of their lives spent with age-related diseases, from 17.9% of their lives in the controls, to 9.4% in the nonagenarians, down to 5.2% in the supercentenarians. In other words, the longer they lived, the less they suffered from disease. These findings support the "Compression of Morbidity" hypothesis.  

What is that, you ask? In 1980, a Stanford researcher named James Fries proposed the “Compression of Morbidity” hypothesis which states that as one approaches the limit of human life span, they must compress the time that they develop diseases towards the very end of their life and he proposed that people around the age of 100 do this. Although the NECS research shows that 43% of centenarians may suffer from age related illnesses before age eighty, and 42% suffered between eighty and one-hundred, most of the suffering was compressed to the last few years of life. Got it? The longer you live, the more healthy years you enjoy.

What that means for you is that the real reason to want to aim to live to one-hundred is that you will experience a far more pleasant eighties and early nineties, one mostly free of debilities and difficulties, if you succeed.

The Longer You Live, The Healthier You've Been 
Although it is true that living past your late nineties seems to require good genes (more in future blog), living to your mid-nineties is also a function of the lifestyle choices you make.  So the next time someone asks you how long you want to live, I hope you say "as long as possible" and mean it. Aiming beyond and high when it comes to longevity, like in the racing and school analogies, is the way to go.

Monday, August 19, 2013

Food Gives Life and Food Takes It Away

Perhaps the most undeniable fact about life is that food is needed to sustain it. Although some may argue what form that food may take, there can be no doubt that carbon based higher functioning organisms can not function without protein, fatty acids, vitamins, minerals, water and air. At the same time, perhaps the most inscrutable fact that people do seem to struggle with accepting is the role that food plays in ending life.

I was at a wedding yesterday. Like most weddings, it was a replete with an avalanche of things to eat. The choices seemed endless. There was all types of appetizers including caviar and lamb chops, choices of entrees from Filet Mignon to sea bass, and unlimited desserts including wedding cake, pretzels, ice pops, sliders (yup more meat), and a variety of other delicacies.

When faced with such a plethora of choices, it really is hard to remember that food plays such a profound role in our health. It is easy to rationalize that one little dessert will not make a difference; that a few more hot-dogs or a 16 ounce piece of steak can't possibly do much harm. All one must do is look around as others similarly gorge themselves on the enticing cuisine in order to throw caution to the wind and dive in. Boy, was I tempted. It's lonesome being the one who is constantly calculating in my head what I already ate and what makes sense to still eat. My wife will tell you that it doesn't make for polite company if I share such concerns in public.

"For G-d's sake," my wife would say, "we are at a wedding." She's right. I know that the hosts paid a lot of money to make sure that their guests are fully sated. It's not the time or place to point out poor food choices and potential dietary mishaps; rather, it's a time of celebration and enjoyment. But still I glance around watching both friends, neighbors and total strangers indulge themselves with apparently not the slightest regard for the consequences to their health.  As if asked at a wedding ceremony "if anyone objects," I want to scream out that I do. I want to leap to their defense, the defense of their long term health and longevity.  But I hold back.

I know their struggles. After policing myself exceptionally well for most of the affair, I finally succumbed to consume a miniature soft-baked salted pretzel. My fallible will-power proved the old adage that when it comes to food, "will-power will fail you." Ever cognizant of my folly, I sprang to my feet to quickly work off my error (no, the pretzel will not in and of itself kill me, but the momentary pleasure really wasn't worth it) by dancing relentlessy with highly flailing movements, the type of frenetic activity that prompted more than one observer to ask my wife what I had been drinking. (For the curious among you, there was no alcohol, just club soda with a splash of cranberry.)

Nevertheless, even as I burned calories, I wondered about it all. What's a man to do who some may say is burdened with the knowledge of what happens when we eat too much or constantly eat the wrong foods. When is the right time and place to share such knowledge? Most it be solicited or can one offer insights without any prompts?

Last year, I was sitting on a bench outside a restaurant waiting for an associate in a less than desirable neighborhood when a rather obese young man, who appeared to be from the neighborhood, sat next to me. His girth was clearly unhealthy and I was challenged to refrain myself from sharing my thoughts. Fearing for my safety, I remained silent but saddened that maybe I could help. When a similar opportunity presented itself six months later when I found myself at a bus stop in New Orleans standing next to a teenager smoking a cigarette, I showed no such restraint and shared some thoughts. Did it make a difference? He seemed to be listening, perhaps from the mere shock that a total stranger would even address him on the topic. I honestly cannot say what benefit he received, but it was the right thing to do.

Although my family and friends may be weary of my constant musings about food and its affect on their health, I am on a crusade from which I will not be easily dissuaded.  If you share my passion for making the world healthier, please let me know. It's always nice to know that what I am trying to do matters to you. Either way, please remember that just as the right food in the right amount gives life, the wrong food also takes it away.

On that point, let me share a final anecdote. I was at a birthday celebration a few months ago, when I was seated next to an uncle of the host family. My friend introduced me to his uncle as someone who specialized in helping people live longer.

When they served chopped liver, the uncle jokingly turned to me to ask if eating the chopped liver would kill him. I shrugged my shoulders, but responded, "I know it won't help" and left it at that. He proceeded to eat the chopped liver; he died a few hours later. Heavy fat meals are known to constrict blood vessels by as much as twenty-six percent within six hours of a meal. Enough said. Food gives life and food takes it away.

Friday, August 16, 2013

The Most Remarkable Book About Longevity--You Won't Believe When It Was Written

In the iconoclastic, long running animated television series The Simpsons, Homer Simpson, one of the main characters who is the husband of Marge, and father of Bart, Lisa and Maggie, is portrayed as a bumbling idiot. One is therefore not surprised when he declares one day that he is "not easily impressed" and then whirls around to declare in excitement "look, a blue car!"

Like Homer, I am also not easily impressed, not even by blue cars. So let me tell you that I just finished a book that really made an impression on me; I hope you will give it serious consideration.

It's a free book written by Luigi Cornao and it can be found under the name, The Art of Living Long. Some refer to it as Discourse on the Somber Life.

What made this health related book different from the 50 other health books I've read in the last 2-3 years. For starters, it was first published in 1558. That's right, it's over five hundred and fifty years old.

Alvise "Luigi" Cornaro (1467–1566) was a Italian nobleman who lived in Venice and wrote treatises on eating properly, including Discorsi della Vita Sobria (Discourses on the Sober Life). Finding himself near death at the age of 35, Cornaro modified his eating habits on the advice of his doctors and began to adhere to a low calorie regimen.  Even though he was born into an affluent family, he fell on hard times, which is well described in the book's introduction about him.

His first treatise was written when he was 83, and its English translation, often referred to today under the title The Sure and Certain Method of Attaining a Long and Healthful Life, went through numerous editions; this was followed by three others on the same subject, composed at the ages of eighty-six, ninety-one and ninety-five respectively. The first three were published at  Padua in 1558. He is said to have died at Padua at age 98, although some references state he was 103.

Although the available edition is obviously in translated English, as the original was written in Italian, I found the writing to be profound, if not poetic.

For those less inclined to read the entire book, I've taken the liberty to cull excerpts that really resonated with me. With each, I add a few comments.


Later in the book, Luigi wrote, "For I have observed that long discourses are read by a few only, while brief ones are read by many; and I most heartily desire that this be read by many, in order that it may prove useful to many. Eloquence…in men of intellect, verily has great power; so much so, indeed, that it will persuade some people to believe things that are not and can not be true."

I agree with him that it is more likely that you will read my writing if I keep them brief, but I overflow with things to write, so I apologize in advance for my sometimes lack of brevity. 

Using Reason

Luigi beseeches us all to use our given skills in reason when it comes to making good decisions regarding our health when he writes, "In a being endowed with reason, the desire for life and health possesses greater weight than the mere pleasure of doing things which are known to be hurtful."  Don't we value life over the mere satisfying of appetite? If so, why do repeatedly choose unhealthy foods despite the consequences?

One of Luigi's more profound statements was, "Whosoever wishes to eat much must eat little." Luigi looks at life in its totality. He is saying that people who don't overindulge their appetites and overeat will live longer and therefore over the course of their lives will have eaten more food than those who overindulge and die early.

Choices Matter

When I read, "The food from which a man abstains, after he has eaten heartily, is of more benefit to him than that which he has eaten," it really struck a chord with me.  Patients and readers have heard me say and write time and again how harmful certain foods, such as added sugars, are to our health, and why eating mostly healthy doesn't neutralize the harmful effects of foods, such as french fries covered in acrylamide, that cause ill-effects.

Process Works

With "It is through order that the sciences are more easily mastered; it is order that gives the victory to armies; and, finally, it is due to order that the stability of families, of cities, and even of governments is maintained," Luigi is explaining the importance of process in living a healthy life. Patients often ask how should they control their appetite when they go out to eat? I explain they need a process such as consuming almonds before leaving for the meal. pre-choosing a selected item from the menu deemed healthiest, and pre-cutting fruits at home so they know it awaits them for dessert when they get back, making them less likely to succumb to temptation to consume a very poor choice from the restaurant menu.

The Value of Life

In my previous blog, A Decade of Life, I used the next quote to exemplify the shortsightedness of sacrificing up to ten years of you personally enjoying healthy living in order to eat what you want. Luigi concurred when he wrote, "Men are as a rule, very sensual and intemperate, and wish to gratify their appetites and give themselves up to the commission of innumerable diseases. When, seeing that they cannot escape suffering the unavoidable consequence of such intemperance as often as they are guilty of it, they say—by way of excuse—that it is preferable to live ten years less and enjoy one’s life.  They do not pause to consider what immense importance ten years more of life, and especially of healthy life, possess when we have reached mature age, the time, indeed, at which men appear to the best advantage in learning and virtue—two things which can never reach their perfection except with time.

First Steps

Yesterday, a patient told me that my suggestions to her to reduce her stress were easier said than done. I agreed, but that didn't mean she shouldn't try. Like Luigi said, "The only difficulty, if any there be, consists in making a beginning." 

More importantly, being healthy is a noble goal and in concordance the Luigi's words,"When a man has fully resolved to realize a noble enterprise and one which he is convinced he can accomplish,--though not without difficulty,--it is made much easier by bending all his energy upon doing it and actually setting to work...Unworthy of a man to abandon a noble undertaking simply on account of the difficulties encountered."

He adds, "Do not think that what is hard for thee to master is impossible for man; but if a thing is possible and proper to man deem it attainable by thee. Persevere then until thou shalt have made these things thy own."  Just do it! Start!

Nature Guides

Sometimes it seems that the reason there is so much food around us is because we are meant to enjoy it. Is that true? Is that natural? "Nature, being desirous to preserve man as long as possible, teaches him what rule to follow in time of illness; for she immediately deprives the sick of their appetite in order that they eat but little—for with little…Nature is content."

Bad Examples

Some people live in denial and/or rationalize to themselves that they are different. They will not succumb to an unhealthy lifestyle including poor food choices. To them, Luigi responds, "I do wish to be told here that among those who lead the most irregular lives there are men, who, in spite of this fact, reach, healthy and robust, those furthest limits of life attained by the temperate; for this argument is grounded upon a position uncertain and dangerous, and upon a fact, moreover, which is of so rare occurrence that, when it does occur, it appears more a miracle than a natural result...There is no doubt, of course, that a man blessed with a strong constitution will be able to preserve himself longer by living a temperate life than he who has a poor one, and it is also true that G-d and nature can cause men to be brought into the world with so perfect constitutions that they will live for many years in health, without observing this strict rule of life…But such instances are so rare that, it is safe to say, there is not more than one man in hundred thousand of whom it will prove true."

Irreparable Damage 

You may also think if something goes wrong, you can change course later as doctors will fix you the first time. When something break, they stay broken and that is so true for your body. Just ask Luigi who says, "With the increase in years and the consequent decrease of natural heat, dieting cannot always have sufficient power to undo the grave harm done by overeating…for sickness shortens life even as health prolongs it.

So what's a person to do?

Making Sense of it All

First avoid unhealthy foods in their entirety as much as possible. Why? "The gratification of the tastes and appetites means infirmity and death. If this pleasure of the taste were a lasting one, we might have some patience with those who are so ready to yield to it. But it is so short-lived than it is no sooner begun than ended; while the infirmities which proceed from it are of very long duration."


Will willpower work? Can you spot with just  a little cake, ice cream, bread, pasta, etc. No way! "It is necessarily impossible, in the nature of things, that a man should be determined to satisfy his taste and appetite, and yet, at the same time, commit no excesses." 

Then what?

A Season For Change

"Persons would live to enjoy the blessings of extreme old age, if, as their years increase, they were but to reduce the quantity of their food and distribute it into several meals during the day, eating but a little at a time." Five hundred years ago, you got it, Luigi. "Man is, in his youth, however, more a sensual than a rational creature, and is inclined to live accordingly. Yet, when he has arrived at the age of fifty or fifty, he certainly ought to realize that he has been enabled to reach the middle of life through the power of youth and a young stomach, those natural gifts which have helped him in the ascent of the hill.  Now he must bear in mind that, burdened with the disadvantage of old age, he is about to descend it towards death. And, since old age is exactly the opposite of youth, just as disorder is the reverse of order, it becomes imperative for him to change his habits of life with regard to eating and drinking, upon which a long and healthy life depends. As his early years were sensual and disorderly, the balance of them musty be exactly contrary, reasonable and orderly; because without order nothing can be preserved—least of all, the life of man."

Be Useful

Luigi doesn't just limit himself to dietary advice, he also covers as a devout Catholic, the importance of spirituality, of being charitable to others, or as he call it, "being useful to others."

All in all, this was an extremely moving book fro me. As Luigi said,we are "born to die." However like Luigi, I would like to delay this inevitability as long as possible with a sound mind in a healthy body. What about you?

Here is a link to a free copy of the book.
Start with page 30 and read to 113.

Thursday, August 8, 2013

A Decade of Life

The Pew Research Center just released the results of a recent survey that has everyone abuzz. It turns out that many Americans would prefer not to live past 100 and many would even settle for a number of years earlier. These results have spurred much debate about the consequences of extending the longevity of an already burgeoning elderly population. Many of the commentaries cite statistics about how our life expectancy has climbed from around 50 at the turn of the twentieth century until 79, the current expectation. While on average, human beings are living longer, living past 79 is nothing new to homo sapiens.

Since at least the Bronze Age, or 3,500 BC, a fair share of Sardinians have lived past 100. Hippocrates, who lived around 500 BC, is said to have lived between 87 and 110 years. The Greek philosophers are believed to have lived into their 90s. Michelangelo lived to 87. None of these humans relied on major technological advances for their longevity. Instead, they respected their bodies, understood the relationship of food to their health, stayed physically active, and dealt effectively with their stress. They also valued family and social connections above all else.

Abraham Lincoln once said that its not the years of life that matter but the life in your years that do. Rather than focus on what chronological age we live to, the emphasis should be on what we do with that time. As a physician who often asks patients during their first visit, "Why do you want to live?," I can tell you that answers vary from, "I don't want to die" to very specific reasons to live. Based on these answers, I help people prioritize what is important to them and make decisions accordingly. They begin to understand, some for the first time in their lives after many decades, the consequences of their health related choices and their reason(s) to keep living.

The sustaining of life merely to add candles to a birthday cake is meaningless. The true value of longevity is predicated on living a life with meaning and purpose. Although what is meaningful and purposeful can only be decided on an individual basis, when such a foundation exists, there is no reason not to keep living. However, the absence of such meaning and purpose makes life intolerable at any age.

As Henry David Thorough wrote in Walden Pond, “The mass of men lead lives of quiet desperation. What is called resignation is confirmed desperation...Alas for those that never sing, But die with all their music in them."

Let's focus our energies not on extending life, but on improving. It really is quality, not quantity that counts. The first step is striving to live in a healthy body, free of infirmity. For the most part, this is a choice, one predicated on lifestyle.  The six biggies are food, physical activity, stress, sleep, engagement, and social. I've already written about all of these ad nauseum so I will leave it to you to peruse my previous blogs.  The bottom line is that good choices often mean good results.  No one, including me, can promise you how long you will live or exactly what kind of life it will be.  But please don't live your life with blinders on to the consequences of obvious bad choices like regularly eating french fries and drinking coke or hardly getting off the couch.; please don't predicate your life on the belief that avoiding such foods or activity somehow makes life less worth living; please don't trust that medical care somehow fixes you--it usually doesn't. I know it's a personal choice  and I also know that neither I nor anyone else can tell you how to live your life.  But choices really do have consequences.  Good choices take effort; exert yourself. Scientists now believe that a healthy lifestyle is worth up to a decade of life. What's a decade of life worth to you?

As you ponder your answer, please consider for a moment the words of Luigi Cornaro, an Italian senior citizen from the 16th century who wrote in his book, The Art of Living Long, that "Men [and women] are as a rule, very sensual and intemperate, and wish to gratify their appetites and give themselves up to the commission of innumerable diseases. When, seeing that they cannot escape suffering the unavoidable consequence of such intemperance as often as they are guilty of it, they say—by way of excuse—that it is preferable to live ten years less and enjoy one’s life.  They do not pause to consider what immense importance ten years more of life, and especially of healthy life, possess when we have reached mature age, the time, indeed, at which men [and women] appear to the best advantage in learning and virtue—two things which can never reach their perfection except with time."  This is as true today as it was some five hundred plus years ago.

Nevertheless, I write and care for those who value their health and are looking for guidance to live more good years. Sometimes I think it is a Sisyphean struggle to get people to focus on protecting their health, but I wouldn't give it up for anything.

Thursday, August 1, 2013

The Path To Longevity and A Healthy Life: Ancient Wisdom with Timeless Relevance - 16 Principles To Live By

It seems that hardly a month goes by without some new book being published that promises new insights into what it takes to be healthy.  Most of these books single out one ingredient or category of food or lifestyle that if only avoided or embraced would be a cure-all. Most of these books also have a tie-in to losing weight because the presence of guilty pleasures(s) or the lack of claimed positive inluencers are always blamed for unintended weight gain.  The better books are chock full of often half-baked studies that line up to support the 'new' assertion even when the 'new' assertion really isn't new at all.

I've pondered many times writing my own book, but remain reluctant to part people from their hard-earned money only to offer them nothing more than common-sense, ageless advice. There really is no secret to staying healthy. For me, the shiny path comes from studying, but not solely relying on what has come before. I'll explain later on what I mean. Nevertheless, there is a passage often ascribed to King Solomon from the Book of Ecclesiastes, a part of the Bible, that states "What has been will be again, what has been done will be done again; there is nothing new under the sun." When it comes to health advice, I believe this statement to be a perfect truism.

Ancient wisdom has often stood the test of time. One need only read what Hippocrates, the Greek physician, wrote some 2500 years ago to agree. There is much to be learned from our predecessors, particularly from those considered to be the wisest among them. Among this group, a few stand out for their sage advice related to a healthy life.  In addition to Hippocrates, I count among them Plato, Maimonides, The Buddha, and Lao Tzu. Regardless of your religious orientation or lack thereof, each of these men has something to teach you. Before I tell you what, let me give you historical context with a few facts about each of these great people.  (All images are merely for illustrative purposes.)

Hippocrates Facts

Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles, and is considered one of the most outstanding figures in the history of medicine. 
Born: 460 BC, Kos, Greece
Hippocrates, often referred to as the father of western medicine, is known to have penned Aphorisms, which contain many of his known quotes about health. It is worth a read.

Lao Tzu Facts

Lao Tzu was a philosopher of ancient China, best known as the author of the Tao Te Ching. His association with the Tào Té Chīng has led him to be traditionally considered the founder of philosophical Taoism. Wikipedia
Born: 604 BC, Henan, China
Died: 531 BC, China

Maimonides Facts
Mosheh ben Maimon, called Moses Maimonides and also known as Mūsā ibn Maymūn, or RaMBaM, was a preeminent medieval Spanish, Sephardic Jewish philosopher, astronomer and one of the most prolific and influential Torah scholars and physicians. Among Maimonides most famous health related writings is his Guide for the Perplexed, another great read.

Plato was a philosopher in Classical Greece. He was also a mathematician, student of Socrates, writer of philosophical dialogues, and founder of the Academy in Athens, the first institution of higher learning in the Western world. Wikipedia
Full name: Plato

Buddha Facts
Buddha in Sarnath Museum (Dhammajak Mutra).jpgGautama Buddha, also known as Siddhārtha Gautama, Shakyamuni, or simply the Buddha, was a sage on whose teachings Buddhism was founded. A native of the ancient Shakya republic in the Himalayan foothills, Gautama Buddha taught primarily in northeastern India.
Born c. 563 BCE
Lumbini (present-day in Nepal)
Died c. 483 BCE (aged 80) or 411 and 400 BCE
Kushinagar (present-day in Uttar Pradesh, India

All these great thinkers and teachers understood the connection between a healthy mind and a healthy body; they recognized that ultimate good health (and longevity) cannot be achieved without both.

From an assortment of famous quotations from each of them comes the rules of healthy living. Mind you, following rules or checking off boxes on a checklist does not make one healthy. These are rules of life that one must fully embrace with both mind and body if one is to enjoy their fruits, no pun intended. I offer each quote with a brief explanation of its timeless relevance. There is no order to these rules because each is important.

Rule #1

Do not to solely rely on books, websites, blogs, TV shows, ancient quotations, etc. for your health advice. Mark Twain once quipped that if one relied on a health book for advice, one could die from a misprint.

Maimonides wrote, "Do not consider it proof just because it is written in books, for a liar who will deceive with his tongue will not hesitate to do the same with his pen."

Rule  #2

Follow the science not the consensus. Hearsay and anecdotal evidence does not often make for appropriate action.

Hippocrates nailed it when he wrote,"Science is the father of knowledge, but opinion breeds ignorance" and "There are two things, science and opinion; the former begets knowledge, the later ignorance."

Maimonides also weighed in with “Truth does not become more true by virtue of the fact that the entire world agrees with it, nor less so even if the whole world disagrees with it.”

Rule #3

Life is meant to be lived, not avoided.  Experiencing ups and downs is part of what it means to be alive. There is no viable alternative. Also, don't look for issues, but when they arise, deal with them.  To solve every problem, requires a first step. Don't be afraid to take it. You will feel better when you proactively deal with life's challenges.

As Lao Tzu wrote, "Do the difficult things while they are easy and do the great things while they are small. A journey of a thousand miles must begin with a single step."

Rule #4

Forgive yourself of past transgressions and live in the moment. No one is perfect and everyone makes mistakes. Learn from your mistakes, but don't dwell on them. Learn from other people's mistakes and try not to repeat them; but, let the past remain in the past where it belongs. You have to live and enjoy the moment if you are to fully enjoy your life. Now is a gift; that's why it's called the present.

According to the Buddha, "Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment." He also said, "You can search throughout the entire universe for someone who is more deserving of your love and affection than you are yourself, and that person is not to be found anywhere. You yourself, as much as anybody in the entire universe deserve your love and affection."

Rule #5

Forgive others, even if you can't or shouldn't forget what they did. An angry person will never be a healthy person.

Again the Buddha understood this reality when he said "Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned" and "You will not be punished for your anger. You will be punished by your anger."

Rule #6

Be kind to others.There is never a reason to be mean.

According to Lao Tzu, "Kindness in words creates confidence. Kindness in thinking creates profoundness. Kindness in giving creates love."

Rule #7

Share your happiness with others; it only expands your joy.

As the Buddha said "Thousands of candles can be lit from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared.”

Rule #8

Be true to yourself and your values regardless of who you encounter in life.

Lao Tzu explained that context should not define us when he said to "Treat those who are good with goodness, and also treat those who are not good with goodness. Thus goodness is attained. Be honest to those who are honest, and be also honest to those who are not honest. Thus honesty is attained."

Rule #9

Make embracing rule #8 easier by surrounding yourself with people who share your values and your zest for a healthy life.

The philosophic Plato used a unexpected metaphor when stating that "People are like dirt. They can either nourish you and help you grow as a person or they can stunt your growth and make you wilt and die."

Rule #10

Help others (which is more than just being kind in your demeanor). The satisfaction of helping others is nourishing to your soul. Helping others can take many forms and is life-affirming. Help people help themselves and don't make them feel like they needed your charity.  Take pleasure in good deeds without any expectation of reward other than a good feeling.

According to Maimonides, the greatest level of charity, "above which there is no other, is to strengthen another by making a partnership with him or finding him a job to strengthen his hand until he no longer needs charity."

A common rephrase is that if you give a man a fish, you feed him for a day; but if you teach a man to fish, you feed him for a lifetime.

Rule #11

Avoid excess in any form, even in regards to healthy pursuits.

Hippocrates understood that when he wrote, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." He also said that "Everything in nature is opposed to excess."

Rule #12

Stay active and busy, while finding meaning and purpose in life. Move not just for the sake of movement; rather, move to accomplish things.

Once again, Hippocrates was prescient when he stated that "walking is man's best medicine."

Plato also understood this same truth stating,"Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it."

But it was the Buddha that recognized that such activity must be purposeful, sharing, "To be idle is a short road to death and to be diligent is a way of life; foolish people are idle; wise people are diligent.

Rule #13
Be positive and constructive in your thoughts  A good night's rest facilitates a positive perspective. Stop worrying as Mark Twain noted in later life, "I've spent most of my life worrying about things that never happened."

As the Buddha stated, "all that we are is the result of what we have thought. The mind is everything. What we think we become." 

Remember, thoughts are not facts.

Rule #14

Eat right. Eat real food. Eat it slowly. Don't overeat. No single factor will have a greater influence on your overall health than what you put into your body.

“No disease that can be treated by diet should be treated with any other means.”
― Maimonides

"Let food be thy medicine and medicine be thy food." -- Hippocrates

Both these statements should be self-explanatory.  Real food promotes health. Just say "No" to the other stuff.

Rule #15

Make good health a priority. Recognize the mind-body connection as it is critical to your overall sense of a life well-lived. Be conscious of how you live your life, but don't obsess about your health.

To keep the body in good health is a duty... otherwise we shall not be able to keep our mind strong and clear. -- Buddha

Rule #16

Find a doctor who understands you are an individual, not a statistic. Doctors are not perfect and it is perfectly fine to question your doctor. Western medicine has a role to play in your health, but you have a greater role. Make sure you understand both your diagnosis and what you can expect from any treatment.

“The physician should not treat the disease but the patient who is suffering from it”-- Maimonides

"Whenever a doctor cannot do good, he must be kept from doing harm " -- Hippocrates

I mentioned earlier why I don't simply rely on the past to guide me in the present. The reason is because as food manufacturers continue to tinkle with what is now inappropriately called 'food,' this new-fangled so called 'food' may be creating potential long-term dangers that have not been fully vetted for human health. I am not a conspiracy theorist, but I do worry that our best interests may be sacrificed by government overseers for the expediency of allowing cheaper, more accessible 'food' to be created.  So with a mind towards ancient wisdom, I try to avoid 'new foods' as much as possible.

You may not agree with all of the ancient wisdom shared today, but I hope you agree that none promises any harm. If you follow this ancient wisdom, I think you will discover what a life well lived really means. As the ancient comedian George Burns once said, "If you ask what is the single most important key to longevity, I would have to say it is avoiding worry, stress and tension. And if you didn't ask me, I'd still have to say it." Amen, George.