tag:blogger.com,1999:blog-55498826057513262592024-03-05T13:40:01.392-08:00The Park Avenue DietThe Park Avenue Diet Program is a comprehensive image makeover that will change the way you look and feel, hopefully forever. It consists of four office visits that will serve as opportunities to evaluate yourself and your progress, as well as to discover a "new you" that can continue to refine, improve, and dazzle.
Reinvent yourself! Lose weight, have a total makeover, and develop dynamic interpersonal skills and self-confidence...all in one revolutionary program: The Park Avenue Diet.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.comBlogger64125tag:blogger.com,1999:blog-5549882605751326259.post-63287748739542524372012-01-19T09:19:00.000-08:002012-01-19T09:42:24.762-08:00Thank you, Paula DeanRule #1 in healthcare: don't try to fool Mother Nature.<br /><br />The telegenic and endearing celebrity chef Paula Dean is herself a victim of the American diet. Too many calories? Check. Too much saturated fat? Check. A disproportionate amount of refined sugars without accompanying exercise? Check. Cook for 5-10 years (the time diabetes remains "silent" yet causes 60% of its eventual cardiovascular damage). Serves one.<br /><br />Paula Dean's recipes may be unique but her biochemistry is similar to everyone else's. Unknown to her and apparently her physicians, she passed through the relative calm of insulin resistance. Then three years ago, her blood sugar rose above 126mg and diabetes "suddenly" appeared. The HIPAA laws prevented this information from leaking out to her fans, but now that she has appeared on national television in a selfless act of contrition, all is forgiven.<br /><br />Except of course by the small arteries in her heart, brain, and kidneys. On the other hand, a profitable relationship with a new sponsor seems a good fit--it's as all-American as any of her recipes. I have been pleased to endorsed diet plans, nutritionists, personal trainers, and vitamin supplements that are health-promoting. If a physician told an obese patient to eat pecan pie, fried chicken--let's not go there.<br /><br />But in a crazy way, Paula Dean may have contributed an important service. And it's therefore up to the American public, 67% of whom are struggling with weight issues, not merely to marvel at the complexity of these media/medical/ethical issues but to look inwardly for healthcare. Paula Dean is a lovely, talented, and inspiring chef--but you can't fool Mother Nature.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-38170619636048050582011-04-04T05:11:00.000-07:002011-04-04T05:37:19.405-07:00"Let Them Eat Celebration Cake"When told that the peasants were starving and had no bread, the cruel French artistocrat Marie Antoinette responded "Let them eat cake." Or so the legend goes. Soon thereafter, the Parisian citizens exacted their revenge in a barbaric form of weight-loss surgery not covered by current medical insurances. Of course times have changed, and today, the New York City Health Department issued new rules for their own staff. According to the <em>Daily News</em>, employees received a brightly-colored pamphlet which spells out a set of regulations guaranteed to cure obesity at the workplace: 1) Tap water must be served as a healthy (?) alternative to other fluids. All beverages must be less than 25 calories per 8 ounces. 2) "Cut muffins and bagels into halves or quarters or order mini-sizes. " 3) No deep-fried foods can be served. 4) For celebrations, cake and air-popped popcorn "popped at the party and served in brown paper lunchbags" are permitted. 5) If a "celebration cake" is served, cookies are not permitted. Here is an excellent example of your tax dollars at work. You might not have known about the health benefits of zero-calorie water or smaller-sized muffins if the medical researchers and exercise physiologists at the NYC Health Department had not done their homework. Yesterday, cookies were a choice--now their illicit use is regulated by the same individuals who have turned second-hand smoking into a frightening toxin...and have ignored epidemic pediatric diabetes for decades. Perhaps with added civic revenues and governmental controls, a child's "celebration cake" will be available only from the Department of Health. Parents may need to have their child weighed by designated civil servants, and once his or her BMI is calculated, an appropriately sized/calorized pastry can be purchased. But no cookies ! And small-sized balloons at the party. How far we have come since the days of the A<em>ncien Regime</em> of Marie Antoinette and Louis XIV. Or, as these beheaded artistocrats might have put it before their demise, <em>plus ca change, plus la meme chose</em>.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-22089758921071209402011-03-28T07:14:00.000-07:002011-03-28T11:12:40.835-07:00Notes on "The Park Avenue Diet Show: Controversies in Weight Loss"; March 27, 2011From its very earliest days the world of weight loss has been filled with controversy. The very first diet doctor was Banting, and he wasn't even a physician. Banting was an undertaker in the mid-1800's who invented a primitive form of the low carbohydrate diet. In fact the term "banting" was synonymous with dieting for many decades. Just as Dr. Robert Atkins did in the late 1960's, Banting advocated eating a disproportionate amount of protein. Most modern nutritionists would find this alarming, for among other things this program increases the risk of gout and kidney stones. When he was the on-site physician for Bell Telephone, Dr. Atkins adapted Banting's philosophy into a more concise set of recommendations. Controversy followed Dr. Atkins throughout his professional career. And the arguments still rage eight years after his death. You can buy Atkins Bars virtually everywhere, but are they correctly utilized by purchasers in the context of a low carbohydrate diet or assumed to have magical weight loss properties despite the high fat content? The Kempner Rice Diet, the bill of fare at the same-named institute at Duke University, seems like a sensible therapy. You check in prepared to eat nothing but steamed rice for several weeks and hope that the pounds melt off as quickly as possible. Sounds like a winner, no? But as Dr. Atkins himself told me, the "patients" must leave a urine sample in a jug outside their door at the end of every day. Lab technicians will test the urine for protein, something that is totally absent in steamed rice. But where would such protein be coming from? A tech-savvy patient could use his or her smart phone to find any one of dozens of gourmet restaurants surrounding the Kempner Institute. Dr. Atkins told me that the overweight comedian Buddy Hackett used to switch his urine sample with that of his neighbors after a delicious forbidden meal. Fast forward to 2011 when obese individuals who have had lap band surgery have devised a multitude of ways to have their liquified cake and eat it. Who is being cheated by this type of irrational behavior? The manufacturer of the lap band? The surgeon? The insurance company that paid for the procedure in the first place? The other policy holders in that insurance plan who must contribute additional moneys in their premiums to support such behavior? The scientific community encourages healthy debate in order to find the objective truths in the areas of health care of most benefit to society. You'll find very little objectivity in the world of weight loss. From banting to bariatrics, controversy have raged for almost two hundred years. <em>Plus ca change, plus la meme chose.</em>Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-59942508084379800892011-03-21T07:18:00.000-07:002011-03-21T09:13:55.299-07:00Notes on "The Park Avenue Diet Show: The Capacity for Close Relating"; March 20, 2011What are the most important defining characteristics of someone who has lost weight, changed his or her image, and maintained their new-found health consistently? Surprisingly, this subject has rarely been addressed at the annual convention of the American College of Physicians, a convocation I have attended almost continuously since 1983. But this year at the upcoming meeting in San Diego in a few weeks, an answer might be forthcoming.<br /><br />In a seminar entitled "Treatment of Obesity", Dr. Robert <span id="SPELLING_ERROR_0" class="blsp-spelling-error">Kushner</span> will present data that provide a fascinating but not surprising set of answers. He asks: "What behavioral issues need to be appreciated for successful weight loss?" And he provides a partial list, one that dovetails remarkably with the philosophical and psychological infrastructure of <em>The Park Avenue Diet.</em><br /><em></em><br />First we should mention what is not important or predictive of success, namely the <span id="SPELLING_ERROR_1" class="blsp-spelling-error">macronutrient</span> food constituents of a weight-loss program. Endless ink has been spilled over the supposed benefits of the American Heart Association/ Atkins/ South Beach/ Weight Watchers/ <span id="SPELLING_ERROR_2" class="blsp-spelling-error">Pritikin</span>/ etc program--take your pick because their results are almost uniformly <span id="SPELLING_ERROR_3" class="blsp-spelling-corrected">identical</span> and depressing: a 5-10% "success" rate, with "success" being defined as approximately 10-15 pounds in one year, hardly a remarkable achievement. The American College of Physicians and the AMA have stated that they will not be accepting papers for presentation on the supposed benefits of any of these programs anymore. There is no point comparing one "therapy" to another when none of them isn't even remotely beneficial to a majority of people.<br /><br />On the other hand Dr. <span id="SPELLING_ERROR_4" class="blsp-spelling-error">Kushner</span> provides a list of seven defining characteristics of the successful weight-loss patient, and here they are exactly as enumerated:<br /><br />1) Coping capacity<br />2) Self-efficacy<br />3) Autonomy<br />4) Healthy narcissism<br />5) Motivation for weight loss: more confidence<br />6) Stability in life<br />7) Capacity for close relating<br /><br />Virtually all of these are covered in one way or another in <em>The Park Avenue Diet</em> by either the famed humanistic psychologist Dr. Stanley <span id="SPELLING_ERROR_5" class="blsp-spelling-error">Krippner</span> or the glamorous, wise socialite <span id="SPELLING_ERROR_6" class="blsp-spelling-error">Tinsley</span> Mortimer. And the publication of the book predates this <span id="SPELLING_ERROR_7" class="blsp-spelling-error">ACP</span> academic presentation by two years.<br /><br />Several of the behavioral issues might be defined by Dr. <span id="SPELLING_ERROR_8" class="blsp-spelling-error">Krippner</span> as offshoots of personal myths, the rulebook, narrative, or code we have formulated based on our life experiences and upbringing. Autonomous, efficacious people are self-reliant and self-motivated. Those of us who are better at coping with stress may avoid relying on "comfort foods" or high-calorie snacks for temporary pleasure during life crises. And more self-confidence means more pride in <span id="SPELLING_ERROR_9" class="blsp-spelling-corrected">appearance</span>, behavior, and <span id="SPELLING_ERROR_10" class="blsp-spelling-corrected">physicality</span>.<br /><br />But it is the inclusion of "the capacity for close relating" that most interested me. One's need for intimacy, close relationships, bonds based on trust and affection--this is also crucial for <span id="SPELLING_ERROR_11" class="blsp-spelling-corrected">maintenance</span> of weight, a matter I can attest to professionally and personally. The converse situation, wherein an individual eats, relaxes and sleeps alone, is sometimes a scenario for introversion, loneliness, carelessness, self-neglect, depression, and an unhappy existence.<br /><br />Except for <em>The Park Avenue Diet</em> I have never seen "the capacity for close relating" applied to any medical condition. But it certainly is important for one's health, especially as defined by the World Health Organization. "Physical, mental and social well-being, and not merely the absence of disease." Social health depends in part on self-confidence and good interpersonal skills, two of the seven most important components of image. And social health is a dynamic construct--you cannot measure it by weight, height, or a blood test value. You must actually do something, namely <span id="SPELLING_ERROR_12" class="blsp-spelling-corrected">interact</span> well with others on a professional, familial, and personal/intimate level.<br /><br />We'll return to this topic after I return from my <span id="SPELLING_ERROR_13" class="blsp-spelling-error">ACP</span> conference in about three weeks. But you can certainly learn a lot from my guest expert Bernadette <span id="SPELLING_ERROR_14" class="blsp-spelling-error">Penotti</span>--in our book, on the radio, on her website, or in person !Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-62773527142048791202011-03-16T06:43:00.000-07:002011-03-16T07:26:40.703-07:00The Last Word on Stress (for now)The topic of stress can not be covered in too great detail. There are so many aspects to the subject, neurochemical, behavioral, hormonal, pathological, social--such that any brief discussion might seem overly simplistic. Moreover an academic presentation might leave out what readers or listeners need the most, namely practical advice.<br /><br />Coping with stress is a learned skill. One needs multiple attempts, failures, and successes before having a confident approach to life's trials and tribulations. This is a learning curve that never ends because the stresses of adolescence, challenging as they may appear, have little relationship to the stresses one encounters late in life. But the self-confidence we gain by learning "not to sweat the small stuff" is a way to become better equipped for dealing with more momentous issues.<br /><br />As a physician I have always felt that the stress of illness is the most important stess to learn to cope with. A young child overreacts instinctively to a slight accident or infinitesimal bodily harm. A fall in the playground will result in minutes of loud crying for no apparent purpose. A mother knows her duties well: not just soothing the area but giving psychological support. "Awww, it's okay." or "This is not something to cry over." I'm sure you've heard these before even if you don't remember. And your mother's advice on how to cope with stress is probably not too far from the truth right now as well.<br /><br />The pre-eminent psychologist Jean Houston teaches people to view stressful situations in an unusually objective way. She instructed one of her colleagues (currently the Secretary of State) to put her problems in an imaginary box when dealing with other matters. The problems have not been solved, but they are seemingly isolated, to be dealt with at another time. She also teaches people to bolster their own self-confidence by dealing with complex issues as if they were famously self-assured celebrities.<br /><br />We naturally gravitate to movie heroes who never reflect stress in their physical demeanor or conversation. Think of Gary Cooper in <em>High Noon</em>, Sigourney Weaver in <em>Alien</em>, Daniel Craig in <em>Casino Royale</em> or any other of your favorites. They do not ponder or complain about problems. They solve them. And part of coping with stress is not repeatedly enumerating all of one's current stressful issues, especially at 1 a.m., the worst time possible.<br /><br />Psychotherapists, physicians, and in fact all health care providers must be able to offer constructive and user-friendly techniques of coping with stress to their patients. A personal favorite of mine was Albert Ellis, who certainly understood the ways that negative thinking can actually inhibit people from finding an appropriate solution to a troubling issue.<br /><br />But you don't need a professional license to be able to offer good advice to a stressed-out friend. The most serious challenges of life must be handled in a calm and rational way. As an emergency room physician, I learned that speech patterns and body language can be equally as calming as the actual message. Even in dealing with your own problems, slow, calm, and methodical thinking is the first order of business no matter what the stress is. And the stronger and healthier you are physically, the more this will be reflected in mental acuity and a rational approach to stress.<br /><br />Let's leave this subject for now. Stress will not go away, as you can see right now on the front page of any newspaper in the world. But coping with stress is an ongoing learning process, so pick some examples of "easy" problems and think of how you can frame them, analyze them, and solve them in a rational and healthy way. Your physical well-being depends on it.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-7193677073606810492011-03-09T06:11:00.000-08:002011-03-09T08:59:46.964-08:00How to Cope With Stress (Part Three)Stress is such an important topic that two lengthy discussions of the subject are a mere introduction. I have lectured on this topic frequently, and Dr. Krippner and my DOROT Institute co-presentation from 2004 can be heard on my website. Our recent follow-up discussion is the March 13th WOR broadcast of "The Park Avenue Diet Show".<br /><br />What is the biochemistry of stress? Although incompletely understood, it can be simplified by focusing on three discrete body parts: the hypothalamus, the pituitary, and the adrenal gland. Let's start at the top, namely the cerebral cortex, the outermost part of the brain where we do most of our thinking. As we view challenging situations or think stressful thoughts, impulses are sent to the hypothalamus, a tiny organ at the base of the human brain.<br /><br />In addition to dozens of other known and unknown functions, the hypothalamus will secrete a chemical called corticotropin releasing hormone. This will travel a very short distance to the pituitary gland nearby, which will in turn secrete ACTH, adrenocorticotropin hormone. And this chemical in turn will stimulate the adrenal glands adjoining the kidneys to release cortisol.<br /><br />You may not have heard of any of these chemicals before, and you are probably not aware of this cascade of hormones that rapidly follows exposure to a stressful situation. But you certainly know the feelings that they engender: nervousness, palpitation, dizziness, forgetfulness, and unremitting worrying.<br /><br />Human neurochemistry is an extremely complex topic, as is physiological psychology, although both are extraordinarily interesting. Why we think what we think is an amalgam of neurotransmitters, hormones, behavioral patterns, social relationships, and personal mythology. Yet no one needs to be told what stress feels like. Everyone experiences it from cradle to grave.<br /><br />Sometimes we can get used to stress and become less worried under a given set of circumstances. This is called desensitization. New Yorkers for example are accustomed to hearing car horns, police sirens, and other noises that might be startling to someone from a quiet rural area. Emergency room physicians are unaffected by beeps, buzzers, flashing lights, and other noises that might startle or frighten an already tense patient.<br /><br />The stress response that is "pre-installed" in our bodies was a protective mechanism in our pre-historic past. "Fight or flight" might have been a daily activity in the dangerous world of cavemen and cavewomen. The adrenal gland was thus a lifesaver: this organ which sits on top of both kidneys is the control center for dealing with pre-historic environmental crises. Not only would it allow humans to flee dangerous animals by increasing cardiac and respiratory rates, it would allow the glucose supply to be rapidly increased, fueling the leg muscles so they could work in overdrive.<br /><br />But these days, although we may have severe stress throughout the day, we certainly do not need excessive blood sugar, a racing heart, or hyperventilation. A simplistic definition of anxiety might be excessive secretion of cortisol and adrenaline when none is necessary.<br /><br />Anxiety is also a complex topic, one usually discussed by prominent psychologists like Dr. Stanley Krippner rather than physicians. Needless to say anxiety like many other mood disorders depends in part on altered or dysfunctional neurochemistry.<br /><br />People who suffer from unremitting anxiety may also have certain generalized fears, sometimes worsened by stress. Acrophobia (a fear of heights) is actually quite normal: extremely few people feel comfortable standing on a cliff overlooking Grand Canyon. But agoraphobia (a fear of public places) can be extremely debilitating and frightening. Acute and/or chronic stress can make certain individuals extremely reclusive, prohibiting them from virtually all social interactions.<br /><br />Stress can affect one's perception of one's own health. Unremitting anxiety can lead to a somatization disorder, when an individual seeks medical attention repeatedly for an illness that doesn't exist. Another possible scenario is called a conversion disorder where neurological symptoms such as paralysis, numbness, or apparent blindness are a direct result of extreme personal stress.<br /><br />These are considered psychiatric conditions, but stress unfortunately can be a co-factor in dozens of medical ailments. Excessive cortisol can decrease the production of mucus that lines the stomach and protects it from highly caustic hydrochloric acid. In this way, stress causes ulcers, a subject which I unfortunately am an expert in (having suffered an attack in 1991).<br /><br />Stress is translated into hair loss for many people. How do you know if this is affecting you? When you run your hands gently through your hair, if 5 out of 12 hairs become loosened and fall out, stress may be the reason. And how does stress cause hair loss? "Growing" hairs are converted into "resting" hairs (which are not implanted as well) and fall out.<br /><br />One of the most fascinating medical expressions of stress can be seen in a hyperventilating patient. Due to carbon dioxide and calcium imbalances, an extremely stressed out person may develop<em> main d'accouchment </em>[delivery hand, namely the hand shape that an obstetrician uses].<br /><br />But enough talk about the neurochemistry, physiology, and pathology of stress. I'm sure that you are familiar with a great deal of this already. Did you know that the human body also has embedded anti-stress hormones and "software"? We have focused primarily on the sympathetic nervous system, which is responsible for "fight or flight". It has a mirror-image in the parasympathetic nervous system, a parallel set of nerves, neurotransmitters, hormones, and physiologic responses.<br /><br />By gently rubbing one side of the neck near the carotid artery, a cardiologist or emergency room physician is able to stimulate an "anti-adrenaline" mechanism when faced with a patient with an extremely rapid heart rhythm. Don't try this, but gentle pressure on the eyes elicits a similar response, namely stimulation of the vagus nerve, the superhighway of the parasympathetic nervous system.<br /><br />Another outstanding example is the "diving reflex". When certain birds and animals plunge into ice water, their heart rate, breathing rate, and metabolic rate all rapidly decrease. One of the extremely rarely used emergency room treatments for palpitations due to life-threatening arrhythmias is to plunge the patient's face into a basin of ice water, eliciting a type of "diving reflex" in a human being. Do not try this at home.<br /><br />These examples although quite dramatic will show you that there exists in the human body a neurochemical balance to the stress mechanisms we have already discussed. Of course these emergency room heroic techniques are inappropriate for solving personal problems or coping with daily stresses. I'm sure you probably have not been aware of this unusually complex interrelationship.<br /><br />Depersonalization, however, is a common and rather unconscious technique of coping with stress. This can be broadly defined as a technique of forgetting about one's self and directing one's thoughts totally externally. And I'm sure you have done this rather frequently in the last few months. Going to an exciting sports event, watching a thrilling James Bond movie, even reading a gossip magazine--all of these are activities that allow us to escape from our problems and briefly enter a "parallel universe" nearby. The stressful problems we are temporarily escaping will still be there later on, but our bodies are refreshed by the relief from unremitting bombardment by stress.<br /><br />Alpha waves in the brain appear on EEG's when people are in a relaxed state, and quite often people can be taught how to achieve this level of psychological comfort. One classic way is through meditation, which can be somewhat duplicated by repeating a particular word or phrase over and over. Recent research has focused on endorphins, neurochemicals that are associated with positive and pleasurable feelings. You have no doubt heard that aerobic exercise, particularly jogging, is associated with the release of endorphins. Moreover, aerobic exercise "tones down" the sympathetic nervous system. This partially explains why "cardio" is a useful ancillary therapy for high blood pressure and heart disease.<br /><br />Many people feel that coping with stress is best achieved through the use of minor tranquilizers such as Valium or Xanax. But I think it's more important to understand the neurochemical, physiological, and psychopharmalogical aspects of the topic rather than simply resorting to the simplistic therapy of prescription medication. Let's leave our discussion of this extraordinarily important issue at this point. We will continue at another time. Now go have a totally stress-free day!Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-4145630521034775092011-03-08T06:15:00.001-08:002011-03-08T07:44:02.485-08:00Notes on "The Park Avenue Diet Show: How to Cope With Stress (Part Two)"; March 13, 2011Stress. You can't live with it, you can't live without it. But what is it?<br /><br />Stress may be an acute reaction to a traumatic event or the breaking point when multiple challenging issues overwhelm a given individual. Stress varies from person to person, age group to age group, country to country, and continent to continent. It is classically thought of as a psychological disorder yet there is strong evidence for biochemical mediation. Everyone experiences stress at some time in his or her life, with only about 5-10% of the population experiencing severe recurrent symptoms.<br /><br />What may provoke stress in one person may not necessarily affect others the same way. Yet no one would deny that these are especially stressful times. In addition to the unavoidable personal issues we may struggle with, there are plenty of problems locally and internationally to complicate the picture: terrorism, financial instability, chronic diseases, international conflicts.<br /><br />While you may not know the names of the areas of the brain associated with feelings of stress (the hippocampus, amygdala, and cerebral cortex) you certainly know the feelings: restlessness, exhaustion, inability to concentrate, labile emotions, insomnia, incessant worrying. Some people may react to stress with emotional detachment, carelessness, and depersonalization. The latter describes a type of flight from reality, where the person temporarily escapes anxiety-provoking situations by retreating into an imaginary world.<br /><br />Stress, however, is definitely a more serious problem when it creates or worsens medical conditions. Virtually every known illness can be affected negatively by stress. Blood pressure may rise, glucose levels may double, coronary arteries may narrow, and breathing may become difficult. Stress may also create or worsen lifestyle patterns such as overeating (or paradoxically anorexia nervosa) and may unfortunately lead to substance abuse as the individual self-medicates his or her anxiety with alcohol, cigarettes, or illegal drugs.<br /><br />As you are well aware the primary treatment of stress in the United States is with prescription medication under the supervision of a psychopharmacologist. Supportive psychotherapy is not part of a typical visit to an internal medicine specialist. Moreover, since the average length of such a medical visit is only eight minutes long in 2011, the physician has absolutely no time to discuss his or her patient's life stressors. Not surprisingly, physicians too have stressful lives. If you don't believe me, read <em>Uncle Vanya </em>by Anton Chekhov.<br /><br />Just like watching your weight and doing structured physical exercises, learning how to cope with stress is a skill that is necessary for optimal health. It is not merely a useful tool, it is a necessary technique for survival. Debilitating stress can derail any of our long-term personal or career goals quite rapidly. And simplistically relying on tranquilizers, sedatives, or antidepressants does not change the nature of the stress or give us guidance in how to resolve challenging issues.<br /><br />I have been lucky to know Dr. Stanley Krippner since 1967 when I was his file clerk at Maimonides Medical Center during my high school years. As one of the most esteemed humanistic psychologists of the recent past, he has written dozens of books and hundreds of articles about mood disorders and how they affect an individual's thinking, interpersonal relationships, creative work, and community activities. We have discussed this enormous topic in various venues, and although we are seemingly experts in the field, we still experience enormous stress for which we must continually reinvent our own coping mechanisms and positive strategies.<br /><br />Some of these are explored in our WOR radio interview and our lengthy lecture at the DOROT Institute, both of which you can hear on this website. You will never be able to totally eradicate stress from your life. You will certainly have something stressful happen to you within the next twenty four hours, hopefully minor. But you must not avoid learning and relearning how to cope with stress. And if you are suffering from palpitations, hair loss, insomnia, feelings of worthlessness, extreme sadness, or similar symptoms, the time to learn how to cope with stress is right now.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-16494509270343943962011-03-01T06:36:00.000-08:002011-03-01T08:12:59.088-08:00Notes on "The Park Avenue Diet: A Tale of Two Books"; Sunday, March 6, 2011How do you define "health"? The arrival of spring is the perfect opportunity to consider this issue. I tend to agree with the definition as articulated by the World Health Organization: "Physical, mental, and social well-being, and not merely the absence of disease." Dr. Stanley Krippner reminds his students and readers of the extreme importance of social well-being, something that has obviously had a tremendous impact on my personal and professional philosophy.<br /><br />Health is definitely an evanescent entity: one minute you have it, the next minute it may be lost. I learned this first-hand as a medical student at Maimonides Medical Center. I also learned that health is an ongoing responsibility. If you relax your efforts and vigilance, you may not be able to regain lost ground.<br /><br />I have had the honor of having two books published consecutively by the erudite company, Hatherleigh Press. They are <em>The Little Book of Big Medical Emergencies</em> and <em>The Park Avenue</em> <em>Diet. </em>Does the topic matter for these books seem wildly divergent to you? One of the editors at Hatherleigh Press asked me if the two books had anything in common. Of course they did, I said, they are both about health.<br /><br /><em>The Little Book of Big Medical Emergencies, </em>which I wrote with Mark Steisel, is a user-friendly guide to the most serious and life-threatening health issues. It reflects my four years as an emergency room attending physician at Cabrini Medical Center where I worked between 1983 and 1987 for 600 twelve-hour shifts. Naturally I saw every conceivable type of medical, surgical, orthopedic, urological, and psychological emergency, just to name a few.<br /><br />But what seemed most crucial to me was the patient's ability to minimize or avoid debilitating consequences, if possible, by recognizing the onset of the medical emergency. Certainly many emergencies can not be predicted, such as accidental falls or fractures. But others such as cardiac problems, back pain, and fainting might require immediate attention and first-aid before an ambulance is called.<br /><br /><em>The Little Book of Big Medical Emergencies </em>is a concise guide to a complex subject, written in easy to understand terms and covering hundreds of possible scenarios. The book was originally published in 2002 by Barricade Books: the legendary publisher Lyle Stuart personally selected it for his catalogue, one of the greatest honors of my life. Hatherleigh Press published an updated and more elegant edition in 2007. For this version I asked fourteen different academic physicians to proofread and add comments as they felt necessary. The contributing physicians, all brilliant and generous colleagues, included famed diabetologist Dr. Philip Felig, pioneering surgeon Dr. Avram Cooperman, pediatrician Dr. Amy Glaser and superlative orthopedist Dr. Jacob D. Rozbruch.<br /><br />Simply put, this is a book that belongs in every home, and here is one way to get a copy:<br /><br /><br /><br /><em>The Park Avenue Diet </em>is also ground-breaking, albeit in a totally different way. I had been approached by numerous publicists and publishers to write a diet book after my nine year professional relationship with Dr. Robert Atkins. Most weight loss books seemed too monolithic to me: they were essentially a list of recipes, some pseudo-scientific gobbledygook, and perhaps a few semi-fictional case studies. Moreover, study after study in respected medical journals conclusively proved that the constituents of a weight loss menu have no predictive outcome in an individual's ability to become thinner. Macrobiotic=low carbohydrate=low fat. Even worse, diets that are food-centric have a 95% chance of failure. The "cure" rate of obesity is approximately the cure rate for lung cancer, namely 5%.<br /><br />The only people who successfully lose weight and maintain their new-found body shape have undergone changes in their philosophical approach to physical, mental, and social health. In common parlance, they have adopted a "healthy lifestyle." That's why I set out to write not merely a "diet book" but a guide to changing one's entire image.<br /><br />As with <em>The</em> <em>Little Book of Big Medical Emergencies, </em>I sought input from multiple experts, this time in unusually diverse fields. <em>The Park Avenue Diet </em>is thus the only book of its kind to juxtapose advice from celebrities such as Tinsley Mortimer, Laura Geller, and Joel Warren with personal health specialists such as Dr. Stanley Krippner, Berrnadette Penotti, and Chef Marie Annick Courtier. As a bonus, internationally respected fashion consultant Helene Hellsten is there to show you how to choose the most flattering clothing.<br /><br />And here's how to get your own copy.<br /><br /><br /><br />It's even available as a Kindle download.<br /><br /><br /><br />And that's "A Tale of Two Books".Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-70760271148720897812011-02-21T05:09:00.000-08:002011-02-21T05:49:49.682-08:00Notes on "The Park Avenue Diet Show: The Mathematics of Dieting"; February 20, 2011The subject of weight loss lends itself to analysis from an anatomical, physiological, sociological, biochemical, pathological, psychological, histological, and epidemiological point of view--one at a time, please.<br /><br />But mention "The Mathematics of Dieting" and even the most frustrated overweight people become fascinated with the intricate workings of the machine we all inhabit, the human body. Like a car, a television remote, and a NASA rocket, we too need fuel, and as one would expect, there are relatively strict numerical formulations involved in the conversion of food to energy. The energy was may utilized immediately during a calisthenics class--or the "energy" may be stored visibly as body fat, encircling one's body like a corset of AA batteries.<br /><br />3500 calories equals one pound in either direction. To gain a pound, the American equivalent of falling off a log, one must eat an excess of 3500 calories over one's metabolic needs. To lose a pound, not as easy as it seems, one must burn off 3500 calories--by swimming for 6 hours, for example.<br /><br />How many calories do you eat per day? You can find this number approximately by multiplying your weight by 15. Therefore, a 200-pound individual is ingesting 3000 calories daily in order to stay the same weight. Any physical exercise must be taken into account and additional caloric requirements considered. But the math is still the same, and since many American do minimal if any physical exercise daily, the above calculation is quite accurate...and startling.<br /><br />A 300-pound worker at my radio station was totally fascinated by "The Mathematics of Dieting" like a child hearing about Santa Claus or the Easter Bunny. And no cross examination was needed: he silently added up his foods for the day and the math was correct. And if that person were to cut out 500 calories per day from any meal or snack, he would lose one pound per week.<br /><br />Let's invert the formula and express it a different way. Since there are 365 days in a year and 3500 (let's pretend 3650) calories in a pound, any additional of 10 calories per day results in a one-pound weight gain in one year. A single 20 calorie biscuit per day will add two pounds per year. A 150 calorie can of soda per day will make anyone gain 15 pounds per year.<br /><br />Review your daily food habits with this in mind. Are the extra pounds (daily or yearly) worth it? You might find ways of cutting back on calories that seem insignificant, yet it all adds up. Enjoying flavored seltzer (no artificial sweeteners, please) instead of juice or soda could remove 15 pounds of visible or visceral fat--all by itself.<br /><br />"The Mathematics of Dieting" is a practical way of explaining that your weight is an understandable phenomenon. There will be a variation amongst people of about 15% due to slow metabolism, certain satiation hormones, and other biochemical parameters. But the basics are most definitely real, so write down what you eat, calculate your energy intake per day (weight times 15), see if exercise or its absence needs to be accounted for...and change for the better.<br /><br />What's the first step in understanding the metabolic workings of your own body? Do the math !Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-47953287241521411232011-02-14T06:56:00.000-08:002011-02-14T07:31:28.853-08:00Notes on "The Park Avenue Diet Show: What Should I Have for Lunch?"; February 13, 2011Lunch means different things to different people. Having traveled the world and temporarily becoming immersed in dozens of different civilizations. I have experienced as wide of a variety of noon-time meals as anyone I know. In Mexico I enjoyed <em>ceviche</em>, raw fish served as a beach food on the sands of Puerto Vallarta overlooking the Pacific Ocean. In Sherpa villages near Mount Everest, Nepal, I enjoyed momos, a type of dumpling. And in Ouarzazate, Morocco, I dug into chicken<em> tajine</em>, a hearty stew eaten native-style with both hands.<br /><br />None of these exotic lunches is available in the United States. Moreover, these meals are part of a total cultural experience. A visitor to New York City from Puerto Vallarta, Nepal, or Morocco would probably be fascinated by and drawn to the same fast food franchises that millions frequent every day.<br /><br />When I was about ten years old, a drive-in hamburger joint named Wetsons opened on Empire Boulevard and Flatbush Avenue, near my home. My mother was shocked that anyone would deny himself or herself the pleasures of a home cooked meal for a boxed cheeseburger and greasy fried potatoes. Unfortunately this was the shape of things to come, as H. G. Wells might have said.<br /><br />The shape of things to come might also have included the shape of 21st century Americans. Although you can download, print, or read the nutritional content of your local chicken/burger/pizza/hero sandwich menu, few people if any read the fine print.<br /><br />Except in individuals with highly physical jobs, lunch should never exceed 500 calories. Inattention to caloric content has immediate implications for weight. Inattention to salt and/or macronutrient content has immediate implications for blood pressure, fluid balance, and blood sugar. A high triglyceride level after a meal usually means that the person has the metabolic syndrome and is rapidly transforming dietary glucose into circulating, potentially dangerous fats.<br /><br />A healthy lunch is not impossible to find. The choice is up to you. Please consider substituting the immediate gratification of fast foods for the delayed gratification inherent in longer life and better health. Which will you have for lunch?Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-35768160816939766452011-02-07T12:27:00.000-08:002011-02-07T13:05:56.182-08:00Notes on "The Park Avenue Diet Show: The Hidden Cost of Being Overweight"; February 6, 2011"A tsunami of obesity" is how an editorial last week in the British medical journal <span style="font-style: italic;">The Lancet</span> described the latest worldwide statistics. One in three people on Earth is overweight, one in nine people is obese. That this could happen in previously healthy, relatively isolated populations is indeed quite shocking. Even more frightening is the fact that the percentage of obese individuals doubled since 1980. "Worldwide" now has another meaning.<br /><br />No one in the United States will be surprised since here the percentages of overweight and obesity are both 33%. We always stay ahead of the pack! At least initially, because residents of Pacific island nations currently have the highest BMIs on the entire planet. If <span style="font-style: italic;">Mutiny on the Bounty</span> were being filmed today, the romantic scenes might not seem as glamorous.<br /><br />Everyone will have his or her own explanation of this sorry state of affairs, whether socioeconomic, geopolitical, culinary, or biochemical. That doesn't change the fact that this "tsunami" is a mere harbinger of worse to come. As reported by various experts in the American College of Physicians, obesity is a risk factor for 40 illnesses in 9 different organ systems. Most people are aware of the most prevalent ones, namely hypertension, diabetes, high cholesterol, and circulatory illnesses. Yet obesity is unique in being directed implicated in breast cancer and prostate cancer, diseases worsened by diametrically opposite hormones. Also on this list: asthma, atrial fibrillation, colon cancer, sleep apnea, mood disorders etc...Such is the nature of visceral fat, a topic covered in depth elsewhere on this website and on the WOR radio show.<br /><br />"The Hidden Cost of Being Overweight" refers to the various medications, emergencies, and hospitalizations due to the aforementioned illnesses. There cannot be a price on human suffering, for every life is precious--and good health is a priceless gift. The media at times have raised fear of global warming to a near hysterical pitch. In epidemic obesity, we have a health crisis that will affect younger generations within several decades. Meteorology is a most elusive science. Internal medicine is not, and unfortunately, things may have to get worse before they get better.<br /><br />Just this once, please don't think about the rest of the world. Think about yourself !Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-39920147229909312802011-02-01T07:08:00.001-08:002011-02-01T07:42:46.182-08:00Notes on "The Park Avenue Diet Show: The Salt of the Earth"; January 30, 2011I haven't touched a salt shaker since 1976 when, as a medical student at Maimonides Medical Center, I saw the immediate effects of sodium chloride on blood pressure and fluid retention. When was the last time you used a salt shaker? Did you stop in 1976 as well?<br /><br />What were those early clinical experiences that so alarmed me? One had to have been repeatedly seeing elderly people rushed to the emergency room after a large salty meal. The patients were sitting upright gasping for breath, blue in the face, alarming their family and friends. Pulmonary edema, commonly referred to as "water in the lungs" was what these unhappy people were experiencing. There was literally a parade of ambulances and stretchers on Christmas Eve after the Feast of the Seven Fishes. That enormously salty meal resulted in fluid retention and terrifying medical emergencies.<br /><br />Sodium chloride exerts its dangerous effects via an osmotic affinity with water. That's why the people almost drowned internally after overeating on Christmas Eve. The same osmotic effect is responsible for sodium chloride's ability to preserve food. Did you know that? When added to a can of recently cooked string beans, for example, salt will draw fluid from any nearby bacteria, thus dehydrating and killing them. This property has been known for thousands of years and is exactly why Austrian "cavemen" and Roman soldiers learned to use salt as a means of preserving fresh foods. It certainly was not added to make the items taste better.<br /><br />How much salt do you need in a day? Very little, because our kidneys miraculously extract just the right amount from what we eat. Rarely can adding salt to food be considered life-saving or essential (the only examples of the contrary would apply to people who have fainted or have severe diarrhea or dehydration).<br /><br />Since only 2,000 milligrams of sodium is recommended per day, why would anyone throw caution to the wind and eat foods that have unnecessarily high amounts included? I have no idea. Even the innocuous gesture of adding salt to water when making pasta needs some re-evaluation. Do you know why salt is added? It's to raise the boiling point of the water. In that way the pasta will cook more quickly and thoroughly, especially if it is preferred "al dente". If salt were added simply for taste, it could just as easily be added afterwards.<br /><br />Salt and its effect on weight is well documented. The last thing that someone struggling with weight needs is fluid retention. Therefore please consider doing what I did in 1976 and give up table salt for the next thirty-five years. And in thirty-five years, ask me whether or not to continue this way.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-1421068441741107752011-01-10T07:29:00.000-08:002011-01-10T08:00:15.290-08:00Notes on "The Park Avenue Diet Show: Log Cabin Exercises"; January 9, 2011When Americans think of exercise, if indeed they do, it is viewed as a chore or a hardship or an <span id="SPELLING_ERROR_0" class="blsp-spelling-corrected">unpleasant</span> atonement for the sin of sloth. Our mechanized society, where transportation is totally automated and home conveniences make housework almost unnecessary, has resulted in epidemic overweight and obesity. But that's not true in other parts of the world.<br /><br />Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical <span id="SPELLING_ERROR_1" class="blsp-spelling-error">health</span>. There are no weight-loss clinics in the villages near the highest Himalayan mountains. I took a two week trek to the base camp of Mount Everest about twenty years ago which I described to friends as the ultimate Stair Master. The Sherpa people, the famed indigenous population of this <span id="SPELLING_ERROR_2" class="blsp-spelling-error">Shangri</span>-la, do not suffer weight problems at all.<br /><br />Even in the "lower" ranges of the Austrian Alps or the Moroccan Atlas mountains, everyone appears fit and trim. A walk to the local store in <span id="SPELLING_ERROR_3" class="blsp-spelling-error">Badgastein</span> takes one down a forty-five degree angled street for twenty minutes. No matter what Viennese pastry one might eat as a snack, it is thoroughly burned off after the ascent back to the train station. Was it worth it? I could hardly move my legs the day after I tried this for the first time, despite going to a New York City gym daily for twenty years.<br /><br />According to the American College of Physicians, via their workshops and seminars, exercise is much less important than diet if someone is obese. Caloric control is therefore a necessary first step in any attempt to lose weight. However, as one gets closer to an ideal weight or a realistic goal, exercise becomes mandatory. Regular structured exercise is necessary for weight maintenance, for which reason I sometimes call those "last ten pounds" "exercise pounds".<br /><br />All exercise programs must include strength training and <span id="SPELLING_ERROR_4" class="blsp-spelling-error">cardio</span>, and the most skillful personal trainers have learned how to teach these to their clients simultaneously. Attention must also be paid to flexibility and balance; these are extraordinarily important for aging baby boomers, especially those born in Brooklyn.<br /><br />Are there psychological benefits to exercise? I feel that the ability of skeletal muscles to use lactic acid as a fuel (a property that must be developed through <span id="SPELLING_ERROR_5" class="blsp-spelling-error">cardio</span> exercise) makes an individual more energetic and upbeat. Other researchers feel that endorphins are released during exercise, but I favor the reduction of lactic acid levels as a biochemical explanation of the beneficial psychological effects.<br /><br />A good personal trainer is not merely a human textbook of calisthenics. He or she must be a motivational speaker and somewhat of a psychologist. Most people who do not exercise need to be inspired, and this will <span id="SPELLING_ERROR_6" class="blsp-spelling-corrected">jump start</span> their participation in physical activity. For the 67% of adult Americans who are overweight or obese, this needs to be more than a temporary New Year's resolution. I didn't like to exercise at all when I was in high school and college. Then I grew up. Now it's your turn.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-64750673384004290652011-01-03T11:15:00.000-08:002011-01-03T11:57:29.465-08:00National Diet DayJanuary 2nd has been renamed National Diet Day, at least in my own imaginary calendar. I invented this non-existent holiday 20 years ago as the Associate Medical Director of the Atkins Center when I noticed patients' remorse over dietary indiscretions during the holiday season. The same people who had over-indulged in eggnog, candy-canes, and Chanukah chocolates now felt sorry for themselves. And like penitents confessing a minor sin while omitting a larger one, they "promised to themselves" a more healthful future.<br /><br />This is properly labeled a New Year's Delusion, something Dr. Stanley Krippner might call a negative personal myth. The mere act of "repenting" is a supposed antidote to the wretched excess of the past few weeks or months. Self-esteem is falsely boosted by the individual's newly found self-observation, as if that in itself melts the pounds away.<br /><br />And then comes January 2nd, when one's conscience and seemingly the entire "diet" industry revs ups their engines to promote weight-loss plans for all palates and sizes. The American College of Physicians notes that 95% of these programs fail their followers...or is it the other way around? When an industry giant like [name redacted] promises weight-loss via lasagna, cookies, and pizza, who can resist?<br /><br />You can, if you realize that none of these supposedly "nutritious" programs dare to publish their statistics of success and failure. In tiny type, there is a message flashed on your TV screen for a microsecond: "results not typical", which I rephrase as "it is not typical for you to get results", a perfectly legal recasting of their devilishly insincere message. Those exercise programs like [redacted] and [redacted]? January is an unusually busy month for sign-ups at your local health-club, but lifting the pen to sign a contract is unfortunately the last exercise many people will do there.<br /><br />Without simultaneous attention to all the components of image, not just the one an overweight post-holiday dieter might focus on, nothing will ever be lastingly accomplished. National Diet Day (and Month, actually) is therefore a form of mock penitence that cannot lead to better health. Our bodies are not aware of any holidays; diabetes and its complications can occur at any time of year. The Angel of Death, unlike many public service union members, goes to work every single day.<br /><br />My imaginary holiday, National Diet Day, is a reaction to the cyclical nature of many overeaters' thought processes--eat, drink, and be merry, for tomorrow you die(t). But for the 33% of adult American not affected by overweight or obesity, National Diet Day is every day of the year. And for them, the celebration of health--and life--takes precedence over the temporary pleasures of high calorie foods. Statistically, the better your weight is, the more likely it is that you will celebrate many more January 2nds. Now there's a great reason to say "Happy New Year"!Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-79497577044648086552010-12-27T05:30:00.000-08:002010-12-27T07:16:57.703-08:00A Walk Through the Snow with Doctor AstrovWhen most people awaken to see the after-effects of a mammoth blizzard, their thoughts don't drift to visions of physicians from long-ago, trudging through mountains of snow to see a sick patient or comfort those suffering from chronic illnesses. But that's what preoccupied me this morning after New York City was blanketed with a titanic storm that has since moved northward.<br /><br />Such a country doctor was one of my role models, albeit a fictitious one: Dr. <span id="SPELLING_ERROR_0" class="blsp-spelling-error">Astrov</span>, the world-weary, philosophical character in <em>Uncle Vanya</em> by Anton Chekhov, himself a country doctor. When I looked out my West Village window and saw the entire street blockaded by snow in every direction, walled off to traffic, devoid of pathways for pedestrians, I thought of those heroic "primary-care physicians" in Czarist Russia whose never heard the words "co-payment", "<span id="SPELLING_ERROR_1" class="blsp-spelling-corrected">deductible</span>', or "referral."<br /><br />They were men on a mission of mercy, and nothing would stand between them and human suffering. Dr. <span id="SPELLING_ERROR_2" class="blsp-spelling-error">Astrov</span> seemingly gives up his whole life for his professional responsibilities; he's unlucky in love and sometimes the patients can't pay. My first and best Dr, <span id="SPELLING_ERROR_3" class="blsp-spelling-error">Astrov</span> was the incredible George C. Scott, and Julie Christie was the girl that got away ! Talk about dedication ! Seeing those actors in 1973 and experiencing Chekhov's bittersweet musings gave me a taste of what it's like to be a physician, even 100 years and thousands of miles away.<br /><br />Dr. <span id="SPELLING_ERROR_4" class="blsp-spelling-error">Astrov</span> might have carried his "little black bag" dozens of miles in sub-freezing temperatures, armed with what we would now consider primitive medications and tools. There were no antibiotics, X-rays, or blood tests. Although superficially understood, heart disease, diabetes, and<br />hypertension were decades away from adequate treatments. The rural doctor like Dr. <span id="SPELLING_ERROR_5" class="blsp-spelling-error">Astrov</span> was essentially a general practitioner with experience in orthopedics, surgery, internal medicine, and sometimes pediatrics--something utterly impossible today.<br /><br />A very real general practitioner in my family, my only close relative who was also a physician, was my great-uncle Abe Fischer. He inspired me for many years, first as a frequent visitor to our home and then as an attendee at conferences at Maimonides Medical Center during the years of my internal medicine residency (1980-83). He looked like a character from a Chekhov play, with theatrical eyebrows and a Freudian goatee. Uncle Abe would immediately sit himself at the head of the table when he came for dinner--the doctor was an honored member of society and thus the immediate focus of attention at family gatherings. He would automatically become the principal conversationalist, and Uncle Abe had plenty of stories to tell.<br /><br />Some of these stories were about various A-level patients he had treated, such as Al Capone, "Dutch" Schultz, and Maria Callas (during her childhood in <span id="SPELLING_ERROR_6" class="blsp-spelling-error">Boro</span> Park, Brooklyn). More often, the stories were about his difficult early years as a physician-in-training. In the 1920's, internships at Maimonides Medical Center (then Israel Zion Hospital) were a precious commodity; in contrast to my starting <span id="SPELLING_ERROR_7" class="blsp-spelling-corrected">salary</span> in 1980 of $25, 000 per year, Uncle Abe had a salary, as he put it, of -$110 per month----the fee he had to pay for room and board. I was on-call every three nights for a continuous 33 hours for three years. Uncle Abe was on-call every single night for three years. And when things were "slow" in the hospital, the medical residents had to ride the ambulance.<br /><br />Such a schedule is unthinkable today. So is that type of dedication, empathy, "bedside manner," integrity, and love of humanity. Uncle Abe was perhaps my greatest inspiration, and I can only hope that I have done something <span id="SPELLING_ERROR_8" class="blsp-spelling-corrected">analogous</span> over my own 30-year career as a physician. Bad weather would never have slowed him down, and he would regularly make all-weather <span id="SPELLING_ERROR_9" class="blsp-spelling-error">housecalls</span> during the Great Depression (the fee was a chicken). I assume that Dr. <span id="SPELLING_ERROR_10" class="blsp-spelling-error">Astrov</span>--and Dr. Chekhov--would have done the same (and the fee would have been similar).<br /><br />Wading through hip-high snow, scaling mini-mountains from one plowed street onto another, dodging icicles, braving frigid blasts of cold air---that's the least I can do to commune with the spirits of those sublimely inspired healers who forged a path for me. I thought of them as I bundled up this morning and headed for my office, one of very few souls in my neighborhood to even venture outside. And I thought about the life of world-weary Chekhovian physicians, those amazing role-models that captured my imagination decades ago. I remember them now. But who will remember me?Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-76543963169781833382010-11-22T09:07:00.000-08:002010-11-22T10:48:10.606-08:00Notes on "The Park Avenue Diet Show: Inflammation: an Introduction"; November 21, 2010The inflammatory response is the body's way of protecting us when infections or injuries <span id="SPELLING_ERROR_0" class="blsp-spelling-corrected">threaten</span> our health. The biochemistry is extremely complex, involving many different chemical mediators (<span id="SPELLING_ERROR_1" class="blsp-spelling-error">prostaglandins</span>, <span id="SPELLING_ERROR_2" class="blsp-spelling-error">leukotrienes</span>, <span id="SPELLING_ERROR_3" class="blsp-spelling-error">thromboxanes</span>) secreted by many different types of cells (<span id="SPELLING_ERROR_4" class="blsp-spelling-error">granulocytes</span>, macrophages, leukocytes).<br /><br />In medical school we were taught the classic signs of inflammation along with their Latin names (which are redness/<span style="font-style: italic;" id="SPELLING_ERROR_5" class="blsp-spelling-error">rubor</span><span style="font-style: italic;">,</span> swelling/<span style="font-style: italic;">tumor</span>, heat/<span style="font-style: italic;" id="SPELLING_ERROR_6" class="blsp-spelling-error">calor</span>, and pain/<span style="font-style: italic;">dolor</span>). Of course, these are the signs of inflammation that you can see; a good example would be a skin infection like an infected cuticle.<br /><br />But inflammation has a dark side. It may also be a destructive process on a microscopic level and might be so small that someone might feel entirely well yet may be perilously ill.<br /><br />Remember our program called "Oil and Water" a few months ago? If not, you might want to listen again on my website <a href="http://www.parkavenuediet.com/">http://www.parkavenuediet.com/</a>. Here's a quick recap, but try to listen again to the entire program.<br /><br />Cholesterol floats through your bloodstream isolated from water-soluble molecules. Being fat-soluble, <span id="SPELLING_ERROR_7" class="blsp-spelling-corrected">cholesterol</span> cannot dissolve and therefore is in somewhat of a state of suspension, like grease stains on a shirt or the fatty component of lamb stew, chicken soup, or spaghetti with meat sauce. Ever leave beef stew leftovers in a plastic container overnight in your refrigerator? In the morning you'll find an orange-yellowish wax that has floated to the top. Oil and water don't mix.<br /><br />So when you're overeating and your triglyceride levels and <span id="SPELLING_ERROR_8" class="blsp-spelling-error">LDL</span> start overflowing, some of those fat droplets wind up in the walls of the larger arteries. And you know that oil and water don't mix. These fat droplets are very irritating to the surrounding tissues, and your body decides to try to get rid of them, or at least wall them off and neutralize their effect. This happens by the process of inflammation; those chemical mediators we mentioned are called into action and white blood cells swarm into the area.<br /><br />But this process is totally counterproductive. The arterial wall, a most delicate organ, is now a battleground between oil and water.<br /><br />The extent to which damage occurs depends on many factors: which arteries are affected (brain/heart/kidneys); if the individual decides to avoid further damage by making lifestyle changes (such as you will read in <em>The Park Avenue Diet); </em>and if the individual is wise enough to use the benevolent force of good nutrition to help save the day.<br /><br />We've been discussing inflammation, which as you know is part of the human body's normal response to injury or infection. But when it occurs in an inappropriate way, such as when the arterial wall becomes a battleground between cholesterol droplets and white blood cells, the result is tissue destruction, circulatory impairment, and other self-inflicted wounds.<br /><br />The abnormal inflammation in the walls of the heart's arteries is thus a form of "friendly fire." Instead of bullets, white blood cells release powerful chemical mediators that are forms of <span id="SPELLING_ERROR_9" class="blsp-spelling-error">arachionic</span> acid and its precursor, <span id="SPELLING_ERROR_10" class="blsp-spelling-error">linoleic</span> acid.<br /><br />An enzyme called <span id="SPELLING_ERROR_11" class="blsp-spelling-error">cyclo</span>-<span id="SPELLING_ERROR_12" class="blsp-spelling-error">oxygenase</span> turns the <span id="SPELLING_ERROR_13" class="blsp-spelling-error">arachionic</span> acid into one of several possible potentially dangerous chemicals. These are named; <span id="SPELLING_ERROR_14" class="blsp-spelling-error">prostaglandins</span>, <span id="SPELLING_ERROR_15" class="blsp-spelling-error">thromboxane</span>, and <span id="SPELLING_ERROR_16" class="blsp-spelling-error">leukotriene</span>. <span id="SPELLING_ERROR_17" class="blsp-spelling-error">Thromboxane</span> A2 is a good - or rather a bad-example . This chemical mediator causes platelets, those sticky little cells that are part of the clotting system, to become even more sticky and start to clump together while circulation throughout the body.<br /><br />You can see them at work, and even feel them, if you are a male medical student at Maimonides Medical Center shaving in the morning too quickly. Those teeny red "shaving-nicks" are in part made up of platelets. But <span id="SPELLING_ERROR_18" class="blsp-spelling-error">Thromboxane</span> A2, one of the <span id="SPELLING_ERROR_19" class="blsp-spelling-error">prostaglandins</span> made from <span id="SPELLING_ERROR_20" class="blsp-spelling-error">arachidonic</span> acid, turns this usually appropriate function into something altogether different.<br /><br />In people with high levels of <span id="SPELLING_ERROR_21" class="blsp-spelling-error">Thromboxane</span> A2 (and by the way, this is a chemical that becomes excreted due to stress), <span id="SPELLING_ERROR_22" class="blsp-spelling-corrected">platelets</span> start to stick to those irritating cholesterol droplets inside the arterial wall. The more platelets that stick to the cholesterol droplet, the narrower the artery becomes. Then , the entire irritated area literally explodes-just like a pimple on the surface of your skin. Except this pimple is inside a coronary artery. And after it explodes, more platelets become stuck to the lesion.<br /><br />I'm sure you have heard the medical term for this horrible cascade of biochemical events. It's called a coronary thrombosis. And you've heard about the illness that is the immediate and sometimes fatal result. It's called a heart attack. The end result of a heart attack might have severe pathological, psychological, and social <span id="SPELLING_ERROR_23" class="blsp-spelling-corrected">repercussions</span>. But it all began due to abnormal biochemistry...biochemistry that activated the body's inflammatory response in an inappropriate, painful, and sometimes tragic way.<br /><br />And now for some really good news: there's a way to manipulate these chemical mediators in an extremely beneficial way. Nature has provided beneficial molecules called <span id="SPELLING_ERROR_24" class="blsp-spelling-error">Eicosanoids</span> that have the ability to offset the dangerous accumulation of <span id="SPELLING_ERROR_25" class="blsp-spelling-error">thromboxanes</span>, <span id="SPELLING_ERROR_26" class="blsp-spelling-error">leukotrienes</span>, and malevolent <span id="SPELLING_ERROR_27" class="blsp-spelling-error">prostaglandins</span>.<br /><br /><span id="SPELLING_ERROR_28" class="blsp-spelling-error">Eicosanoids</span> are made from omega-3 or omega-6 essential fatty acids. And the more omega-3 oils one has <span id="SPELLING_ERROR_29" class="blsp-spelling-error">circulationg</span> through the body, the more healthy the overall picture. Omega-3 oils reduce the inflammatory effects of <span id="SPELLING_ERROR_30" class="blsp-spelling-error">arachionic</span> acid and its products.<br /><br />Let's review this: <span id="SPELLING_ERROR_31" class="blsp-spelling-error">Arachionic</span> acid promotes inflammation. Omega 3 and 6 oils are much less inflammatory, or inactive, or even anti-inflammatory.<br /><br />Tune in next week when we will continue with our discussion on inflammation.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-68501046845455547582010-11-15T08:04:00.000-08:002010-11-15T08:33:14.025-08:00Note on "The Park Avenue Diet Show: What Should I Have for a Snack?"; November 14, 2010Snack foods have been around since the Paleolithic Era, when cave-dwellers first discovered berries, nuts, and certain vegetables right on their doorsteps--although they lacked doors and steps. These foods provided energy, nutrition, and enjoyment. Ten of thousands of years later, snacking has evolved, or rather devolved, thanks to prepackaged, unhealthy "foods" developed during the Industrial Revolution.<br /><br />But enough of an anthropology lesson and pseudo-political commentary! Snacks foods, and there are literally thousands of them, need not be unhealthy, fattening, or carcinogenic, especially the ones you choose to sustain yourself between meals. Armed with a full understanding of insulin resistance, you now know that unstable blood sugar levels usually force people to choose unwisely--potato chips, salted peanuts, candy, pastries. Your choice of snack may be related to whatever you had for breakfast--the more sugar in your breakfast, the more likely you will be to pick a sweet snack.<br /><br />The ideal snack food for people on a weight-loss diet is precisely the one Dr. Atkins taught me: a slice of turkey wrapped around a carrot stick or celery stalk...extremely low-calorie, extremely low-fat, and obviously very nutritious. The relative macronutrient balance (namely more protein, less carbs) keeps insulin stabilized, thus preventing another swing of blood sugar several hours later.<br /><br />Think about this when you reach for "nutrition" bars at the grocery: these glorified candy bars, containing negligable amounts of vitamins, were primarliy designed for weight-lifters and exercise enthusiasts. Just because a candy bar has 30 grams of protein doesn't mean that you'll be more muscular tomorrow. Ya gotta exercise beforehand, otherwise the protein is metabolized as fuel, just like glucose is---a total waste of time, nutritionally speaking.<br /><br />Read labels carefully, and avoid artificial sweeteners--these might also over-stimulate insulin even though no calories are involved or somehow attempt to trick one's brain into thinking that a huge amount of sugar has just been ingested--which the body overcorrects later on by doing just that!<br /><br />Your grandmother told you (and mine told me) that breakfast is one of the most important meals of the day. She probably also knew that balancing your insulin levels was important so that you wouldn't overdo it at snack time and thereby jeopardize your weight and your health. People who pick the right snacks remove a tremendous obstacle to weight loss. They gain Enlightenment...and Lightenment !Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-63444922532137959202010-11-08T06:36:00.001-08:002010-11-08T07:09:30.351-08:00Notes on "The Park Avenue Diet Show: Diabetes Mellitus"; November 7, 2010Diabetes Mellitus has been recognized throughout virtually all of recorded history. Scholars and physicians from ancient Greece, Rome, India, Japan, and China had their own names for the disease, explanations of its causes, and ineffective remedies.<br /><br />Diabetes has had a tumultuous history even within the past forty years. I was taught about Adult Onset Diabetes Mellitus in medical school. This term no longer exists since the exact same problem occurs now in teenagers and young adults.<br /><br />Even the more scientific-sounding term "non-insulin dependent diabetes" which replaced AODM is somewhat misleading. It is now thought that virtually 100% of diabetics will eventually need injections of this pancreatic hormone. Strictly speaking, NIDDM means that a given patient will not develop ketoacidosis within 48 hours if he or she does not take insulin.<br /><br />"Juvenile diabetes", another antiquated term is an auto-immune disease that results in total and permanent absence of insulin. People with NIDDM may be taking insulin every day, but they will not die suddenly without it.<br /><br />Most people who have diabetes in 2010 have the more "benign" form. And 95 or more percent of these individuals have overweight or obesity provoking or complicating this disease. As modern medical research shows, diabetes actually exists in a hidden form in these individuals for up to ten years before a blood sugar rise is noted by the patient or a physician.<br /><br />I'm sure you would not like to have the flu for ten years in a hidden form before you start coughing and sneezing and realizing you are sick. Diabetes is hundreds of times worse than that and potentially debilitating or fatal.<br /><br />While it is true that modern pharmaceuticals can immediately correct blood sugar abnormalities, they have little effect on pancreatic exhaustion and death of the beta cells of the Islets of Langerhans where insulin is produced. Simply put if you are a diabetic who has not corrected their diet or achieved a normal weight, your diabetes will worsen with the years, requiring even more medicine, repeated doctor visits, and protection against numerous emergencies.<br /><br />The next time you go to the supermarket, take a peek at some of those diabetic cookbooks or magazines. They feature lascivious pictures of chocolate cake, creme brulee, brownies, cupcakes, cheesecake, etc. If you were a recovering alcoholic, would you want the newsletter for Alcoholics Anonymous to be strewn with ads for vodka, beer, or wine? If you are a member of PETA and idealistically are committed to protecting all living creatures, what would you think if the PETA journals featured pictures of shotguns, bows and arrows, or animal traps? This is how I view those horrid magazines that tempt diabetics with seemingly forbidden pleasures.<br /><br />Diabetes is not an incurable illness like pancreatic cancer. Its prevalence reflects the prevalence of obesity, which is most certainly a self-inflicted wound. While obesity does not strike many as inherently unhealthy, diabetes has frightened scholars and physicians for over 2000 years. In an era where we are reminded often to treat "root causes", please consider diabetes a "clear and present danger", and do your best to erase it from your life.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-91907421291632164482010-11-01T07:18:00.000-07:002010-11-01T07:53:39.468-07:00Notes on "The Park Avenue Diet Show: Trick or Treat?"; October 31, 2010"Trick or Treat?" is not usually a question applied to health topics. But there's a first time for everything. Last night was the world premiere of a one-time-only quiz show with that name as part of "The Park Avenue Diet Show".<br /><br />Using the format of "You Bet Your Life", a legendary television program starring Groucho Marks, the choice was expanded to the areas of nutrition, obesity, personal myths, food additives, and even Hollywood monsters. Noah Fleischman, my fantastic broadcast associate, channeled the spirit of George Fenneman, a legendary 1950's announcer.<br /><br />"Trick or Treat" could be rephrased very simply "is it good for you or bad for you?" Here are some examples of things that are bad for you: margarine, Olestra, sugar-free creme brulee, a bmi of 40, taenia solium (pork tapeworm, definitely not a recommended treatment for obesity), GM (genetically modified) foods and ayahuasca tea (a psychadelic).<br /><br />Some of the "treats" included: branched-chain amino acids (leucine, isoleucine, valine), dandelion tea, a blood pressure of 90/60, and positive personal myths.<br /><br />Here are a few questions that were not used in the quiz. What's your answer? Trick or Treat? Quinoa; Turducken; Christmas pudding; Scotch Egg; Bulgaricum; Alfalfa; Borjomi water; Ectoplasm; Fugu; "Muffin Top"; leptin.<br /><br />Our final caller amazingly knew two out of the three medical questions in the category of Hollywood movie monsters. Boris Karloff modeled the Frankenstein monster's walk from knowledge of <em>tabes dorsalis</em>, a sign of neurosyphilis. This would have been especially frightening in a pre-antibiotic era. Victims walk with extremely stiff legs, their arms outstretched to achieve balance. Imagine my surprise when Dr. David Grob demonstrated this walk during a lecture on neurology while I was a medical student at Maimonides Medical Center.<br /><br />Our caller from Freehold, New Jersey also knew that Dracula has type AB-+ blood and is thus protected against "transfusion reactions". Did you ever think that you can learn so much medical information on Halloween? Of course "The Park Avenue Diet Show" is entertaining and informative every week of the year!Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-56771190353163098842010-10-25T07:51:00.000-07:002010-10-25T07:53:37.248-07:00Notes on "The Park Avenue Diet Show: The Only Thing Constant is Change"; October 24, 2010“The only thing constant is change.”<br /><br />This famous quotation attributed to Herakleitos (written 2500 years ago) has implications that are philosophical, existential, and medical. It appears in Lives of the Philosophers by Diogenes Laertius. Other translations: “Only change is unchanging”. “Nothing is permanent except change.”<br /><br />We tend to think of our bodies almost as statues, impervious to outside influences and figuratively fixed in stone. You know however that virtually every component of human anatomy and biochemistry is renewable as growth and metabolism proceed.<br /><br />Sometimes we cannot see change. If you look in the mirror every day, the person staring back at you always looks the same. But take a look at your photos from ten years ago and you’ll have to admit that things are different. I certainly hope they are better.<br /><br />On the other hand, if the tensions of life and misplaced priorities have led you down the path of dietary indiscretion, you certainly need change—primarily a change in your personal mythology, your personalized rule book or code of behavior. Change occurs with every chronic illness, although the illnesses due to obesity change very quickly and seriously.<br /><br />At a recent convention of the American College of Physicians, data was presented that shocked the world of endocrinologists: at the time of diagnosis of a typical type 2 diabetic, 60% of damage to the major blood vessels and the heart has already happened. In essence, the disease has been diagnosed at an advanced state and there are already potentially fatal complications.<br /><br />Moreover even if the patient is taking prescription medication, diabetes is constantly worsening although blood sugar values may be deceptively normal. These findings provide a frightening view into the nature of some bodily disease processes, but unfortunately in diabetes the only thing constant is change.<br /><br />http://www.ajmc.com/supplement/managed-care/2006/2006-11-vol12-n14Suppl/Nov06-2399ps369-s381<br /><br />Here’s another quotation from Herakleitos: “One’s bearing shapes one’s fate” which can also be translated from the ancient Greek as “character is destiny.” This is reflected in The Park Avenue Diet by my own philosophy that your lifestyle is reflected not only by external and internal characteristics but also in your opportunities and relationships.<br /><br />“You cannot step into the same river twice” as Herakleitos reminds us. This is certainly true because new waters are continuously flowing past your feet. It is also true because of the element of time. And for the human body, time means aging.<br /><br />Knowing this, you need to be proactive in matters that concern your health. Just like diabetes having a long, silent “waiting period” before complications occur, so too do problems of physical, mental, or spiritual illness have a “calm before the storm.” Don’t wait therefore for problems to arise. Your vigilance and attention to health must be constants despite the ever-changing nature of our world, your environment, and the human body.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-2169295441099048822010-10-18T07:23:00.001-07:002010-10-18T07:49:41.237-07:00Notes on "The Park Avenue Diet Show: All About the Abs"; October 17, 2010The abdominal muscles are necessary parts of your anatomy. They are also featured in book titles, exercise routines, and vitamin advertisements. But for 67% of the adult American population, abdominal muscles are sandwiched between layers of subcutaneous and visceral fat, a most unhealthy sandwich indeed.<br /><br />Epidemiologists have determined how to answer the most profound question of the 21st century: "How do you know if you're fat?" Here are several ways of answering this:<br /><br />1. Waist circumference, where normal for men is under 40 inches and for women is under 35 inches.<br /><br />2. Waist-to-hip ratio (abnormal is greater than 0.9 in women, greater than 1.0 in men). This measurement correlates strongly with the most <span id="SPELLING_ERROR_0" class="blsp-spelling-corrected">significant</span> complications of obesity because upper body fat (visceral fat) is more dangerous than leg or buttocks fat (subcutaneous fat).<br /><br />3. Look at yourself sideways in the mirror.<br /><br />The abdominal muscles support the front of the upper body, thus helping breathing, and also support the spine and lower back muscles, helping your posture. The abdominal muscles also help with balance and flexibility.<br /><br />Since you are probably envious of people with well defined abdominal muscles, it might be motivating to learn their proper names. The innermost is the transverse <span id="SPELLING_ERROR_1" class="blsp-spelling-error">abdominus</span>, a band of muscles that totally encircles the lower body. Nearby are two internal oblique muscles and on top of these are two external oblique muscles. The latter can sometimes be seen in well developed athletes.<br /><br />The most famous abdominal muscle of all is the <span id="SPELLING_ERROR_2" class="blsp-spelling-error">rectus</span> <span id="SPELLING_ERROR_3" class="blsp-spelling-error">abdominus</span>, a long, flat band of muscles that extends from the ribs to the pelvis. These muscles are crossed by three tendons called the <span id="SPELLING_ERROR_4" class="blsp-spelling-error">linae</span> <span id="SPELLING_ERROR_5" class="blsp-spelling-error">transversae</span>. This structure has the appearance, as you well know, of a "six-pack".<br /><br />People who are physically fit know that there is no single exercise for the abdominal muscles. Quite the contrary, all exercises should utilize the abdominal muscles. For example curls with hand weights do not merely strengthen the biceps. The exerciser should also maintain a perfectly flat abdomen during biceps curls for stability and isolation of the arms. The abdominal muscles do not participate in the active movement of the weights but they certainly receive a workout.<br /><br />What other exercises are good for the abdominal muscles? The plank, the "bicycle", the crunch, the extended-arm crunch, and "sit-ups" using an exercise ball. All of these are described in detail on various sites on the <span id="SPELLING_ERROR_6" class="blsp-spelling-error">internet</span>. Bernadette <span id="SPELLING_ERROR_7" class="blsp-spelling-error">Penotti</span>, my brilliant colleague and health expert, favors the plank for beginners and seasoned athletes.<br /><br />Your abdominal muscles will not see the light of day until you lose weight, so make that your number one priority for shaping up in general. In "The Park Avenue Diet" is an entire 42 day exercise plan that takes you from beginner to expert. By the end of the book you will be able to duplicate, albeit slowly, the exact routine that Bernadette <span id="SPELLING_ERROR_8" class="blsp-spelling-error">Penotti</span> does herself.<br /><br />It's all about the abs, so get started on improving yours today.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-1137577448092857862010-10-11T07:50:00.000-07:002010-10-11T07:55:32.303-07:00Notes on: "The Park Avenue Diet Show: Eggs-istentialism"; October 10, 2010Misinformation and misunderstanding about eggs represent errors in thinking that confuse the American public and lead to poor nutritional recommendations. For several decades many people have been lead to believe that eggs cause hardening of the arteries, coronary artery disease, strokes and other cardiovascular abnormalities. The simplistic reason? Since eggs contain cholesterol, they are inherently unhealthy.<br /><br />The truth is quite the opposite: cholesterol is not a poison but an important component of many crucial bodily hormones. Moreover, as has been determined from research on the metabolic syndrome, weight gain and high calorie diets trigger insulin resistance which in turn elevates dangerous lipoprotein levels in the bloodstream.<br /><br />What do you eat for breakfast? If you check out the breakfast menu of your local fast food franchise, you will find numerous items whose caloric content may be seven to ten times more than that of a hard boiled egg. For people struggling with weight, a high protein, low calorie food is indeed the perfect choice, and that’s exactly what eggs are.<br /><br />Here are several scholarly articles on the subject. Note that in no case do the researchers recommend egg-white omelets or avoiding eggs entirely.<br /><br />The first article, dating from 1999, was a trailblazing study that upset the nutritional applecart. Egg consumption was found to have any impact on the risk of serious cardiovascular illnesses.<br /><br /><a href="http://jama.ama-assn.org/cgi/content/abstract/281/15/1387">http://jama.ama-assn.org/cgi/content/abstract/281/15/1387</a><br /><br /><br />A more recent article in The American Journal of Clinical Nutrition came to the same exact conclusion. Here the blame for atherosclerotic disease is attributed to saturated fats and trans fats. The latter two are supplied in abundance in those 1,000 calorie breakfasts that many Americans unreservedly embrace.<br /><br /><a href="http://www.ajcn.org/cgi/content/full/87/4/799">http://www.ajcn.org/cgi/content/full/87/4/799</a><br /><br /><br />An article in Circulation in 2008 studied the effect of egg consumption on heart failure. Once again there was no causal relationship.<br /><br /><a href="http://circ.ahajournals.org/cgi/content/full/117/4/512">http://circ.ahajournals.org/cgi/content/full/117/4/512</a><br /><br /><br />Here is the most important study that we discussed this week, published in the journal Risk Analysis. Eating one egg per day is responsible for less than 1% of the risk of coronary heart disease in healthy adults. On the other hand, poor lifestyle choices (unhealthy diet, smoking, obesity, physical inactivity) contribute 30-40% of heart disease risk. The remaining 60-70% of heart disease risk is due to unavoidable factors (genetics) and potentially treatable risk factors (diabetes, high blood pressure). Next to those numbers, the 1% risk attributed to eggs seems extraordinarily small. Perhaps someone can explain why diabetes is treated so flippantly in some circles—on “diet” magazine covers that promote “healthy” chocolate cakes—yet eggs are still considered nutritional pariahs.<br /><br /><a href="http://www.physorg.com/print148641987.html">http://www.physorg.com/print148641987.html</a><br /><br /><br />The larger issue, once we accept the fact that eggs have a place in virtually everyone’s diet, is: where does the average American turn when there is so much misinformation in our media-cluttered society? Unfortunately, it is up to you to refer to trusted sources of health information exclusively, no easy task. Sorting through supposedly conflicting data and controversial issues—that’s my responsibility. Your responsibility? Eat a healthy breakfast!Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-62088936949073047972010-10-04T09:56:00.000-07:002010-10-04T09:59:37.175-07:00Notes on "The Park Avenue Diet Show: What Should I Have for Breakfast?"; October 3, 2010My grandmother said it, and so did yours: “Breakfast is one of the most important meals of the day.” Although somewhat simplistic, this statement reflects not only old-world values but physiologic biochemistry. <br /><br />People who begin their day with a breakfast that is nothing more than a junk heap of refined carbohydrates are truly starting off on the wrong foot. Carlton Fredricks, the famed nutritionist, was one of the first people to speak out against America’s overindulgence with sugar. Not only are most breakfast foods highly caloric, they have the ability to set into motion insulin resistance and a pattern of glucose instability throughout the day. <br /><br />Donuts, pancakes, French toast, waffles, bagels, syrupy coffee concoctions all have in common an absolute lack of nutrition and a 100% composition of sugar. Take a look at the shape of people who start their day with these foods. Or better yet, take a look at yourself. “Saving money” by making a glazed donut your breakfast will be offset eventually by the high price of prescription medication for one or more of the illnesses caused by the metabolic syndrome. <br /><br />A healthy breakfast should be a balanced one, namely one that includes good carbohydrates and protein. The caloric total should not exceed 500 calories, since this is 25% of one’s daily needs. A very healthy breakfast might even “weigh in” with 250 calories. Now take a look in person or online at the calorie content of breakfasts foisted on you by the fast food industry. Who needs 800 to 1100 calories upon waking up from a deep sleep? Perhaps a construction worker, an athlete, or a hiker in the Himalayas. Certainly not you or your children. <br /><br />If you want to know if a friend or colleague has good nutritional insights, the easiest way is simply to ask him or her what was for breakfast. And if you are struggling with weight, changing your breakfast is probably the first thing you should do. <br /><br />Here are some great ideas that can start you on the road to enlightenment. The longest journey begins with a single step. The pathway to better health should start with your next breakfast. <br /><br />---------------------------------------------------------------------------------<br />And now here are some excellent breakfast tips from an honored colleague:<br /><br />----------------------------------------------------------------------------------<br /><br /><br />Hi everyone, this is Jennifer, and you may have heard Dr. Fischer mention my name on this week’s show. I have been very fortunate to work with Dr. Fischer as his practice nurse for the past 2 ½ years. <br /><br />I would like to share with you some of my favorite breakfast items. For starters I always enjoy a cup of Jasmine-Green tea without milk or sugar (this is such a flavorful tea that additives are unnecessary). <br /><br />On mornings when I may not have much of an appetite I will have a vanilla yogurt with a few blueberries added in. This will run you anywhere from 150-200 calories. <br /><br />There are other mornings that I wake up and require something a little more substantial. On these days I may have a frittata (a baked omelet) made with egg whites, tomatoes, spinach and feta cheese; about 230 calories. One of my other recommendations is actually my favorite of breakfast items and that is one poached egg over a bowl of steel-cut oatmeal. For a little extra flavor I sometimes sprinkle Parmigiao-Reggiano cheese right over the top; for a total calorie count of 230 calories. Besides being absolutely delicious, the combination of protein and carbohydrates will keep your appetite satiated right till lunchtime.<br /><br />A healthy breakfast is exactly what you need to start your day off right.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-65660646793819126462010-09-27T06:17:00.000-07:002010-09-27T06:18:42.586-07:00Notes on "The Park Avenue Diet Show: The Little Book of Big Medical Emergencies"; September 26, 2010This week’s show focused on medical emergencies, a topic reflecting my four years as an attending physician in the emergency room of Cabrini Medical Center. From 1983 to 1987 I worked three 12-hours shifts in a crowded, noisy, somewhat chaotic facility where people came around the clock for a wide variety of medical, surgical, psychological, and social ailments. <br /><br />Although I had worked in the Maimonides Medical Center emergency room during my internal medicine residency, the Cabrini experience was quite different. I was figuratively and literally in charge of all of the patients simultaneously. For those with an artistic view of the health care experience, this is like conducting several orchestras at the same time. <br /><br />The emergencies ranged from life-threatening accidents to panic attacks, as well as comforting social outcasts and unfortunate homeless people whose isolation and loneliness were truly painful. As you probably know from personal experience, medical emergencies are very frightening, and even doctors and nurses are not immune. Knowing what to do and recognizing the most serious warning signs can be life-saving, and that’s what impelled me to write The Little Book of Big Medical Emergencies.<br /><br />The book was originally published by Lyle Stuart, the legendary literary figure, in 2002. Hatherleigh Press published a second edition in 2007, this one updated and reviewed by fourteen noted specialists in diverse medical and surgical fields. <br /><br />Medical emergencies happen to everyone. I hope that yours have been minor and inconsequential. The statistics show that a given individual will have some type of medical emergency every three years, so being prepared with the proper information and tips on prioritization is absolutely essential. <br /><br />What could medical emergencies possibly have in common with the usual recommendations of a diet doctor? I’ve answered that question dozens of times: it’s all about your health. Although emergency medicine is crisis intervention and lifestyle advice is preventative medicine, both are ways that you can take care of that most precious and delicate machine, the human body. <br /><br />Even if you are the most glamorous, healthy, and happy individual, The Little Book of Big Medical Emergencies belongs in your home.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0tag:blogger.com,1999:blog-5549882605751326259.post-53874342793057466022010-09-20T07:39:00.000-07:002010-09-20T07:40:52.648-07:00Notes on "The Park Avenue Diet Show: Butter and Apples"; September 19, 2010Do you know what to order when you go to a restaurant? Our glamorous First Lady, Michelle Obama, thinks that you don’t. She recently addressed a meeting of the National Restaurant Association and asked them to change their menus in ways that improved nutrition and lower the risk of obesity.<br /><br />Among the suggestions were smaller portions, substituting whole wheat pasta for white, less butter, and more carrots. Here’s one emblematic idea: serving apple slices as the side dish with hamburgers instead of French fries. Diners would have to be especially careful not to cover the fruit with ketchup and cheese.<br /><br />Although Mrs. Obama has the best intentions, these recommendations are an unrealistic solution to an extremely serious problem. Do parents not know that macaroni and cheese is fattening? Do you know that salt raises blood pressure and causes fluid retention in cardiac patients almost immediately? Why are we pretending that it is the responsibility of a waiter, chef, or restaurant owner to take responsibility for your personal health? <br /><br />Since health is not the number one priority for most people (<em>and must be</em>) we now have surrogates like the government interceding on your behalf with potentially disastrous social and financial consequences. It’s much easier for you to be your own nutritional “traffic cop”. Certainly you can police the caloric environment of any restaurant or fast food franchise and figure out what’s best for you in the long run. If you need a government official to tell you or force you to eat less macaroni and cheese, you obviously missed a few classes of high school science. <br /><br />Another article focused on kids being bullied and humiliated about their weight and inability to compete athletically. <br /><br /><a href="http://news.yahoo.com/s/livescience/20100910/sc_livescience/overweightkidsbodyimagetakespoundingfrombullies">http://news.yahoo.com/s/livescience/20100910/sc_livescience/overweightkidsbodyimagetakespoundingfrombullies</a><br /><br />This is definitely a real phenomenon but is nothing new. Kids have been mocked and teased since the dawn of time, and sometimes adults are no better. The way to avoid this is not through counseling and psychotherapy or anti-depressant medication. Why not solve the problem realistically and definitively by weight loss? <br /><br />What do you think about when you see extremely overweight people on television? When they are featured in your favorite comedies or dramas, do they serve as role models the way some people might admire Derek Jeter or Halle Berry? Some psychologists think that “fat acceptance” is a compensatory reaction to a potentially serious health problem. The self-esteem of the overweight is more important (incorrectly) than their additional risk for 40 different illnesses in 9 organ systems. <br /><br /><a href="http://www.foxnews.com/entertainment/2010/09/16/shows-focusing-overweight-characters-obesity-problem/">http://www.foxnews.com/entertainment/2010/09/16/shows-focusing-overweight-characters-obesity-problem/</a><br /><br />As a physician, I am more concerned with the health and wellness of the actors than their physical suitability for the roles. But if we are so paranoically concerned about showing people smoking cigarettes on television, how can we allow walking advertisements for an unhealthy lifestyle? 20% of American adults smoke cigarettes; 67% of American adults are overweight or obese. You do the math. <br /><br />Do you think it would be helpful during the upcoming television show “Mike and Molly” for them to be eating apple slices with their cheeseburgers? If so, please direct your comments to 1600 Pennsylvania Avenue.Stuart Fischer, M.D.http://www.blogger.com/profile/17788385902228517316noreply@blogger.com0