The Park Avenue Diet

Thank you, Paula Dean

2012-01-19T09:19:00.000-08:00

Rule #1 in healthcare: don't try to fool Mother Nature.

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.

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.

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.

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.

"Let Them Eat Celebration Cake"

2011-04-04T05:11:00.000-07:00

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 Daily News, 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 Ancien Regime of Marie Antoinette and Louis XIV. Or, as these beheaded artistocrats might have put it before their demise, plus ca change, plus la meme chose.

Notes on "The Park Avenue Diet Show: Controversies in Weight Loss"; March 27, 2011

2011-03-28T07:14:00.000-07:00

From 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. Plus ca change, plus la meme chose.

Notes on "The Park Avenue Diet Show: The Capacity for Close Relating"; March 20, 2011

2011-03-21T07:18:00.000-07:00

What 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.

In a seminar entitled "Treatment of Obesity", Dr. Robert Kushner 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 The Park Avenue Diet.

First we should mention what is not important or predictive of success, namely the macronutrient 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/ Pritikin/ etc program--take your pick because their results are almost uniformly identical 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.

On the other hand Dr. Kushner provides a list of seven defining characteristics of the successful weight-loss patient, and here they are exactly as enumerated:

1) Coping capacity
2) Self-efficacy
3) Autonomy
4) Healthy narcissism
5) Motivation for weight loss: more confidence
6) Stability in life
7) Capacity for close relating

Virtually all of these are covered in one way or another in The Park Avenue Diet by either the famed humanistic psychologist Dr. Stanley Krippner or the glamorous, wise socialite Tinsley Mortimer. And the publication of the book predates this ACP academic presentation by two years.

Several of the behavioral issues might be defined by Dr. Krippner 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 appearance, behavior, and physicality.

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 maintenance 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.

Except for The Park Avenue Diet 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 interact well with others on a professional, familial, and personal/intimate level.

We'll return to this topic after I return from my ACP conference in about three weeks. But you can certainly learn a lot from my guest expert Bernadette Penotti--in our book, on the radio, on her website, or in person !

The Last Word on Stress (for now)

2011-03-16T06:43:00.000-07:00

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.

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.

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.

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.

We naturally gravitate to movie heroes who never reflect stress in their physical demeanor or conversation. Think of Gary Cooper in High Noon, Sigourney Weaver in Alien, Daniel Craig in Casino Royale 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.

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.

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.

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.

How to Cope With Stress (Part Three)

2011-03-09T06:11:00.000-08:00

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".

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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 main d'accouchment [delivery hand, namely the hand shape that an obstetrician uses].

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.

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.

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.

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.

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.

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.

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!

Notes on "The Park Avenue Diet Show: How to Cope With Stress (Part Two)"; March 13, 2011

2011-03-08T06:15:00.001-08:00

Stress. You can't live with it, you can't live without it. But what is it?

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.

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.

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.

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.

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 Uncle Vanya by Anton Chekhov.

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.

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.

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.

Notes on "The Park Avenue Diet: A Tale of Two Books"; Sunday, March 6, 2011

2011-03-01T06:36:00.000-08:00

How 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.

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.

I have had the honor of having two books published consecutively by the erudite company, Hatherleigh Press. They are The Little Book of Big Medical Emergencies and The Park Avenue Diet. 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.

The Little Book of Big Medical Emergencies, 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.

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.

The Little Book of Big Medical Emergencies 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.

Simply put, this is a book that belongs in every home, and here is one way to get a copy:

The Park Avenue Diet 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%.

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.

As with The Little Book of Big Medical Emergencies, I sought input from multiple experts, this time in unusually diverse fields. The Park Avenue Diet 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.

And here's how to get your own copy.

It's even available as a Kindle download.

And that's "A Tale of Two Books".

Notes on "The Park Avenue Diet Show: The Mathematics of Dieting"; February 20, 2011

2011-02-21T05:09:00.000-08:00

The 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.

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.

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.

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.

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.

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.

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.

"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.

What's the first step in understanding the metabolic workings of your own body? Do the math !

Notes on "The Park Avenue Diet Show: What Should I Have for Lunch?"; February 13, 2011

2011-02-14T06:56:00.000-08:00

Lunch 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 ceviche, 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 tajine, a hearty stew eaten native-style with both hands.

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.

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.

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.

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.

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?

Notes on "The Park Avenue Diet Show: The Hidden Cost of Being Overweight"; February 6, 2011

2011-02-07T12:27:00.000-08:00

"A tsunami of obesity" is how an editorial last week in the British medical journal The Lancet 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.

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 Mutiny on the Bounty were being filmed today, the romantic scenes might not seem as glamorous.

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.

"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.

Just this once, please don't think about the rest of the world. Think about yourself !

Notes on "The Park Avenue Diet Show: The Salt of the Earth"; January 30, 2011

2011-02-01T07:08:00.001-08:00

I 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?

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.

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.

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).

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.

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.

Notes on "The Park Avenue Diet Show: Log Cabin Exercises"; January 9, 2011

2011-01-10T07:29:00.000-08:00

When Americans think of exercise, if indeed they do, it is viewed as a chore or a hardship or an unpleasant 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.

Having traveled to remote, challenging locations throughout the world, I appreciate the role of daily exercise in the maintenance of good physical health. 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 Shangri-la, do not suffer weight problems at all.

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 Badgastein 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.

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".

All exercise programs must include strength training and cardio, 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.

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 cardio 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.

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 jump start 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.

National Diet Day

2011-01-03T11:15:00.000-08:00

January 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.

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.

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?

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.

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.

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"!

A Walk Through the Snow with Doctor Astrov

2010-12-27T05:30:00.000-08:00

When 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.

Such a country doctor was one of my role models, albeit a fictitious one: Dr. Astrov, the world-weary, philosophical character in Uncle Vanya 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", "deductible', or "referral."

They were men on a mission of mercy, and nothing would stand between them and human suffering. Dr. Astrov 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, Astrov 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.

Dr. Astrov 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
hypertension were decades away from adequate treatments. The rural doctor like Dr. Astrov was essentially a general practitioner with experience in orthopedics, surgery, internal medicine, and sometimes pediatrics--something utterly impossible today.

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.

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 Boro 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 salary 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.

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 analogous over my own 30-year career as a physician. Bad weather would never have slowed him down, and he would regularly make all-weather housecalls during the Great Depression (the fee was a chicken). I assume that Dr. Astrov--and Dr. Chekhov--would have done the same (and the fee would have been similar).

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?

Notes on "The Park Avenue Diet Show: Inflammation: an Introduction"; November 21, 2010

2010-11-22T09:07:00.000-08:00

The inflammatory response is the body's way of protecting us when infections or injuries threaten our health. The biochemistry is extremely complex, involving many different chemical mediators (prostaglandins, leukotrienes, thromboxanes) secreted by many different types of cells (granulocytes, macrophages, leukocytes).

In medical school we were taught the classic signs of inflammation along with their Latin names (which are redness/rubor, swelling/tumor, heat/calor, and pain/dolor). Of course, these are the signs of inflammation that you can see; a good example would be a skin infection like an infected cuticle.

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.

Remember our program called "Oil and Water" a few months ago? If not, you might want to listen again on my website http://www.parkavenuediet.com/. Here's a quick recap, but try to listen again to the entire program.

Cholesterol floats through your bloodstream isolated from water-soluble molecules. Being fat-soluble, cholesterol 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.

So when you're overeating and your triglyceride levels and LDL 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.

But this process is totally counterproductive. The arterial wall, a most delicate organ, is now a battleground between oil and water.

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 The Park Avenue Diet); and if the individual is wise enough to use the benevolent force of good nutrition to help save the day.

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.

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 arachionic acid and its precursor, linoleic acid.

An enzyme called cyclo-oxygenase turns the arachionic acid into one of several possible potentially dangerous chemicals. These are named; prostaglandins, thromboxane, and leukotriene. Thromboxane 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.

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 Thromboxane A2, one of the prostaglandins made from arachidonic acid, turns this usually appropriate function into something altogether different.

In people with high levels of Thromboxane A2 (and by the way, this is a chemical that becomes excreted due to stress), platelets 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.

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 repercussions. But it all began due to abnormal biochemistry...biochemistry that activated the body's inflammatory response in an inappropriate, painful, and sometimes tragic way.

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 Eicosanoids that have the ability to offset the dangerous accumulation of thromboxanes, leukotrienes, and malevolent prostaglandins.

Eicosanoids are made from omega-3 or omega-6 essential fatty acids. And the more omega-3 oils one has circulationg through the body, the more healthy the overall picture. Omega-3 oils reduce the inflammatory effects of arachionic acid and its products.

Let's review this: Arachionic acid promotes inflammation. Omega 3 and 6 oils are much less inflammatory, or inactive, or even anti-inflammatory.

Tune in next week when we will continue with our discussion on inflammation.

Note on "The Park Avenue Diet Show: What Should I Have for a Snack?"; November 14, 2010

2010-11-15T08:04:00.000-08:00

Snack 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.

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.

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.

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.

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!

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 !

Notes on "The Park Avenue Diet Show: Diabetes Mellitus"; November 7, 2010

2010-11-08T06:36:00.001-08:00

Diabetes 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.

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.

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.

"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.

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.

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.

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.

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.

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.

Notes on "The Park Avenue Diet Show: Trick or Treat?"; October 31, 2010

2010-11-01T07:18:00.000-07:00

"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".

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.

"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).

Some of the "treats" included: branched-chain amino acids (leucine, isoleucine, valine), dandelion tea, a blood pressure of 90/60, and positive personal myths.

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.

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 tabes dorsalis, 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.

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!

Notes on "The Park Avenue Diet Show: The Only Thing Constant is Change"; October 24, 2010

2010-10-25T07:51:00.000-07:00

“The only thing constant is change.”

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.”

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.

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.

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.

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.

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.

http://www.ajmc.com/supplement/managed-care/2006/2006-11-vol12-n14Suppl/Nov06-2399ps369-s381

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.

“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.

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.

Notes on "The Park Avenue Diet Show: All About the Abs"; October 17, 2010

2010-10-18T07:23:00.001-07:00

The 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.

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:

1. Waist circumference, where normal for men is under 40 inches and for women is under 35 inches.

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 significant complications of obesity because upper body fat (visceral fat) is more dangerous than leg or buttocks fat (subcutaneous fat).

3. Look at yourself sideways in the mirror.

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.

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 abdominus, 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.

The most famous abdominal muscle of all is the rectus abdominus, a long, flat band of muscles that extends from the ribs to the pelvis. These muscles are crossed by three tendons called the linae transversae. This structure has the appearance, as you well know, of a "six-pack".

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.

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 internet. Bernadette Penotti, my brilliant colleague and health expert, favors the plank for beginners and seasoned athletes.

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 Penotti does herself.

It's all about the abs, so get started on improving yours today.

Notes on: "The Park Avenue Diet Show: Eggs-istentialism"; October 10, 2010

2010-10-11T07:50:00.000-07:00

Misinformation 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.

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.

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.

Here are several scholarly articles on the subject. Note that in no case do the researchers recommend egg-white omelets or avoiding eggs entirely.

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.

http://jama.ama-assn.org/cgi/content/abstract/281/15/1387

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.

http://www.ajcn.org/cgi/content/full/87/4/799

An article in Circulation in 2008 studied the effect of egg consumption on heart failure. Once again there was no causal relationship.

http://circ.ahajournals.org/cgi/content/full/117/4/512

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.

http://www.physorg.com/print148641987.html

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!

Notes on "The Park Avenue Diet Show: What Should I Have for Breakfast?"; October 3, 2010

2010-10-04T09:56:00.000-07:00

My 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.

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.

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.

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.

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.

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.

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And now here are some excellent breakfast tips from an honored colleague:

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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.

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).

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.

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.

A healthy breakfast is exactly what you need to start your day off right.

Notes on "The Park Avenue Diet Show: The Little Book of Big Medical Emergencies"; September 26, 2010

2010-09-27T06:17:00.000-07:00

This 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.

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.

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.

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.

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.

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.

Even if you are the most glamorous, healthy, and happy individual, The Little Book of Big Medical Emergencies belongs in your home.

Notes on "The Park Avenue Diet Show: Butter and Apples"; September 19, 2010

2010-09-20T07:39:00.000-07:00

Do 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.

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.

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?

Since health is not the number one priority for most people (and must be) 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.

Another article focused on kids being bullied and humiliated about their weight and inability to compete athletically.

http://news.yahoo.com/s/livescience/20100910/sc_livescience/overweightkidsbodyimagetakespoundingfrombullies

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?

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.

http://www.foxnews.com/entertainment/2010/09/16/shows-focusing-overweight-characters-obesity-problem/

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.

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.

Notes on "The Park Avenue Diet Show: September Song"; September 12, 2010

2010-09-14T08:03:00.000-07:00

This week’s show, entitled “September Song”, heralded the arrival of the Fall Season. We tend to think of such landmarks in our datebooks in terms of school, the theatre season, autumn foliage, or something more personal. I’m a bit more monochromatic: for me, it’s all about health, mine and yours.

Every season, and in fact every day, is a good opportunity to reevaluate your health status. Don’t forget that I follow the World Health Organization definition of health: “Physical, mental, and social wellbeing, and not merely the absence of disease.” As the author of The Park Avenue Diet, I focus on image which I define as an amalgamation of seven different components of appearance and behavior. One of these is weight.

For the last forty years, The Dark Ages of Dieting, people have mistakenly gravitated towards weight loss programs that exist in a vacuum. Namely, they only address food choices as if all of the other components of image somehow improve by themselves (interpersonal skills, skin, hair, clothing, self-confidence). I do not blame the well-meaning and well-deserving American people for believing this utterly illogical hogwash. Pick up any supermarket tabloid or “health magazine” and you will see pseudo-science at its worst.

Now for some real science: here are a few articles from the bibliography of The Park Avenue Diet. At the most recent convention of The American College of Physicians, researchers asked that no more studies be done comparing the various mass-market “diets” since none has a success rate over ten percent. It is a thorough waste of time to see whether “low carb” or “macrobiotic” foods produce better results since experimental subjects do not follow either program consistently or successfully.

http://jama.ama-assn.org/cgi/content/full/293/1/43

http://cardiology.jwatch.org/cgi/content/citation/2005/211/6

http://www.annals.org/content/142/1/56.abstract

http://www.annals.org/content/147/1/41.abstract

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16986-9/abstract

The above articles, as well as a monograph by the British Medical Journal, all result in the same scenario. The attrition rate (people who drop out of a study) is almost ninety percent no matter which article you read. This leads researchers to believe that weight loss in itself no matter what’s on the menu is not a sufficient reward.

Put another way, dropping a few pounds and staying the same in other ways is at best a tenuous state of affairs. This accounts for the fact that yo-yo dieting, temporary and ineffective attempts to be thinner, is the prevailing practice. As a result the overweight and obese percentages of our population are growing daily, and this unbelievably unhealthy practice is now being foisted on the next generation. The implications of this disastrous scenario are medical, social, and worst of all financial.

The Park Avenue Diet provides a truly comprehensive program for improving one’s physical, mental, and social health. As such it is realistic, holistic, and quite enjoyable. One measures success here by an improved lifestyle and better worldly opportunities, not merely poundage. In times such as these, only realistic solutions to our challenging problems should be discussed. It is time to emerge from The Dark Ages of Dieting into a physical, mental, and social renaissance.

Notes on "The Park Avenue Diet Show: The Party's Over"; September 5, 2010

2010-09-06T10:58:00.000-07:00

Remember those essays you had to write in your first weeks back at school? "How I Spent My Summer Vacation." I'd hope that your summer was devoted in part to taking care of your yourself healthwise. Summer's meant for fun...and so is the rest of your life. Did you make all the right food choices? Did you exercise every day? Were you as sociable as possible, challenging yourself with new opportunities and projects?

Whether you did or not, the summer's gone, the party's over, and many of us, far too many, have neglected our responsibilities to the upkeep and upgrading of that most remarkable piece of machinery, the human body. But that's what the Fall Season is ideal for, which will be the topic of next week's edition of "The Park Avenue Diet Show."

My summer was a most momentous one. I celebrated my 60th birthday with a spectacular party that featured my debut as a standup comedian. And I attended two amazing theater festivals, seeing the brilliant actor/director Everett Quinton in "Oh Dad, Poor Dad" as well as his moving, haunting production of "The Elephant Man" ...followed by 8 performances at the Salzburg Festival as a chaser.

This week's show cited three particularly upsetting articles in the news.
1) Many Americans Don't Even Know They're Fat'----
http://www.businessweek.com/lifestyle/content/healthday/642638.html

2)Parents Turn to Personal Trainers to Help Fight Obesity---
http://www.cbsnews.com/8301-504744_162-20015552-10391703.html

3) 40% of NYC Students are Too Fat----
http://www.nypost.com/p/news/local/your_kids_are_getting_so_big_p9iTxEeieCpuwUoj7OjWZJ

The latter is particularly upsetting, since these kids will grow up with very high risk of early cardiovascular disease and cancer. Obesity, as you know, is a risk factor for 40 different illnesses in 9 different organ systems.

So...how did you spend your summer vacation? And watcha gonna do about it? It's time to get in shape for the Fall Season, and your image--your appearance and behavior--is especially important in times of economic uncertainty. The new season of "The Park Avenue Diet Show" begins next week. Its only goal is to improve your health, which the World Health Organization defines as "physical. mental, and social well-being and not merely the absence of disease." And who will be the principal beneficiary? You !
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If you're looking for an terrific personal trainer, by the way, check out Stefan Aschan and his excellent website. He's a health-care professional of the first rank, an insightful and charismatic motivator with superlative credentials.
http://www.stefanaschan.com/welcome/

Notes on "The Park Avenue Diet Show: Big Business"; August 29, 2010

2010-08-30T08:50:00.000-07:00

“The Park Avenue Diet Show” on August 29, 2010 discussed “Big Business”, namely the industry and products surrounding and helping people struggling with obesity. Most people do not appreciate how difficult and uncomfortable life can be for someone with excess weight. The sheer effort of moving as well as self-care can be extremely frustrating and painful, both physically and emotionally.

It is difficult to understand why someone would remain in a state of relative incapacitation rather than reduce their body size and take advantage of products utilized by healthier individuals. Nevertheless, American industry in its wisdom has invented dozens of products and devices that make life easier for obese individuals and may unknowingly keep them in that condition.

You can find the websites alluded to on your own. There is no need to provide links to show you the actual items mentioned on the radio program. Just to remind you, here are the 13 products discussed:

1. A 96” tape measure, not the conventional 60” one used by tailors.

2. A smaller-sized steering wheel.

3. Large chairs that can accommodate individuals weighing several hundred pounds.

4. Tools that aid in reaching things, such as dropped objects or objects on shelves. Some websites offer leg-lifters that help people get into cars more easily.

5. A zipper device that allows a woman to reach easily down the back of her own dress to pull the zipper up. The promotional material states “You don’t need a man to pull up that hard to reach zipper on the back of your dress!” The latter seems like a very depressing state of affairs.

6. A long-handled under and between toe washer.

7. A toilet paper holder. Which is more grotesque, the item itself or the mentality of an individual that allows this need to exist?

8. Tricycles for “exercise”, since people struggling with morbid obesity cannot balance properly on a two-wheeler.

9. A portable bidet with a two-quart tank, advertised as great for travel.

10. A scale that goes up to 1,000 pounds.

11. A large-sized bib that covers the entire body and lap. Why should obese people be more likely to stain their clothing than others? Is it because of the anatomical or psychological complications of their excessive weight? I have no idea.

12. A jumbo coffin, the ultimate indignity.

13. Iodine scrubs, usually used for sterilization in operating rooms, necessary in obese people because of more prevalent bacterial infections.

The above products were discussed at length, as was a reminder of the grim medical statistics about obesity. Namely, obesity (BMI 30-35) reduces life expectancy by approximately three years; morbid obesity (BMI greater than 40) reduces life expectancy by ten years. Also according to the American College of Physicians, obesity increases the risk of forty different illnesses in nine different organ systems. Although you now have access to conveniences such as the thirteen products listed above, obesity ain’t no picnic.

Notes on "The Park Avenue Diet Show: Why is Exercise Good For Me?"; August 22, 2010

2010-08-23T08:52:00.000-07:00

The topic for this week was “Why is Exercise Good For Me?”, a rather straightforward question that apparently eludes 67% of adult Americans whose weight is problematic. Exercise provides a “sink”, namely a place for calories to be burned off just as a sink provides a conduit for emptying refuse.

Exercise can be either anabolic (weight lifting for example) or catabolic (jogging). Jeff Halevy was the guest for this show and an articulate spokesperson and example of the multiple benefits of regular exercise. Most people think of exercise as a chore, but he repeatedly reminds his clients to think of exercise as fun. From a strictly nutritional point of view, exercise seems like the ideal way to treat the various components of the metabolic syndrome. Elevated triglycerides, cholesterol, sugar, and blood pressure are almost immediately approved by regular exercise.

As people age the need for regular exercise becomes especially crucial. The goals here are increased flexibility and balance, so that an individual will sustain less serious injuries due to an accidental fall. Even short walks have been found to be beneficial in the elderly population. Activity promotes increased circulation and avoids venous stasis, particularly in the lower legs where phlebitis can evolve into a major medical emergency.

Your physique is an important component of your image. There’s no getting around the fact that how you look is extraordinarily important in diverse situations ranging from job interviews to dating. If you are foolish enough to neglect your own body, how would a prospective boss want to hire you to help improve his or her own business? If you do not care how you look, how could a prospective mate imagine that you would care about their wellbeing?

The quiz question was: Which “organ” in overweight or obese people is most helped by exercise? None of the callers got the right answer, which is visceral fat. As you remember from our discussion of this topic, visceral fat releases extremely dangerous hormones and chemicals into the circulation. These are directly responsible for additional risk to overweight or obese people for dozens of illnesses and cancers. Aerobic exercise seems to be fueled initially by visceral fat and therefore it is the perfect way both to lose weight and improve risk factors.

A recent article in the August 2010 issue of Harvard Woman’s Health Watch confirmed these exact points:

http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch.htm

Another interesting article discussed contraction-induced signaling. This is a process by which exercise stimulates glucose transport into the muscles of the body. What is most interesting is that it does not depend on insulin, and therefore exercise is especially helpful for people with insulin resistance. Somehow exercise helps the intracellular pathways leading to glucose transport:

http://www.news-medical.net/news/20100821/Study-supports-role-for-SNARK-protein-in-regulating-glucose-transport-during-muscle-contraction-and-exercise.aspx

These are new and rather complex biochemical findings but the message is the same. No matter what your weight is, exercise is extremely important for you.
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Here is Jeff Halevy's contact information. He is a superlative personal trainer and fitness expert whom I unhesitatingly recommend to everyone.

Halevy Life(212) 233-0633 www.HalevyLife.com

Notes on "The Park Avenue Diet Show: What is the Metabolic Syndrome?"; August 15, 2010

2010-08-16T06:24:00.000-07:00

This week’s WOR program centered on the metabolic syndrome, one of the most important discoveries in the past fifty years. Until recently it was not known how several seemingly disparate illnesses occurred simultaneously, for example hypertension and heart disease. None of the facts we are about to discuss were in any of my medical school text books and were totally unknown at the time of my internal medicine residency at Maimonides Medical Center.

The metabolic syndrome is quite simply a group of three blood tests and two physical findings. It has been defined slightly differently by different health organizations in various studies. One such definition (by the IDF) is as follows:

• 1. Abdominal (central) obesity: waist circumference >37 inches (men); >31.5 inches (women) [these are lower for South Asian/Chinese/Japanese].
Plus 2 of the following 4
• 2. Blood pressure > 130/85 mm Hg
• 3. Triglycerides > 150 mg
• 4. HDL: under 40 (men); under 50 (women)
• 5. Fasting glucose > 100 mg.

Other scientific papers may utilize different measurements but the overall significance remains the same, namely that the person has an extremely high chance of developing circulatory diseases prematurely as well as the other components of the metabolic syndrome. Note that two of the criteria are essentially “pre-diabetes” and “pre-hypertension.”

What is most interesting about the metabolic syndrome is how those seemingly unrelated components are actually interconnected. There was no “central unifying thesis” until recently. The missing link was insulin resistance.

Insulin resistance, as yet only partially understood, affects all aspects of the metabolic syndrome as well as virtually all aspects of an obese body. Simply put, insulin resistance means that a person’s insulin is not functioning up to its usual capacity. It is somehow weakened or ineffective. This begins to happen in the early stages of weight gain, particularly in those individuals from diabetic families.

Ineffective insulin is unable to allow circulating glucose to enter cells of the body, most notably those in skeletal muscle and the liver. The cells which are not receiving enough energy from glucose send out messages to the pancreas, which in turn overproduces even more ineffective insulin. Thus, paradoxically, a “pre-diabetic”, will actually be producing more insulin then his or her healthy friends.

Multiple abnormalities result thereafter, all somehow related to the overproduction of ineffective insulin. One result is excessive retention of sodium by the kidneys, especially dangerous in a “civilized” country like the U.S.A with our high salt diet. Another result is circulating fats (called free fatty acids) which have numerous potentially dangerous consequences. This can most readily be seen as elevated cholesterol and triglycerides. What is unseen is a possible destructive effect of free fatty acids on the pancreas, leading to its further weakening (and diabetes).

Can we mention two of the most dreaded complications? One is a “pro-inflammatory” state, namely having highly unstable lesions in the coronary/cerebral arteries that can literally explode at any time. The other is a “pro-coagulant” state, one in which blood can clot more easily, the usual scenario for a heart attack or stroke.

The biochemistry charts depicting the various interactions we have just described are unbelievably complex. The above discussion is extremely simplified, and a great deal is not known as yet. However we are dealing with an illness, obesity, that clearly has warning signs well in advance of potential disaster. If you have the metabolic syndrome, you have already developed insulin resistance. And if you have insulin resistance you may already have done serious damage to your heart, brain, and kidneys. The need to take weight off and keep it off would therefore be the most important item on your “to do” list.

Here’s a little more information for those who want bonus points and wish to demonstrate amazing scientific knowledge to their friends:

Metabolic abnormalities associated with insulin resistance

• Endothelial dysfunction (increased adhesion molecules, increased cellular proliferation, less vasodilatation)
• Dyslipidemia (increased free fatty acids, TG, small dense LDL; decreased HDL, adiponectin)
• Procoagulant state (increased PAI-1, fibrinogen)
• Inflammation (increased CRP, IL-6)
-European Journal of Pharmacology 2004
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• 1/3 of the USA population is insulin sensitive.
• 1/3 of the population is insulin resistant. These people have very high insulin levels and really need intervention.
• 1/3 is in the middle.

Notes on "The Park Avenue Diet Show: Sweetness and Light"; August 8, 2010

2010-08-09T07:33:00.000-07:00

The topic of artificial sweeteners is as controversial as they get. These miracles of modern chemistry have changed the palates of the American public since the mid-1960’s. But why were they invented in the first place? Surely there are enough natural substances to go around, for example cane sugar, stevia, fructose and lactose.

Artificial sweeteners however, earned their role in our culture since they purportedly are a useful tool for weight loss and weight control. But, as we also learned in the 1960’s, “everything you know is wrong.” Is it possible that the massive increase in the incidence of obesity that began in the 1970’s is not merely a correlation with the use of artificial sweeteners but a causative factor? Put another way, does the use of artificial sweeteners make people fatter?

This was a possible interpretation of a shocking study presented at the American Diabetes Association convention in 2005. A large-scale study showed that the more diet sodas a person drank, the more likely he or she would be obese. I appeared on CNN This Morning and was interviewed by Soledad O’Brien on this topic. You can actually see this interview on You Tube.

http://www.youtube.com/watch?v=yklNA6oE0DI

Several other journal articles have appeared since 2005 which seem to confirm the suspicions of those researchers. Take a look at these articles. You may not be able to understand the technical language or the statistics, but you certainly will be disturbed to know that the role of artificial sweeteners in your diet is by no means clear—or beneficial.

http://www.ajcn.org/cgi/content/short/ajcn.2008.26792v1

http://sci.tech-archive.net/Archive/sci.med.nutrition/2005-06/msg01172.html

http://www.foodnavigator.com/Science-Nutrition/JAMA-questions-sense-of-sweeteners-for-weight-loss

Non-nutritive (artificial) sweeteners are chemosensory signaling compounds. They tell your brain that you have just ingested many calories of an imaginary sugar, but there may be a backlash of sorts. The sweeteners may condition the body to no longer associate sweetness with calories, thereby disrupting its ability to accurately assess calorie intake. Practically speaking this means that after a diet soda or two, you may overeat dessert because it doesn’t seem as sweet as those chemicals (sucralose, aspartame, saccharin).

In summary, non-nutritive sweeteners:
(1) May increase appetite.
(2) May promote energy intake, not restrict it.
(3) May contribute to obesity.

The last of these three points is obviously the most controversial. This is a source of much back-and-forth arguing in the dietary community. The matter is hardly settled yet. Could overweight or obese people be easing their consciences by substituting an artificial sweetener for a packet of sugar (which only saves them 20 calories)?

Or could the aforementioned chemicals disrupt the feedback mechanism of satiation to such a degree that artificial sweeteners in fact cause the illness, obesity, which they are meant to cure? There is no answer as yet. What do you think?

Here are the two quiz questions explained:

How much swimming do you have to do to burn off the calories from one packet of sugar? Answer: A packet of sugar contains about 20 calories. Swimming burns off approximately 600 calories per hour. Therefore 20 calories would disappear in one thirtieth of that time period, namely two minutes.

If you switch to an artificial sweetener for your morning cup of coffee and do nothing else differently, in how long will you lose one pound? Answer: Since one pound of body fat requires a sacrifice of 3500 calories and there are 20 calories in a packet of table sugar, this process will take 175 days, about six months. Please note that if you are using artificial sweeteners at breakfast time but having a high-calorie meal (like a bagel with cream cheese or pancakes)…naughty, naughty.

Notes on "The Park Avenue Diet Show: A Modest Weight-Loss Proposal"; August 1, 2010

2010-08-03T12:56:00.000-07:00

What could be more controversial than an essay by Jonathan Swift? How about, "A Modest Weight-Loss Proposal", an essay reminiscent of his sardonic wit, describing an imaginary "diet" that would ensure near-total compliance? You'll be able to read the complete essay at the end of this brief introduction and judge for yourself. But please be seated and have smelling salts at hand !

It was only a matter of time before politicians and insurance companies decided to impose penalties on those whose weight is excessive. I wrote the my Swiftian essay about 7 years ago, and it was immediately deleted from the manuscript for "The Park Avenue Diet." Too incendiary, I guess.

But as listeners heard, there are now taxes proposed on soda, sodium, trans fats, and saturated fats. Germany is considering weighing obese schoolchildren daily, with severe repercussions for their parents should no action be taken.

http://www.telegraph.co.uk/news/worldnews/europe/germany/7904990/Overweight-people-should-pay-fat-tax-to-cover-healthcare-costs-German-MP-says.html

Use your favorite search engine to seek out other examples of a "fat tax." You'll have plenty of summer reading material...all of it Orwellian. Or watch the politicians of New York state argue about soda taxes (naturally, all of our elected officials are glamorously and radiantly healthy role-models.)

Whatever your opinion is, don't blame me. I wrote "A Modest Weight-Loss Proposal" as a satire. The April 15th Diet, described below, was only a joke when I thought it up. Will it become reality soon? Ask at your local post office.
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A Modest Weight-Loss Proposal----------------------------------------------------------
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Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference…after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.

Why don’t most of those 67% overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?

Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15^th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15^th Diet you can eat unlimited portions of anything that you want throughout the entire year. Sounds terrific, no?

Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.

Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying”, or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.

The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the health-care system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand.

Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor, “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization, and nursing care?”

Americans share only two things in common: death and taxes. The fear of early death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds, and bellies very quickly.

Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.

Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15^th Diet is the worst diet that you ever heard of…but boy would it work!

Notes on "The Park Avenue Diet Show: Flab Food Nation"; July 25; 2010

2010-07-26T15:03:00.000-07:00

This week's show, entitled "Flab Food Nation", posed the semi-theoretical question: "What is the #1 reason that so many Americans are overweight or obese?". Callers offered their views. providing remarkable insights into this profound issue.

But beforehand there was a tutorial in The Mathematics of Dieting. First off: the definition of a calorie more specifically than a unit of energy. A food calorie (kcal) is the amount of energy needed to increase the temperature of one kilogram of water (one liter) by one degree Celsius. Other useful figures: proteins and carbs, when burned off, produce 4 kcal per gram, whereas fats produce 9 kcal per gram. It's therefore twice as hard to burn off fats...so beware of fast food breakfast sandwiches such as [redacted] with 3 strips of bacon, a sausage patty, 4 slices of ham, an egg, and 2 slices of cheese....yes, it's real.

The recommended daily intake of calories for a young adult or a man is 2500 kcal per day----and for a woman, 2000 kcal per day.

3500 kcal equals one pound of body fat....in either direction, namely putting it on or taking it off. This translates into 5 hours of jumping rope, for example, if that's a favored pastime. On the other hand, the revolting "food" called "turducken" contains 3500 kcal. God Bless America !

Last interesting trivia for now---your weight multiplied by 15 is approximately the number of calories you are now eating in order to maintain your current weight. So if you weigh 200, you are taking in 3000 kcal per day.

These fascinating facts of biochemistry have no place in the world of supermarket tabloids, where thin celebrities "lose ten pounds" on a special food program unmentioned in medical textbooks. Does anyone wonder how far we've gotten off track in our Flab Food Nation?

Back to the question of the week: "What is the #1 reason that so many Americans are overweight or obese?" There were at least six excellent responses from callers, and there were many others who couldn't get through our switchboard. Your humble host, however, provided the correct answer: "Health is not the #1 priority of most Americans." Further amplification was provided, and the discussion will continue next week.

Notes on "The Park Avenue Diet Show: Are My Friends Making Me Fat?"; July 18, 2010

2010-07-19T15:11:00.000-07:00

Are you influenced by people around you, or do you primarily make decisions on your own?

Perhaps we all do a little of both, but for this week's edition of "The Park Avenue Diet Show" we explored how one's social circle may influence his or her foods choices. Those who have maintained a good weight for decades are on automatic pilot, having established a routine that favors nutrition and optimal health from which they rarely deviate. They have their own inner set of self-care priorities, so called positive personal myths.

Other people who are struggling with weight are encircled by individuals who may knowingly or unknowingly intimidate them into overeating. This can be done through a wide range of dysfunction behaviors. Here are some examples, and you can see the pattern--someone is being asked/cajoled/humiliated into eating to fulfill someone else's negative personal myths.

"What's wrong with having a second dessert? You worked hard today and deserve it."

"Let's not talk about unpleasant topics. Let's go have a pizza."

"You don't want seconds? Obviously you don't like my cooking."

"You may be on a diet, but not here. You''ll just have to go to the gym for a few extra hours."

"You're not fat. You look fine to me."

"Enablers" are people who may knowingly or unknowingly steer you in the direction of unhealthy food choices. They are not bad people, and they may actually feel that they are taking care of you. This particularly true with parents who overfeed their children in the mistaken belief that this represents the "comforts" of home. The classic "comfort foods", still promoted by supermarket magazines that promote crackpot weight-loss tips, are well known to you: macaroni and cheese, rice and beans, noodle pudding. Do they conjure up thoughts of childhood and happiness for you?

People who want you lose to weight, improve your image, and get healthier are your "support group." People who undercut your efforts, for whatever reasons, may be "co-dependents." They may not want you to change, possibly because it reflects badly on their inability to do so.

Needless to say, weight loss, an extremely challenging project on its own, is made even more difficult when close friends, family, or colleagues involve others in unhealthy behavior patterns. Part of the learning curve in weight loss is discovering for oneself where those influence lie...and reshaping one's thinking accordingly. This is a central premise in "The Park Avenue Diet", one eloquently elucidated by Dr. Stanley Krippner. He teaches the reader how to respond to enablers and co-dependents, something equally as important as eating low calorie food, perhaps even more so, since this facilitates lifelong lifestyle changes.

The guest discussant on this week's show was the eminent psychologist Debbie Joffe Ellis. You can hear her brilliant insights and mellifluous voice on the WOR section of parkavenuediet.com
She recently completed the last chapter of her late husband's autobiography, and the book is now available...and unmissable. He, of course, is Dr. Albert Ellis, perhaps the most important psychologist of the 20th century and certainly the most influential philosophically for me. What a thrill to have Debbie on my show, but don't take my word...listen for yourself.

Here's the new book:

http://www.amazon.com/All-Out-Autobiography-Albert-Ellis/dp/1591024528

Notes on "The Park Avenue Diet Show: Oil and Water"; July 11, 2010

2010-07-12T15:40:00.000-07:00

My lecture on "Oil and Water" has been popular for many years. I first did it on "Vital Signs", my fondly remembered WEVD program sponsored by The Atkins Center, then recycled it for several lectures.

Oil and water don't mix (they are immiscible), as anyone who has repaired his or her own car knows very well. Oil and water don't mix in milk either, as it eventually separates into curds (fat) and whey (water-soluble protein). When you eat dietary "oils" (fats) like butter, cream, cheese, or salad oil, a separate liquid, bile (which is made in the liver and stored in the gall bladder), is needed to allow their byproducts to flow through the intestines and become absorbed into the circulation.

Once in your bloodstream, the oils take the form of cholesterol, triglycerides, and similar chemicals, and they travel as somewhat isolated molecules (for our convenience these are simplistically named HDL, LDL, VLDL etc...but the constituency of these is very complex.)

Oils have a place in the lungs..."lubricating" the air sacs (alveoli) so that they never collapse fully. We were taught at Maimonides Medical Center that this is partially why chicken soup is so soothing during flu season---the chicken fat makes the lung tissues more compliant, less "dehydrated."

But oil in the wrong place is a bad bad thing, just like butter staining your clothing when it squirts out of Chicken Kiev. Allergic reactions are usually due to oils--the most notorious, diet-wise, is peanut oil. The most notorious, skin-wise, is the plant that causes urushiol-induced contact dermatitis...poison ivy.

Overflow oil (triglycerides, particularly) in the liver causes what I used to refer to as "The Pate Syndrome"--"fatty liver", properly temed steatohepatitis. Oil inflames the tissues, just like "poisonous" plants inflame the skin, and the eventual result can be cirrhosis. Just as a reminder--- it is predicted that young obese diabetics who continue to neglect their diet and weight might need liver transplants in the future (in their 40's) for this entirely preventable condition.

And now, the piece de resistance...oil (cholesterol molecules) in the walls of coronary arteries--very similar to "pimples"--are hidden pockets of inflammation, calcium deposition, and blood clots. These can eventually rupture, just like a pimple, except that the rupture of a coronary artery is the initial event in most heart attacks. Oil in the walls of coronary arteries is "immiscible" in the water-based environment of bodily fluids and tissues. Here, the abnormal collision of oil and water can be fatal.

This is why anti-inflammatory agents (such as low-dose aspirin) are used to prevent strokes and heart attaks. They "soothe" the interface between oil and water...but if there are too many lesions, "something's got to give."

Oil and water----they need to get along somehow in many of your bodily organs. But if you're neglecting your weight and diet...and therefore your health...the collision between oil and water might be explosive !

Notes on "The Park Avenue Diet Show: Weight Loss in Red, White, and Blue": July 4, 2010

2010-07-05T11:04:00.000-07:00

The articles reviewed this week frame the subject of obesity in unusual ways, at least geographically speaking. First this news item:

http://www.theborneopost.com/?p=42767

Borneo and the surrounding islands of the Indonesian archipelago are not usually associated with obesity. How times have changed ! Sad to say, other emerging nations, formerly plagued by endemic malnutrition, are struggling with the same problem, namely China, India, and Mexico.

Leave it to the USA to spearhead the movement, albeit in the wrong ways:

http://www.nydailynews.com/lifestyle/2010/06/24/2010-06-24_open_wide_friendlys_burger_and_cheese_triple_decker_is_even_worse_for_you_than_k.html

I reviewed other fast-food franchise websites as we discussed what to eat during the summer and came up with new, depressing facts. Ice cream is no longer the single scoop treat or Eskimo Bar that your parents might remember. There are now even sweeter, thicker, and more artificial concoctions that pack hundreds of extra calories into swimwear that teeters on the brink of explosion. One such company, advertising a product whose caloric content ranges from 700 to 950 (!!!) has this slogan: "You only live once." If rewritten to utilize data from an article cited previously from The Lancet: "You only live once, and we're taking three years of that away from you."

"Weight Loss in Red, White, and Blue" can be expressed in pleasant and positive ways--like red snapper, egg white omelets, and blueberries. But that same show title can also remind us of the consequences of obesity: excess blood clotting, anemia due to chronic renal failure, and cyanosis due to sleep apnea. Which do you prefer for yourself and your family?

The average male requires about 2000 calories a day, the average woman 1800. With that in mind, please look at certain foods differently this summer: pecan pie (575), 4 ounce cheeseburger (525), giant soft pretzel (500), "club sandwich" (800),.....one carrot (30), papaya (less than 50), corn on the cob (100). Do you really need 500 calories of starch and fat as "popcorn" in order to sit through Eclipse? Send your extra calories to Robert Pattinson !

And what about burning off calories over the summer? I doubt you'll be waterskiing (400 calories/hour). Maybe your type of "exercise" is miniature golf (200 calories). Most likely, your weightlifting will be confined to your cellphone and "cardio" will be gossiping (68 calories/hour).

Want more shockingly high-calorie food stats? A 20 ounce T-bone steak (1500), potato salad (360), "funnel cake" (500) and a gigantic turkey leg (1100) might try to tempt you, overstimulate your insulin, and fill up thousands of lipocytes.

Or would you prefer something nutritious and tasty? Watermelon, papaya, and avocados are alkaline, raising your body's pH very healthfully at a low caloric cost. What's better for you than those grotesque colas, spiked with phenylalanine? Coconut water has the same osmolarity as human serum, perfect for those hot, sweaty days. It's actually better for dehydration than water or that "vitamin" liquid.

In an era when your own health, image, and self-care become increasingly important every day, how much longer can you afford to ignore The Mathematics of Dieting? 3500 calories= one pound of body fat, on or off your body. Summer is as good a time as any to do the math, come to your senses, and reinvent yourself entirely a la The Park Avenue Diet. You are the main beneficiary, and that's the best investment for the future anyone can make !

Notes on "The Park Avenue Diet Show: What is a Personal Myth?"; June 27, 2010

2010-06-29T05:15:00.000-07:00

The article cited this week comes from the current Journal of the American Medical Association. It discusses the link between obesity and the development of diabetes in older adults. Needless to say, the illness indeed develops insidiously, as with other age groups. There are no surprises here:

http://jama.ama-assn.org/cgi/content/abstract/303/24/2504

Much more interesting and sadly emblematic of our times is a cover article in a recent “health” magazine. Last week I saw a famed “nutritional” periodical tell its readers how to “eat more, weigh less”, a physical impossibility. But this week I stared at the cover of a well-known journal with the headline: “Lose 7 Pounds in 6 Days.”

Let’s explore the mathematics of dieting, a favorite topic. 3500 calories = one pound, whether calories are taken in or burned off. In order to lose 7 pounds, you need to incur a calorie deficit of 24, 500 calories. If this is divided among 6 days, that comes to about 4000 calories a day. Now remember, you need a deficit, so that means…no eating at all…as well of one of these “exercise programs”: swimming for 6 hours per day, taking eight aerobic classes in sequence daily, or mowing the lawn for 10 hours per day—a “green” alternative.

Therefore, that article I saw promised something physically impossible. The “weight” lost by any crash program is extracellular tissue fluid—water—which will promptly be regained. Did you get fooled by any similar articles today? I hope not.

The general topic for this evening’s broadcast was “What is a Personal Myth?” This topic has been explored for decades by my lifelong friend, mentor, and literary colleague Dr. Stanley Krippner. My own take on this complex and fascinating topic:

Personal myths make up our “rulebook”, the code of behavior that we have developed for ourselves over a lifetime. Many can be positive, for example: “I can best help the world during my life by being a physician.” [one of mine]

But all of us harbor negative personal myths, and sometimes these can undermine our best efforts at living. A distorted belief system can lead an individual into unrealistic viewpoints, self-deception, and self-validation. The latter is nicely expressed in French as soi disante…[self-styled, making the speaker an authority figure].

Here are typical negative personal myths that interfere with some individuals’ inability to stay on a weight loss diet.

1) It’s been a hard day at work so I’m having another piece of pie.
2) I’m allowed to have “cheat days” because overall I plan to lose weight.
3) I’m going to eat macrobiotic for the rest of my life.
4) I just worked out at the gym so now I can eat whatever I want.
5) Ordering a diet beverage offsets the high calories in the rest of my meal.
6) Buying cakes and muffins in bulk is the perfect way to save money in a recession.
7) My kids aren’t overweight. That’s baby fat.

And so on…

The remedy is to replace each of these incorrect statements with a productive and realistic thought that leads to a healthier lifestyle. That’s part of The Park Avenue Diet, by the way.
In coming shows, we’ll explore how to do this. Meanwhile, can you think of any of your own personal myths…and how I might “rewrite” them to send you off to a happier tomorrow? Give it a try.

Meanwhile, here’s a superlative classic book by Dr. Krippner that belongs in your library.
http://www.amazon.com/Personal-Mythology-Ritual-Imagination-Discover/dp/160415036X/ref=pd_sim_b_1

Notes on "The Park Avenue Diet Show"; June 20, 2010

2010-06-21T07:40:00.000-07:00

A fascinating article was recently published in the British Medical Journal reporting the findings of a survey that found a correlation between obesity and adverse sexual health.

http://www.bmj.com/cgi/content/full/340/jun15_1/c2573

This article is certainly the first of its kind and sparked interesting discussion on many news blogs. A definite correlation was found between Body Mass Index and sexual behavior. Unfortunately, the findings were negative and unpleasant.

What is most interesting was this statement: “The relation between obesity and sexual ill health might be forged via physiological, social, and psychological mechanisms. It is in the social factors influencing sexual behavior, however, that we are most likely to find insights into these findings, particularly for women.”

The correlation between weight and impaired social behavior is addressed as a central premise in The Park Avenue Diet. No other weight loss book or philosophy works on these seemingly unrelated components of image simultaneously. Poor interpersonal skills, however, will lead people into the abyss of dietary excess; food provides the comfort and pleasant feelings that elude them in intimate relationships. Although a harsh reality, this must be addressed as part of a weight loss program. The researchers in the above scholarly article have obviously come to the same conclusion.
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The Ten Commandments of Dieting, as discussed on the 6/20/10 show:

1. Matter is neither created nor destroyed in a chemical equation. [This is The First Law of Thermodynamics which basically states for our purposes that weight gain or loss is totally dependent on calories. Any other explanation defies physics.]

2. No commercially available weight loss program has ever been shown to be better than another. There “success rate” is approximately 5-10% with success defined as 12-15 pounds in one year. These facts are shielded from the American public. They would not be if the issue was car safety, for example. [The studies that prove this can be readily accessed in the bibliography of The Park Avenue Diet. In fact, the AMA and ACP have asked that no further studies be done on this subject since the outcomes will always be the same.]

3. There is no single set of foods associated with normal weight. On the contrary, individuals throughout the world are able to avoid weight gain on hundreds of ethnically different diets. [The foods that magically produce weight loss are figments in the imagination of desperate magazine writers.]

4. A weight loss program that does not take into account other components of image will fail in the long and short run. [Please refer to the discussion above for an illustration of the relationship between BMI and “interpersonal skills.”]

5. Magazines whose cover articles describe “How to Lose Belly Fat” should not accept advertising revenue from products with “empty” calories. Why have we banned cigarette and liquor ads from magazines? [A currently available supermarket magazine tells gullible readers “Eat more, Weigh Less”—a physical impossibility]

6. “Hormonal” imbalances affect weight gain minimally, probably around 15 pounds, according to the American College of Physicians. [Obesity is not a “glandular condition.”]

7. “Yo-yo dieting” is an independent risk-factor for cardiovascular disease. [All the more reason to lose weight and keep it off!]

8. Human genetics do not account for any aspect of weight gain. The obesity epidemic began in the mid-70’s, and 30 years is too short a time for the human genome to be modified. [The idea that human DNA can change drastically in a few decades defies molecular biology and common sense, although not necessarily in that order.]

9. You can not lose weight without proper nutritional supplementation. You can not maintain a healthy weight without regular exercise. [Them’s the rules. I don’t make them.]

10. Do not look at the scale. Observant friends, family, and colleagues will notice any improvement. They, after all, are the ultimate judges of how you look. [This is another central premise of The Park Avenue Diet. If you truly look and act much differently, everyone will notice and be impressed.]

Notes on "The Park Avenue Diet Show"--June 13th, 2010

2010-06-14T15:43:00.000-07:00

Here are a few comments regarding the points covered in the show entitled" The Top Ten Weight-Loss Myths".

The Medical Riddle of the Day was: "What is it called when overflowing oil gushes out into natural surroundings and pollutes everything it touches?" The answer is not you-know-what in the Gulf of Mexico. It's visceral fat, that toxic accumulation of hormonally active, potentially carcinogenic, and thus extremely dangerous "oil"....which "pollutes" millions of American bodies internally. No tell-tale oil slick, since these chemicals (free fatty acids) do their mischief via the circulation.

And here are the Top Ten Weight-Loss Myths
1) Those mass-market diets are very successful. That's why they've been around for years. (See The Park Avenue Diet bibliography for medical articles on this topic----and be prepared to be horrified).
2) "I'm from the government and I'm here to help your weight" (This paraphrase of Ronald Reagan is meant as a warning that no elected official, government agency, or political party is particularly interested in your health...and therefore it's up to you. This will be even more true in future years.)
3) There are foods that can help you lose weight (This is conceptually impossible and defies the first law of thermodynamics).
4) There's nothing wrong with being overweight (Lifespan is reduced by one year in the overweight, 3 years in the obese, and 10 years in the massively obese....please complain to "The Lancet" if this seems unpleasant).
5) Exercise is more important than eating correctly if you want to lose weight (Many 'exercisers' overeat after a workout...conversely, exercise is mandatory for maintenance of a good weight.
6) All health information is equally valid, especially those magazines at the supermarket checkout counter.
7) Weight-loss depends on carbohydrate content and/or glycemic index. (see: the first law of thermodynamics)
8) Diabetes and high blood pressure are benign conditions like athlete's foot.
9) I feel okay so my weight isn't a problem.
10) "Weight loss has magical transformative properties." (This error in thinking is discussed at length in The Park Avenue Diet).

Next week: The Ten Commandments of Weight-Loss (June 20, 2010).

The Greatest Blessing of Life

2010-02-16T17:12:00.000-08:00

At designated times of the year like Easter, Passover and other holidays, we are often asked to count our blessings. Maybe you’ve been reminded of this somewhat hypothetical activity when confronted with someone else’s problems. “There but for the Grace of God go I” seemed an archaic rumination until I had emergency ulcer surgery in 1991—feeling sorry for myself until I realized that my room at St. Claire’s Hospital was on a ward of people with terminal illnesses. All my intravenous lines, electrodes, and tubes seemingly vanished when I pondered the depth of those patients’ despair and suffering. It was an epiphany of sorts, but one arrived at through transformation of selfishness into empathy for others less fortunate.

Are you conscious of how seamlessly the human body works? Think about the organs over which you have no control: your spleen, ureters, ciliary muscles, alveoli, pons, and portal triad (among dozens of other body parts) are actively engaged in highly specific tasks beyond the scope of human understanding, let alone noticeable feelings. Put another way, the parts of your body that you actually notice—your brain (via self-talk and voluntary actions)…your muscles (via your conscious movements)…your digestive tract (via hunger and subsequent satiation)—are a tiny component of the entire machine. The part of you that’s unique (your thoughts, your memories, your knowledge base, your appearance) is really very small when compared with the dazzling molecular structure, biochemical interrelationships, and mechanical intricacies of the musculoskeletal infrastructure. Shakespeare called the human body “the beauty of the Earth, the paragon of animals.”

Yet there is something even more beautiful than the human body, and that is the mysterious set of emotions that draws people together. While we share these unknowable forces with every member of the animal kingdom, we humans seem to do it more poetically. From earliest childhood when we are taught social behavior, we can develop a need to share, a special pleasure in the attention and affection of others, and perhaps even an inner calm and contentment when we find ourselves in intimate relationships.

Like optimal health, personal contentment is an evanescent pleasure, one subject to the whims of fortune, the inexorable forces of nature, and the ultimate fragility of the human body. The people we are closest to will eventually vanish from our lives, even under the best circumstances. The loss will be magnified exponentially the closer and more intense the relationship was. That cannot dissuade us from trying to reach out to others, hoping by some strange twist of fate, or perhaps just good luck, or even the kind intervention of a friend, to find someone who can give a meaning to life that eludes all of medical science.

The greatest blessing of life is the one that transcends the ravages of time, aging, disease, despair, loneliness, and fear. It is the force that ennobles us, makes us capable of being more than ourselves, more than complex biochemical machines, more than a collection of organ systems. Like the human body, it is magical, powerful, uncontrollable, and all-enveloping. It is ample reason for life itself. It is love.

Time's Winged Chariot

2010-01-17T10:54:00.000-08:00

You don’t need to be a physician or sing depressing Brecht/Weill songs to know that mortality is an evanescent state. From cradle to grave, certain biological values decline: heart rate (from a fetal heart rate of approximately 120-150 to zero), the number of brain/heart/kidney cells, all measurements of cognitive function. Other values may increase: blood pressure commonly rises as aging arteries stiffen, sodium is retained, and renal filtration worsens.

Those wishing to know the actual probability that they will die can easily consult an actuarial table. The benevolent souls calculating your health-insurance premiums do this with the same empathy they experience while urinating. Perhaps your need-to-know has lured you into the over-decorated salon of a psychic. Otherwise, how could you possibly know how long your “life-line” is? This crucial information was left out of all my medical school textbooks.

Allow me to simplify this. Life tables reveal such information as the chance that you will survive any given year of your life, your remaining life expectancy, and what percentage of people born the same day are still alive. Here is a straightforward way to determine this important information as you begin a new year and a new decade:

If you were unable to calculate your answer readily, you might have to adopt a different philosophy, namely that each day requires ongoing life-sustaining efforts and life-affirming projects. In fact, you might have to reconstruct the aforementioned approach as a double-negative. Allow me to explain.

Diabetes, hypertension, obesity, overweight, insulin resistance, hypercoagulability of blood, arterial wall inflammation, and elevated cholesterol can and will shorten your life. Perhaps a few hours, perhaps a few months, perhaps a decade. I often ask patients who are unable to control these conditions “How much less do you plan on living?” It has recently become clear that elevation of blood sugar is the last step in the development of diabetes, not the first. Most of the damage done to the circulation occurs in the “quiet” stages when the patient feels well. Where ignorance is bliss, breakfast is an overdose of calories.

In a political environment where the term “healthcare” means some odious type of government program, the true definition seems totally antithetical. Nevertheless, healthcare is what you do for yourself, not what is done to do. Preventative medicine requires self-control, foresight, and delayed gratification. You might be fooling yourself through disordered personal myths, but your bodily organs experience the brunt of unhealthy eating and thinking.

“I can eat diabetic cookies because I take medication”—“I know fat people who never get sick”—“My good deeds will cancel out my bad habits”—there are delusions that can be custom-fitted to any unhealthy lifestyle. “I eat whatever I want to because some day I’ll drop dead” a corpulent patient once boasted. I asked him “How do you know that you won’t have a paralyzing stroke and be in a nursing home for years?” The silence thereafter spoke volumes.

Conversely, living life to its fullest, enjoying the moment, developing new and surprising relationships, and reinventing yourself periodically are techniques of survival and templates for happiness.

The ancient Greeks thought that the sun moved across the sky drawn by Apollo’s chariot and horses. In high school I became fascinated with a poem by Andrew Marvell, “To His Coy Mistress” wherein the “horny” narrator puts the moves on his reluctant girlfriend. The description of mortality is particularly haunting:

“But at my back I always hear Time’s winged chariot hurrying near...
"Though we cannot make our sun stand still, yet we will make him run."

Staying a few steps ahead of our fate, instead of unwittingly hastening it, is distilled wisdom from poets, psychics, and actuaries. So what are you waiting for?

Staring at Death

2009-10-29T06:26:00.000-07:00

While learning “The Sailor’s Tango” from Happy End, a Weimar-era play with songs by Bertold Brecht and Kurt Weill for performances this winter, I recently discovered a major obstacle that had inhibited my full realization of this musical mini-drama. Within the span of a few lines, I would have to evoke and enact the most frightening experience possible: confrontation with the most fearsome, shattering, and terrifying thing in all of life—death.

“Der Matrosen-Tango” tells the story of humble sailors, the lowest ranking men aboard the German ships of the 1920’s. They return from shore leave, bragging about the booze, cigars, and girls left behind. Laughing at God and religion, they depart for Burma, only to meet their fate amidst the whirlwinds of a tropical typhoon. Their last-minute prayers are unanswered as they witness their ship destroyed, drifting down to a watery grave. A “sea of blue” will be their home for all eternity.

Naturally, it’s a rare privilege to learn a Brecht/Weill song, even for someone who directed The Threepenny Opera as a 19 year-old Yale undergraduate. Their music collaboration produced masterpieces whose hypnotic harmonics and intense drama are uniquely haunting. I too have been haunted by “The Sailor’s Tango” and not just by its subtle dance rhythms and literally hair-raising words. A very dear Yale friend, Glenn Mure, a brilliant actor and singer, included this number in a 1986 cabaret program for his closest friends immediately after he was diagnosed as HIV-positive. The horrifying pleadings of the sailor took on an extraliterary significance that still give me chills.

During my years as a medical student, extern, intern, resident, and emergency room attending physician I saw by my estimation approximately 3000 people die in front of me. Almost all doctors have crossed that same battlefield. Some of those people had lived long, happy lives. Others were cut down in their youth. Some were victims of accidents or unforeseen health crises. Others were infants, children, or adolescents who never experienced the beauties of health, friendship, and joy. How did these experiences steel me in a resolve to fight disease and help people in need? I don’t think I will ever know.

Now I find myself reliving the deaths of close friends, family members, and even some strangers as I channel the primal terror that a doomed fictional sailor experiences—compacted into 20 seconds of the Brecht/Weill song. A lifetime of death, as it were, passes through my mind. As does my reaction to this incessant fear caused by the inexorable forces of nature and illness. When I first started to witness multiple cardiac arrests during a typical day in a large Brooklyn hospital—despite heroic measures and amazing dedication by humanitarian physicians, nurses, and assistants—I realized that I needed to live each day fully, caring for others and enjoying my favorite things, namely friends, theater, and music.

When I perform “The Sailor’s Tango” I will be once again staring at death, and it won’t be the last time.

What is the Worst Illness in the World?

2009-10-23T08:24:00.000-07:00

What is the worst illness in the world?

I was reminded of that rhetorical question this week when I examined a patient rapidly losing her vision from retinal hemorrhages and a central retinal vein thrombosis. She had struggled with poor vision in one eye and now has lost almost total vision in both eyes, only being able to perceive shapes and light. Amazingly, although 86 she has no other chronic illnesses and has never taken any prescription medicine.

Naturally this patient is overwhelmed by the sudden development of this affliction. Now she must become reliant on neighbors and friends for her daily activities, and her security and independence have been permanently changed. She humorously pretends to consider suicide but wouldn’t be able to ascend the Brooklyn Bridge on her own.

As a physician, I am repeatedly faced with the difficult task of giving consolation and courage to people such as this wonderful woman. What can you tell them? Throughout 30 years as a doctor and a healer, I have had the singularly unpleasant responsibility to tell family members that a grandparent, relative, friend, lover, spouse, or child is dead. My training for this terrible task came from years of exposure to humanistic psychology, not from medical textbooks. One needs to be especially empathetic because we will all eventually be on the receiving end of such news.

When I lay recuperating from ulcer surgery in 1991 at St. Claire’s Hospital, tubes everywhere, I began to feel sorry for myself. That lasted about ten minutes when I realized that I was in a hospice unit and my neighbors were terminal patients. I imagined going to their bedsides and asking if someone would want to trade places with me. You know the answer: anyone dying of cancer or another frightening illness would welcome the opportunity to erase their disease and substitute a totally healed gastric ulcer. I stopped this foolish and selfish thinking immediately.

Illness brings out our worst fears and challenges our inner strength and stability. Personal myths such as “I never get sick” can be shattered in seconds. Yet, I have seen patients with pancreatic cancer accept their fate. In contrast, I have seen a young patient newly diagnosed with mild asthma commit suicide in his hospital room.

Physicians are not merely diagnosticians, clinicians, tradesmen, or surgical technicians. We deal not only with human bodies but diverse reactions to bodily trauma and incapacitation. Interestingly, a given individual may have multiple different responses to illness at different times. Elisabeth Kübler-Ross discusses this eloquently in On Death and Dying. Even seemingly mundane illnesses such as diabetes or hypertension can elicit diverse reactions ranging from denial and depression to total loss of self-control.

What did I tell the lovely 86 year-old who was now confronting a future of darkness? I recycled my own experience at St. Claire’s and told her to visit a nursing home or hospice and ask patients if they would trade places with her. After a moment of reflection, the patient smiled and decided instead to visit the Lighthouse and the Jewish Home for the Blind. They would be able to provide the necessary support system for her daily activities and routines. She will supply her own courage.

I often ask patients and myself: “What is the worst illness in the world?” The answer is the same every time: “It’s the one that you have.”

A Pig in a Poke

2009-10-01T07:18:00.000-07:00

Which illnesses frighten you the most? Leprosy, with its disfiguring skin and facial changes? Tuberculosis, depicted in the theater by frail, pale young women coughing up blood onto their bed linens? Perhaps high blood pressure, which has the following signs and symptoms…[none]?

Let’s face it: infectious diseases are inherently the most terrifying. The thought of viruses, bacteria, protozoa, or parasites invading our body parts and invisibly spreading toxins remains a child-like fear throughout our lives. The Bubonic Plague (poetically rendered as “The Black Death”) is perhaps the prototype, although centuries have passed since rats swarmed through London. Of late you’ve no doubt heard of the influenza epidemic of 1918, the most infamous public health catastrophe of the 20th century.

Even in recent years, infectious diseases, unlike many more common illnesses, seem to grab the headlines, producing a somewhat distorted view of American health emergencies. Television viewers are apparently numb to the endless litany of articles on obesity and overweight, extremely unhealthy conditions that affect 67% of the adult population. A personal myth seems to be: “If there are commercials about diabetic medications and blood testers, diabetes really can’t be much more dangerous than athlete’s foot.”

On the other hand, mention a new or revived infectious disease on the air and you’re guaranteed an attentive audience. SARS, an extremely rare type of bird-flu, resulted in mass-media hysteria in 2003. Every station covered the story as if a new plague had arrived—the humble author of Dr. Fischer’s Little Book of Big Medical Emergencies did almost 50 separate interviews on the topic! [but he’s not complaining]. Remember West Nile Encephalitis? That caused more panic several summers ago than Elizabeth Taylor’s performance as Cleopatra. And how about “Mad Cow Disease”? I assume that McDonalds hasn’t changed its menu.

Diabetes, hypertension, high cholesterol (and 40 other conditions in 9 organ systems directly related to obesity) don’t grab headlines because of “over-exposure”, although these are the most prevalent threats to anyone’s health at present. Contrast this with wall-to-wall coverage of swine flu: although 25% of the pediatric population is obese, “concerned” parents are rushing their children to local emergency rooms for evaluation and treatment of a transitory infectious disease. Swine flu lasts approximately two weeks. Diabetes and obesity can reduce life expectancy by four or more years. Which seems more serious to you?

In 1976 swine flu became front page news after an outbreak at Fort Dix. A mass inoculation program was rapidly put into effect as thousands of people swarmed to medical offices and hospitals to protect themselves against certain death. Unfortunately, the opposite occurred, as can be illustrated by the story of Stuart Fischer, medical student at Maimonides Hospital. As a dedicated health care worker, I was lucky enough to receive swine flu vaccination thanks to the generosity of the hospital administration. Upon returning home right after the injection, I put on the television news and saw that the entire inoculation program had been abruptly terminated that day.

As it turned out, the vaccination provoked an illness called Guillien-Barre Syndrome. At its worst, this resulted in respiratory arrest and sudden death. Such was the fate of 25 otherwise healthy individuals. In fact more people died from the vaccination than from swine flu itself. Needless to say, I have been extremely suspicious of government health programs since then and have not taken or recommended any flu vaccinations, unless the individual has severe pre-existing cardiovascular conditions.

Influenza epidemics are a fact of life, a necessary evil in a world filled with microbes of every type. Periodically our immune systems need a workout just like our muscles do. If we need a vaccination for every known infectious disease, how will we be ready to fight off other health challenges? Cancer, for example, may be partially due to viral infections.

Now that Americans have been made aware of an impending crisis in healthcare (due to obesity) and health insurance (due to overrun costs) we may need to consider cost-effectiveness on a national level. Simply put, and not unlike your budgeting household expenses, should we be spending millions of tax dollars on a recurrent, seasonal mild infectious disease or utilizing the money for hospital clinics, nursing homes, low cost medication, prenatal care, and ambulances?

By all means, protect yourself and your family as best as possible from viral respiratory illnesses every year. Practically this means hand washing, sanitizing surfaces, avoiding ill people, and covering your mouth when sneezing or coughing. But keep a sense of perspective. Swine flu and its mischievous friends will outlast us all. On the other hand, obesity will shorten your life. Don’t buy a pig in a poke.

Personal Myths

2009-08-14T11:20:00.000-07:00

Have you ever wondered why you act the way you act? Have you ever wondered why you think the way you think? Are your decisions based on past experiences, parental teaching, religious beliefs, or self-generated errors in thinking? Or a combination of some of these? Is your pattern of behavior a thoughtful process or a set of automatic responses?

Psychologists, philosophers, and even some poets (Blake), have viewed human consciousness as a reflection of deeply embedded personal and social beliefs, some productive, some destructive. Behavior patterns and thought processes may be instilled during childhood or may be developed through life experiences. Of course, a great deal of our mental and interpersonal activity depends on mysterious forces, as yet unknown properties of the human brain, of hormones, or of neurotransmitters.

Taking time to examine your own belief systems (your “personal myths”) can be an interesting, beneficial, and life-extending process. This takes the form of self-guided introspection, an activity that can be as healthful as eating correctly or exercising. In fact deconstructing your personal myths—namely, figuring out why you think the way you think and then correcting the errors—can in itself lead to better eating and exercising habits.

Albert Ellis, one of America’s most esteemed psychologists, often discussed “crooked thinking”. Unlike the psychoanalysts of Vienna and their disciples, he taught that personal beliefs and thoughts lead to resultant behaviors and emotions. He recommended that we learn to think in rational, healthy, and goal-enhancing ways. The ego, id, and superego were, to Ellis, nonexistent forces: we are who we are largely through learned behavior (albeit with some influence from our genes) and therefore bad or destructive behavior can be unlearned.

In recent times, Dr. Stanley Krippner has devoted enormous creative energies to helping people discover, rethink, and redefine personal myths. His workshops and writings help teach individuals this process of self-discovery. For him personal myths reflect deep feelings by which people make choices everyday in their acquaintances, jobs, and self-care. Our self-concept is the totality of everything we think about ourselves, and this is certainly dependent on experiences in childhood, our environment, and our most intimate relationships.

Moreover, our image, namely our appearance and behavior, is the projection of our self-concept into the social world. Simply put, this means that what we think about ourselves is viewed by others objectively as our weight, bodily physique, clothing choices, hairstyle, and other components of image. You needn’t be reminded that people suffering from depression, inertia or loneliness have “self-neglect” written all over them. Conversely many individuals with distorted personal myths lead apparently normal lives yet still show signs of carelessness—obesity, unstable medical conditions, unrealistic plans, or limited interpersonal relationships.

Self-actualization and personal improvement must be continuous goals throughout our lives. And examining our own personal myths at any stage of life can be a liberating and thrilling experience as we unburden ourselves of incorrect thinking and destructive habits. The Park Avenue Diet is the first application of this technique to weight loss. Who among us has not thought: "I had a hard day at work, so I deserve to eat and drink whatever I want." For some reclusive individuals, this might be an attempt at rationalizing unhealthy behavior: "No one cares what I look like, so why should I?" Even healthcare professionals are not immune to disordered thinking: "Because I take vitamins I can eat whatever I want to."

All of the above statements are dangerously wrong, although superficially they sound like reasoned thinking. Considering them objectively, however, these personal myths carry with them considerable risks for chronic diseases, shorter lifespan, and unhappiness. Why would anyone want to live that way? Unearthing personal myths, examining them in broad daylight, and realigning priorities can provide benefit on physical, mental, and social levels.

The inner journey to discovering one’s own correct and incorrect belief systems may stimulate spiritual renewal that lasts a lifetime. Simplistic “quick fixes” (such as willpower, a non-existent entity) make weight loss a temporary phenomenon, since irrational and unproductive thought patterns have not been identified and corrected.

Self-understanding must be a constant goal for all individuals, even during times of apparent success. “Know thyself” [γνῶθι σεαυτόν] is received wisdom from the Ancient Greeks, and examination of personal myths is the perfect way to begin this process.

The Physician sings "The Physician"

2009-07-17T06:24:00.000-07:00

I've been a medical student, extern, intern, resident, emergency room attending, diet-doctor, private practice physician, media health-expert, scientific author--and now, just in time for a special birthday, a singer !

"The Art of Medicine", my exploration of poetry and prose on the topics of health, doctors, and related philosophical issues, now turns a new page by opening the Cole Porter songbook. In 1930 the distinguished and witty composer wrote a mock-romantic song for a forgotten musical called "The New Yorkers." He recycled it for "Star Dust" in 1931, but when it appeared in "Nymph Errant" (1933) the song made theater history. You can hear the legendary Gertrude Lawrence sing "The Physician" on a YouTube audio-only recording. Julie Andrews' version in the movie "Star" is beautifully sung, tastelessly staged.

Now it's my turn. After all, as a Yale graduate and a guy, I've got a few things in common with Cole Porter. And who better to grasp the ironies, double-entendres, and musings on the "doctor-patient" relationship represented in "The Physician" than....? I think you see my point.

I first heard the song in 1969 in a revue of forgotten Cole Porter songs, presented by Yale undergradutes and directed by Robert Kimball--the brilliant music-theater historian who is credited with rediscovering one of America's greatest artists. Like the rest of the audience, I was shocked at some of the racy imagery and naughty language--how could these have eluded censorship?

40 years later, I've prepared my own deconstructed version, which I mischievously feel honors Cole Porter's unexpressed intentions (the song is never performed by men, let alone Yale graduates or actual physicians). "The Physician" purportedly describes the plight of a shy patient infatuated by a healthcare practitioner--or does it?

It's showtime !

A Letter from Uncle Abe

2009-05-29T17:04:00.000-07:00

Still reflecting on my recent 30th anniversary of entering the medical profession, I came across a rare piece of memorabilia: a letter written to me in 1979 as I started my clinical studies at Maimonides Hospital from my Uncle Abe--the only other physician in our family, then age 80.

I'm presenting it to you to show the depth of dedication that he and so many of his colleagues demonstrated almost every hour of their lives. His philosophical ruminations haunt me after three decades of direct patient care; I am still humbled by the responsibility and the healing powers that a physician develops. Here is my Uncle Abe teaching me once again, his letter to me in its entirety:

July 21, 1979

Dear Stuart,

Congratulations on your start into the medical profession! Good luck, good health and happiness, and constant efforts on your part will make you successful in your choice of the Healing Art.

I’d like to quote Nietzsche (in spite of his anti-Semitic feelings). “A good physician must possess the persuasiveness that adjusts you to every individual you see as a patient; the suave negotiation and adroitness of an efficient detective in understanding the secrets of a soul without betraying it” (He must have said this about psychotherapists). It applies to all M.D.s.

The world is populated by people who are scared, anxiety propelled, and ill both physically and emotionally. Each person is human and imperfect. No one escapes the trials and tribulations of the human experience. Living is a continuous strife.

Remember in your dealings with mankind that humans are at best frail, phobic, ill, tired, and imperfect--regardless of their social status, their financial accomplishments, religious trends, color of skin, or ethnic origins. Try to be helpful, understanding and apply all you’ve acquired, and will acquire, of knowledge to accomplish some therapeutic gain. The Talmud says, “If one saves one human life, it is equal to having saved all the world.”

You will be rewarded with unusual feelings of expressed gratitude and deep personal satisfaction and happiness.

But never forget that you are a human being too and that no one escapes the frailty, uncertainty, and anxiety that confront all mankind. Be humble in your tasks but avoid self hurt, humiliation and “keep your chin up” while respectfully applying the art of our profession.

Good Luck!

Your Uncle Abe

A House Call by Doctor Astroff

2009-05-25T06:10:00.000-07:00

This week, 30 years ago, I graduated from medical school. My mother, my aunt, and my nanny attended the ceremony; all are gone. You probably know that medical school merely provides the infrastructure and the lexicon of the profession and that the most important learning comes from direct patient care. Only a few weeks after my graduation, I started a four-year stint at Maimonides Medical Center, as extern, intern, and resident in internal medicine.

If asked why I became a physician, my answer has always been the same: to be a healer, to help my community, and to lessen people's suffering. And I'm lucky to have chosen my calling at age 9, thus narrowing my professional aspirations considerably. My idealistic side never evaporated, having been formed and solidified in the late 1960's. And it's a source of happiness and contentment that I've saved thousands of lives by heroic intervention, uplifting motivation, and maybe a book or two.

But the life of a physician is a difficult one, filled with unpleasant tasks, conversations, and decisions. We expect physicians to be humanitarians, not simply scientists, and that is quite a weighty responsibility. Everyone probably has a story of the aid and comfort given to him or her by a doctor, perhaps even an anonymous emergency room physician. The words might stick in our minds forever. I have somewhat more down-to-earth epigrams carved into my memory, such as this one from my internist Benjamin Rosenberg during my teenage years, when I asked him if he liked all his patients: "Stu, I have put my finger into the rectum of people I wouldn't shake hands with."

Perhaps Dr, Rosenberg was being flowery, as we Brooklynites have been known to be. Interestingly, I found out what he meant, metaphorically speaking of course, when I worked as an attending physician at Cabrini Medical Center's emergency room: many of the patients were criminals, Runyoneque-types, or worse, yet my duty was to diagnose broken bones, suture lacerations, and restore vital signs--this was not the location for social change, personal opinions, or dramatic confrontations. I was simply their physician at that moment in time.

My great-uncle Abe Fischer, the only other doctor in my family, had dazzlingly colorful stories that would make me even more excited to be going into his exalted profession. As a general practitioner in 1920's to 1930's Brooklyn, he had suffered through an ordeal in his Maimonides training (being on-call every night for three years), accepted a chicken as payment for a house call during the Great Depression, and treated the high (young Maria Callas) and the mighty (Al Capone and Dutch Schultz). Being a physician, he always sat at the head of the table wherever he went and was the sole speaker, with beautiful silvery hair, orotund tones, and a Freudian beard. He had gravitas, authority, and a wealth of experience, the sort that can only come after witnessing the ravages of disease and the pain of earthly sorrow.

In reflecting on my journey through the medical profession, I recently recalled another early influence, this time a fictional character: Doctor Astroff in Uncle Vanya. I had seen a stellar Mike Nichols production of the classic Russian play on Broadway, with George C. Scott as Astroff and Julie Christie as the woman he loved and lost. The more I watched Astroff's world-weariness, combined with his refusal to stop being a caretaker and healer, the more I knew I was on the right path, challenging though it might be.

Dr. Astroff might be a fictional character, but all students of theater know that he's a stand-in for the playwright himself, Anton Chekhov, also a physician. How much of Astroff is Chekhov? And how much of Chekhov is Sonya, the melancholy and lonely woman who experiences life as a vale of tears and longs for peace in the grave? How could someone have written her final speech without experiencing at least some of the emotions? I'm as ebullient and fun-loving as anyone else yet over the course of 30 years, I've seen, by my own estimate, 3000 people die in front of me.

These conflicting, seemingly irreconcilable aspects of a life in medicine haunted me when I began to record excerpts from Uncle Vanya for my project "The Art of Medicine." A house call by Doctor Astroff proved very dramatic, stirring up memories and feelings that are as much a part of my medical education as pathology and anatomy. How do we become who we are? Sometimes the insights come not from science and textbooks--but from art and life.

The Art of Medicine

2009-04-10T06:37:00.000-07:00

Who said "Ars longa, vita brevis" [Life is short but art is long] ? It was a Greek physician, namely Hippocrates, and although he was referring to the "art" of practicing medicine, we generally use this famous phrase as an appreciation of the durability and complexity of self-expression through drama, painting, movies, and music.

The Roman philosopher Seneca translated this famous statement into Latin, and its common usage is also a truism: our earthly activities have a finite duration but creative work can transcend the boundaries of time, geography, and ethnicity. An easy example: theater pieces dating back 2000 years often surprise modern audiences with their topicality and psychological insights (for example Lysistrata, The Trojan Women, and The Bacchae).

As a physician since 1980, I have always had special interest in artistic works that address medical and health topics. Often the author/composer/poet discusses the topic directly--a favorite might be the role of Dr. Astrov in Uncle Vanya, a stand-in of sorts for playwright Anton Chekov (himself a general practitioner). Other times the focus might be on illness as a metaphor for the tragic arc of a pitiable character; successful performances of Puccini's La Bohème should have the audience in tears when Mimi succumbs to tuberculosis.

I will be sharing some of my lifelong favorites with you on my website--and in upcoming personal appearances--and I'm thrilled to have accumulated a wealth of entertaining, insightful, and quite contrasting selections drawn from diverse sources. The title for this performance anthology seemed to suggest itself: The Art of Medicine.

Up first: ten contrasting literary works that address the topic of health in completely different ways. I’ll leave it up to you to discover how, letting the authors speak for themselves. The settings are quite different (a Civil War hospital, bucolic Tennessee, cholera-infested Venice) and so are the characters (drunken medical students, Medieval true believers on pilgrimage, an artist doomed by tertiary syphilis). To come: two songs from 1929 about health issues, one naughty, one frightening. But the focus is similar: our fragile bodies, the human spirit, and the gift of life.

The Art of Medicine: where science ends--and poetry begins.

Enjoy!

Resilience

2009-04-03T20:23:00.000-07:00

What is resilience? Faced with a serious crisis, some people have the ability to cope with stress in a positive and productive manner rather than crumbling under pressure and falling to pieces. Other people don't, and their world can be shattered as lifelong plans unravel and health deteriorates.

And who has this most evanescent of traits? Where does it come from, innate survival powers or learned behavior?

These questions had always puzzled me before reading a brilliant book by the esteemed psychiatrist Dr. Frederic Flach, Resilience, that focuses on this very lofty and necessary behavioral skill. Yet true to the complexity of life, resilience is also a phenomenon in ecology (whereby an ecosystem tolerates natural disturbances and thereafter returns to a stable state) and physics (the ability of a substance to absorb energy when deformed and then elastically restore itself--something cartilage does as a "shock absorber" in our hips and knees).

I have witnessed careers ruined due to relatively minor personal problems, individuals turned into recluses when intimate relationships ended, psyches scarred by failure preventing further attempts at success. Various philosophers have had their say, as in this passage from Twilight of the Idols by Friedrich Nietzsche:

Was mich nicht umbringt, macht mich stärker.
(What does not destroy me, makes me stronger.)

or in this memorable truism from the Broadway musical Gypsy, via lyricist Stephen Sondheim:

"Some people have it and make it pay. Some people can't even give it away!"

Your ability to be resilient is directly linked to your self-concept (the sum total of all your ideas about yourself) and therefore your image (the projection of your self-concept into the social world, a visible representation of your belief systems). The stronger your self-confidence and the stronger and more realistic your bonds to the outside world, the more impervious you will be to negative thinking, feelings of hopelessness, and abandonment of plans. Resilience isn't courage, egocentricism, or focus, although these may be some of its components--nor is it a conscious effort to ignore pain, loss, or potential tragedy.

Resilience, on the other hand, implies a practical approach to problem solving, one where sadness and despair are redirected into new goals, new situations, and a new set of rules. I have often thought of life as a narrative that Charles Dickens might have written, full of twists and turns of the plot. His most memorable characters, Oliver Twist, Nicholas Nickelby, and David Copperfield, for example, endure poverty, loneliness, and estrangement, only to find themselves unlikely heroes by the end of their ordeals. The outcome of the story could never have been predicted at the onset.

It is this view of life, as a rather prolonged roller-coaster ride, that makes resilience an easier process to accept, a survival technique that must be learned by transcending life's challenges. Various social institutions have proved helpful for many troubled people seeking a pathway back to a happier life: religion, artistic self-expression, therapy. All are potentially helpful, yet the outcome must still be the same: moving on to a new chapter of one's life, turning the page as it were in one's own non-fictional narrative. Like self-confidence, resilience is a learned skill; hopefully, as we mature, it will help to keep us steadfast and comforted.

Resilience, like physical strength, requires effort, repetitive steps, and balance. Practical tips and remarkable insights are provided in Dr. Flach's masterful book, one that belongs in your library. Simply put, whether discussing resilience or Resilience, you can't live without it.

The Other Side of the River

2009-01-31T04:07:00.000-08:00

An inevitable part of life is transition, whether from one height to another, as we grow, from one location to another, as we relocate, or from one image to another, as we change. And may I remind you that "the only thing constant is change" ?

Part of this change--specifically learning how to change--serves as a protective mechanism. This is not unlike an evolutionary modification described by Charles Darwin, when he studied how physical changes in a species (such as larger wingspan or the ability to camouflage) reset the species' genetic makeup and help insure survival.

Humans don't adapt by changing body parts. This takes millennia, not a few decades. Instead, we change by adapting our image to the surrounding world in a way that maximizes our comfort, safety, and success--maybe by developing better interpersonal skills, so we can make new friends in a new setting (a new job, a new school, a new city) or perhaps by changing our "look" (dressing differently when we move to a new area of town, for example from swank Sutton Place to the cooler-than-cool West Village in New York City).

Is transition an enjoyable and painless process? Not really, because truth be told, emotional and social inertia is somewhat reassuring. All of us can get used to unpleasantness, stagnancy, or "a routine" and we may not want to summon up the energy, self-awareness, and courage to change. How many times have you been in a situation that was quite negative but you didn't want to look for an alternative (job, friend, home) because you'd "gotten used to" a modicum of unhappiness and dissatisfaction--or loneliness? Did you convince yourself that being unfulfilled was easier than trying for something better? Such is the "personal myth" of people trapped in go-nowhere jobs, dead-end relationships, social isolation, or, as far as this diet-doctor is concerned, obesity.

People who have forged a successful path though life avoiding its many physical, psychological, and social obstacles have made the ability to change, to transition, a useful and oft-called-upon skill. They upgrade their appearance frequently, watching the latest fashions and choosing the best, most au courant look. Their hairstyle reflects the latest trends; their conversations include the most interesting current subjects; they make new friends gracefully, slowly, and sincerely.

No one is incapable of making such a transition. Conversely put, we all must learn this essential skill and learn not to fear change. Beyond your current surroundings, whether geographical or emotional, are new opportunities for personal enhancement, upward mobility, and fun. By working on improving your weak points (whether in appearance or behavior--or just weight) a better version of you will emerge, one which will be more capable of success and more attractive to the outside world. Surely you don't think you're a "finished product." On the other hand, it's best to believe that you are "a work in progress" and strive daily to add embellishments of every type.

And when the time of transition comes, and you might not recognize it, the hallmark will not be something you see but something that the outside world sees in you: a new friendship might suddenly blossom, for example, someone very special that might have forever remained a stranger or a missed opportunity for intimacy. But once that transition occurs and your life becomes happier and the sun shines brighter, you will never want to reverse the process, go back into your shell, and return to a life of comfortable stagnancy.

I've likened such a transition to crossing a river on a raft. Once you've summoned up the courage to make that journey and made the necessary changes in appearance and behavior to become a better version of yourself, you will arrive on the other side of the river and step into a new world. You might be tempted to look back and see where you came from, but if all the right variables align, you will never want to go back again. Now on the other side of the river, you can take your first steps inland and explore the new territory. Of course you will be a little afraid. All people take their first steps cautiously when their physical or emotional landscape is new.

Learning how to make transitions, how to cross the river, gets easier with each new challenge. Some day it might be much less problematic, but as you learn to improve your life--and you may have to, whether you want to or not--the process will become more comfortable. Get off the raft, put your feet on the dry land of a new chapter of your life, stand tall, walk forward, and never look back.

The Gravitational Pull of the Future

2008-08-22T17:53:00.000-07:00

Great military strategists have told us that the outcome of a battle is determined before a single shot is fired. This is not clairvoyance but an astute insight into ways in which the future is inextricably tied to the present.

Might I extrapolate even further from this idea? We know that heavenly bodies like the sun and the moon exert a gravitational force on all surrounding planets, asteroids, and comets, based in part on their length, width, and depth, the famed three dimensions. Yet what about the fourth dimension, time? Could there be forces at work that draw us inexorably closer to our personal, professional, and pathological fate? Is there, in other words, a gravitational pull of the future?

For most academic physicians, this concept isn’t really too far-fetched. Take, for example, chronic illnesses such as diabetes, high blood pressure, or circulatory problems. Once these have taken root within a given individual’s body, a new course is chartered, as if a ship’s captain has rerouted his craft according to a different set of nautical maps. “Without firing a single shot,” so to speak, an ailment like diabetes recharts the destiny of the person’s heart, arteries, brain, and kidneys. Unfortunately, diabetes is known to cause microvascular changes 5 to 10 years before blood sugar begins to rise—the seeds of future, possibly fatal health crises begin to work their mischief long before the person or the physician have a clue that something is wrong.

To this we can add many other factors, particularly those associated with DNA, the unique “hard drive” that is embedded in every single living human cell—yours is yours alone, unshared with anyone else in human history. Let’s not worry about the specifics of genotype, phenotype, karyotype, histocompatability antigens, and the like; you can read about these in Star Magazine at your leisure. Simply put, you may have an increased risk of cancer, ulcerative colitis, high cholesterol or even acne (from an inability to fight skin bacteria, in case you’re wondering) based on your genetic makeup—your future may be partially predetermined by these mysterious and highly complex molecules.

Of course, your daily routine of selfcare is neither mysterious nor complex. Do you exercise effectively, if at all? Do you eat with isocaloric balance in mind--namely, keeping your weight healthy and stable? Are you developing rewarding and profitable relationships that may flower eventually into financial stability and personal happiness? Are you continuously learning newer skills that enhance and solidify your self-confidence? Is improvement in itself on your “to-do” list?

Or have you convinced yourself by means of delusional personal mythology and/or self-validating beliefs that it makes no difference how much you weigh, what your blood tests represent, or how high your blood pressure is? You might feel that your appearance is adequate, even if your clothing choices and posture telegraph a negative message to the outside world. How much are you in touch with what others see and think, as well as the “first impression” you make at school, work, or a social event?

These insights will also partially determine your future, and, conversely, given your present lifestyle choices in appearance and behavior, your future may evolve as a consequence of how you are acting right now. The “gravitational force” of disease, disability, antisocial behavior,and other negative entities might be pulling you inexorably towards a scenario of incapacitation, frustrated dreams, and unhappiness.

However, unlike unchangeable genetic codes, your lifestyle choices are exquisitely sensitive to change—better skincare, hairstyles, outfits, nutrition, and physique are helpful to anyone at any time, even by glamorous celebrities who continually reevaluate and recreate their image.

Whether “the future” is interpreted as next month, next year, or decades from now, there is always something you can do to make it better. Look in the mirror at your own three dimensions—length, width, and depth (or calculate your Body Mass Index, essentially the same thing). Then consider the fourth dimension, time, and its role in the outcome of your life. Fortune tellers might look at your palm, tea leaves, or a crystal ball in order to divine your fate. But using your own honest powers of self-observation, you can do this in a more predictable and cost-effective way—and, through the enjoyable process of self-reinvention, pave the pathway for yourself to a happier and healthier tomorrow.

A Lifetime of Transitions

2008-08-02T10:10:00.000-07:00

Summer is usually not a time for philosophical reflection, but 2008 is different for me. As I prepare for a series of publicity-related events to promote The Park Avenue Diet, my thoughts have taken me backwards and forwards in time—reflecting on the past and anticipating the future. “This is a transitional time for you,” my friend and mentor Dr. Stanley Krippner noted a few months ago. Agreed, but as I pondered his overview, I began to think of the entire arc of life, in itself, somewhat inflexibly, a series of stages not unlike a grand railway journey with multiple stops.

No matter who you are, where you live, or what surrounds you, you too will experience a social, academic, and professional environment that is continually being reshaped and redefined. How will you be able to manage these multiple transitions seamlessly and painlessly? The answer will depend to a large extent on your ability to redefine your image, an amalgam of visible behavioral and physical characteristics that reflect your philosophical beliefs.

Are you the same person you were a few years ago? Probably not, although you might wish to believe that your current relationships, appearance, and health are permanent—at least the positive aspects. But physicists teach us that “the only thing constant is change.” So prepare yourself for a roller-coaster ride that might last 80 years by learning to adapt, to upgrade your image, and to develop an evanescent trait called “inner strength.” Otherwise, your roller-coaster ride may be a bumpy one.

I have had many life-defining experiences over the past few years, moments of unbelievable happiness and moments of painful heartache, and so have you. But in looking back even further, I’ve been blessed with a most circuitous and surprising pathway that has brought me to this point—and into your life. I’ve been a shy high-school student, an idealistic Yalie, a frazzled medical student, an overworked intern, a colorful emergency room physician, an associate of a famous diet-doctor, and now an author and media personality—all of these without knowing the next chapter of the story.

At each point of transition, my image changed, but not in some vague spiritual way. Building upon one knowledge base after another, I improved my weight, bodily physique, skin, apparel, hairstyle, interpersonal skills, and self-confidence to match my new responsibilities and hopefully impress my new colleagues. However you look today, good, bad, or indifferent, it’s not a permanent state of affairs. Your ability to reevaluate yourself periodically—and honestly—is not a superficial onceover. It is a survival technique that you will need to call upon repeatedly if you want to develop the resilience necessary to endure, thrive, and excel.

Let’s take as an example your weight. It may seem adequate or at least tolerable to you (66% of American adults are either overweight or obese according to recent CDC statistics) but what will someone else think?--someone such as a college admissions interviewer, a potential employer, a new friend. Their first impression of you, a phenomenon that my fashion expert colleague Helene Hellsten estimates as taking three seconds to formulate, may negate your chances of academic advancement, job placement, or romance. Weaknesses in interpersonal skills may mean nothing to you, but they might convince the gatekeepers of your future that you “haven’t got it all together.”

On the other hand, mastering the various components of appearance and behavior—and upgrading them periodically to present yourself as continuously fresh and interesting—allows you to move from one stage of life to another as seamlessly as possible. People who ignore this learning technique are often described as being “in a rut” or stagnant. You may need to transition from school to an office environment, from living with your parents to coping with your own apartment, from solitude to an intimate relationship. Transitions are as complex and multifaceted as the people that they affect, so don’t try to predict the future—instead, prepare yourself for a series of reinventions, opportunities for creativity, redesign, and productive introspection.

Whether you know it or not, this is a transitional time for you too, just as it is for me. You may not know when the next chapter of your life will begin or who will be the principal characters—but change is inevitable, like the change of seasons we experience every year. Nature makes it happen to trees, insects, and weather patterns, and people make it happen with kaleidoscopic social dynamics and relationships. Your armament against these powerful forces is not merely self-knowledge but the ability to reinvent yourself, after careful reappraisal and inventory of your appearance and behavior. It’s an important and necessary skill, and you can have fun doing this with the proper input from experts such as the team assembled for The Park Avenue Diet.

This is not just a transitional time for me…or you. We all lead a lifetime of transitions.

A Modest Weight-Loss Proposal

2008-08-01T08:29:00.000-07:00

As a practicing physician it never ceases to amaze me when an overweight patient doesn’t follow my advice. After a Yale University liberal-arts education, a degree in psychology, four years of medical school, an Internal Medicine residency, four years of emergency room work and more...where did I go wrong?

Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference...after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.

Why don’t most overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?

Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15th Diet you can eat unlimited portions of anything that you want for almost 365 days. Sounds terrific, no?

Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.

Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying” or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.

The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the healthcare system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand. Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor: “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization and nursing care?”

Americans share only two things in common: death and taxes. The fear of premature death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds and bellies very quickly. Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.

Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15th Diet is the worst diet that you ever heard of...but boy would it work!

Book Launch- June 17

2008-06-27T12:42:00.001-07:00

Have you ever been to the launch party for a new book? Neither have I until recently, when The Park Avenue Diet made its debut at a lavish, four-story penthouse on (where else?) Park Avenue. Over a hundred colleagues, friends, celebrities, and revelers converged at 6 p.m. as flashbulbs popped, wine flowed, and general merriment abounded.

Let’s walk around so I can introduce you to some of the celebrity consultants, whose contributions to The Park Avenue Diet make it the unique and revolutionary book that it is. Of course you know Tinsley Mortimer, the glamorous and charitable socialite! She was followed by camera crews and reporters from Access Hollywood and German television, as well a dozen journalists from such publications as W, Elle, and The New York Observer. Tinsley’s empathetic, humanistic, and brilliant insights into interpersonal skills are the epicenter of the book, but you’ll be reading them at a later time.

Here are two other contributors to The Park Avenue Diet, who also sent photographers and reporters into a tizzy: Bernadette Penotti, a personal trainer/fitness expert par excellence, and Helene Hellsten, the distinguished and stunning Swedish fashion expert of international renown.

It was a special thrill to welcome my mentor, Dr. Stanley Krippner, to this exciting and momentous event. He is one of the world’s most distinguished humanistic psychologists, and I have been privileged to be his friend for 40 years—but until now we had never worked together on a book. He flew in from California just for the book launch, then returned for graduation ceremonies at Saybrook Institute. Here he is with my personal assistant, Kristina, and another colleague, Debbie Ellis.

Chef Marie-Annick Courtier and her husband made a rare visit to New York City to join us for the launch of The Park Avenue Diet. Her recipes and wisdom are intrinsic to the message of the book, and I had the unique pleasure of thanking her for her brilliant work by giving her a culinary tour of the East Village, Chinatown, Little Italy, and Soho. The next day, she flew to France to cook at a lavish wedding in a chateau in Burgundy. Salut a la France!

Here’s part of our distinguished team of celebrity consultants for The Park Avenue Diet,together actually for the first time. Most of them had never met each other, but all became fast friends. Four cameras snapped away when the group assembled, as I marveled at this warm, brilliant, and highly photogenic assembly of talent.

It wouldn’t be a party without Aida Turturro, of one America’s greatest actresses. She’s a longtime friend of Bernadette Penotti, and I’ve been lucky to share her company over the past decade at Christmas dinners with the Penotti family. I’ve followed her career as a fan as well, from a stage appearance on Broadway in A Streetcar Named Desire to her legendary television role as Janis in The Sopranos. What an artist!

Here’s the real star of the event, the book itself. All of the copies were gone by the end of the launch, as were all of the wine and sushi appetizers. The guests stayed on, having met new friends and having enjoyed watching a revolutionary new book gets its first media attention.

Some other assorted photos follow. You know everyone by now, so walk around, enjoy yourself, and thanks for being here!

David Grob, M.D.

2008-04-02T08:06:00.001-07:00

Last week I received the news that my greatest teacher, Dr. David Grob, had passed away. We first met in the mid-1970's when I was a medical student at Maimonides Hospital and he was the Director of Medical Education, as well as the chairman of the Department of Internal Medicine.

Dr. Grob was an internationally renowned expert in myasthenia gravis as well as a professor with impeccable academic credentials. To me, however, he was simply the most inspiring healer and teacher of a lifetime. Dr. Grob charted my entire academic pathway after medical school, giving me priceless opportunities to learn clinical medicine on the wards of Maimonides Hospital. From 1978 onwards for five years, I was immersed in patient care as an extern, intern, and resident, spending approximately 108 hours per week mastering the diagnostic and technical skills needed to help critically ill patients.

What made learning from Dr. Grob so very memorable was not merely his orderly and encyclopedic knowledge of the basic health sciences--in addition, he seemed to present medicine as a holy art, marveling at the intricacies of the human body and showing enormous empathy for the suffering individual. At times, while he was examining patients with the manual dexterity of a piano virtuoso, he would close his eyes, as if communing with Hippocrates or healing spirits.

One session of morning rounds in the intensive care unit featured five patients with myasthenia gravis, each one with a different set of signs, symptoms, and response to therapy. He instilled in us that day a great respect for the infinite mysteries of the human body, wherein even an extremely rare disease can unfold in multiple, different ways.

A brilliant practitioner of physical diagnosis, a lost art in itself, Dr. Grob would map out the outline of a patient's liver by percussing the surface of the abdomen, then draw an outline on the bemused person himself (patients enjoyed this as much as the students, by the way). On other occasions, he would lie a pencil down on the left ribcage directly over the "point of maximum impression" [where the heartbeat is most easily felt] and we would watch the pencil bobbing up and down with every heartbeat.

In another impressive display of physical diagnosis, Dr. Grob showed me how to "feel" atrial fibrillation, a sensation resembling a "bag of worms" writhing under my hands. Who else would have taught us how to estimate a blood pressure by touching the wrist artery? I still use this skill almost every day, and several times in Cabrini Emergency Room it was actually of crucial importance.

I hope that you too will have your life enriched and ennobled by brilliant teachers and mentors. Dr. Grob represents to me a Golden Age of healthcare--the technology and information were not as extensive as they are today, but the empathy, sense of wonder, and ability to inspire will last me a lifetime. Thank you, Dr. David Grob. Hail and farewell!

Honi Soit Qui Mal Y Pense

2008-03-08T11:15:00.000-08:00

Human beings have a wide range of belief systems, techniques of reasoning, and methods of problem solving. Some of them are logical. The issue at hand is not how one confronts complex geopolitical or sociological challenges that affect the planet. On the contrary, to paraphrase Mark Twain: “Man is the only animal that lies about its health or needs to.”

In numerous, unintentionally funny studies, experimenters derived statistics about weight loss from telephone conversations with the involved participants. The researcher would discuss height, weight, eating patterns, and exercise regimens with a disembodied voice on the other end of the telephone line. Was proof offered? Was there visible, objective evidence of these statements, perhaps provided by a digital optical device linked to an e-mail address? Or did the researchers rely on scientific noblesse oblige, a blind faith in the honesty and integrity of those being studied?

You already know the answer: many people lied. Interestingly, men lied about their height, hoping that their weight would seem better to the researcher if distributed among extra imaginary inches. Women who were less than contrite would give their weight in high school. Another study, even more mirthful than this one, added another step: the arrival at the experimental subject’s home of a small van with a scale in the back. Oops! The scale’s readings often didn’t match the reported poundage. But the deception these people attempted was minor compared to their self-deception, namely that the vital statistics involved were inconsequential—to the medical study, to the researchers, and to themselves.

Self-deception takes many forms, but the most potentially lethal ones concern health. “I don’t need to get a checkup because I feel okay.” “I read numerous health-related websites daily, which means that I have great insight into my own body.” “I take numerous vitamin supplements—so I don’t need to worry about cancer or heart disease.” “There are many studies that show no correlation between weight and human illness—please pass the chocolate syrup.”

Self-validation is a method used by self-deceptive individuals to rationalize their questionable behavior patterns. Albert Ellis called it “crooked thinking.” Dr. Stanley Krippner has written extensively on “personal mythology.” But I think it sounds better in French: honi soit qui mal y pense. Which I translate somewhat loosely as: “Whatever you say.”

May I offer some medical examples? A diabetic might tell me: “I can eat whatever I want—I just have to take extra insulin.” A hypertensive might offer: “I don’t need to follow a low salt diet. I’m taking a water pill.” An overweight person might step to the counter and order a low-fat muffin with a large orange juice. It’s right because I say it’s right!

The original French expression originally appeared in an entirely different context. It was a reproach to people who think that something relatively innocent is shameful and scandalous (namely, the accidental slipping of a leg garter while a woman was dancing in front of British royalty). I’ve brought the expression into modern times with its converse meaning—it isn’t scandalous because I say it isn’t scandalous.

“I’ve had a hard day at work, so I deserve to eat anything I want, especially at dessert time.” “My children aren’t overweight. That’s baby fat, and they will outgrow it eventually.” “March is the perfect time of year to go on a diet. I needed all that extra padding during the winter to protect me against the flu.” Do any of these sound familiar? Is there anything remotely logical in these statements? Have you heard (or thought) anything similar recently?

If so, go to the mirror, look at yourself, smirk, and repeat after me: honi soit qui mal y pense. And then, stop trying to fool yourself.

The Observer Effect

2008-03-02T02:29:00.000-08:00

Principles of science can be useful tools, especially when you watch or read promotional material from the weight-loss industry. For the past 40 years, The Dark Ages of Dieting, Americans have been offered a wide range of ineffective therapies, all purportedly having innate logic and objective validity. Pharmaceutical corporations-- although themselves the subject of much controversy and scrutiny-- are exemplary models of ethical rigor when compared with supposedly trustworthy “nutritional” sources.

Let’s not discuss, for the moment, whether or not grapefruit, cabbage, red peppers, unlimited protein, the glycemic index, macadamia nut oil, or salmon is the unique cure for obesity—or why these epiphanies were reached by individuals, as opposed to physicians at the Mayo Clinic or the Pasteur Institute. Several years ago, I had the unique pleasure of congratulating a voluptuous television star on her new weight-loss vitamin line--I was being polite, and you would have too. Did she design the formulations from her own research into biochemistry and physiology? Could she spell?

Scientific research, a discipline totally unknown to a majority of Americans, includes certain “checks and balances” that ensure the integrity of the findings and their interpretation. One safeguard is protecting against the observer effect, a phenomenon somewhat tangentially related to the Heisenberg uncertainty principle. Here’s an easy example: students will behave differently if their exams are proctored by several teachers—observation of their behavior (by watchful monitors) will affect their actions (avoiding cheating). Do you drive more carefully when police cars, hidden cameras, or speed traps might be present? Observation of your behavior, whether visible or possible, makes you much more likely to follow the rules of the road.

How about a television spokesperson for a weight-loss program? Is he or she totally motivated by health concerns, idealistic beliefs, or the need to lower cholesterol? On the contrary, the mere fact that this individual is being observed (and, of course, paid) affects his or her own food choices, exercise schedule, and wardrobe contents. This doesn’t happen if the spokesperson is trying to sell you home insurance, power drills, or lawn furniture. Are you impressed when that spokesperson “sticks to the program” and is photographed in smaller-sized clothing?

A fascinating weight-loss study reported in the British Medical Journal several years ago described two groups of experimental subjects. The first group was given precise caloric guidelines by medical personnel and nutritionists. The second group, the “controls”, were simply told that they were in a weight-loss study but given no instructions of any kind. Not surprisingly, both groups lost weight, although the first group did slightly better. The observer effect was responsible for this unusual outcome. When people become aware that their weight is being watched by others—no matter what the reason—behavioral changes can occur, even if not specified or supervised.

How does the observer effect play a part in your daily life? That’s at the epicenter of The Park Avenue Diet, since one’s image—which is a projection into society of a lifestyle pattern—is by definition the only thing other people can observe. Upgrading appearance and behavior can enhance this phenomenon, leading to better relationships, job opportunities, and health. How the outside world perceives us is extraordinarily important—so let the observer effect become your strategic partner, not a mechanism of distortion and misinformation.

Albert Ellis

2008-02-21T18:04:00.000-08:00

The journey to my current professional position has taken me down many exciting and challenging intellectual pathways. I had always wanted to be a physician but became unusually fascinated by human psychology while still in high school. My first exposure to the field was a summer project at Western Michigan University studying the precepts and experiments of B.F. Skinner—a behaviorist whose philosophy was diametrically opposed to the florid and mysterious inner world conjured up by Jung and Freud.

Then came four years of specialized studies at Yale covering, among other topics, abnormal psychology, physiological psychology, dream research, and orthomolecular psychiatry. I attended numerous national and international conferences, read scholarly articles prolifically, and even conducted research on nutritional treatments for hyperactive children. There were many psychological superstars at the time, brilliant pioneers whose take on human thought and behavior was insightful and dazzling—but one stood out above the rest: Albert Ellis.

Albert Ellis felt, as most psychologists do, that thought influences and shapes behavior. But to Ellis, there were no murky subterranean levels of human consciousness such as those proposed by Sigmund Freud: the ego, the id, and the superego—primitive controlling forces inaccessible to our conscious minds. For Ellis, explanation of our daily actions lays quite close to the surface, making introspection and therefore change much easier. What interested me most about him was the pragmatic approach that he advocated, one that involved isolating philosophical errors, repatterning behavior, and subsequently arriving at a different worldly attitude.

He called the philosophical errors “crooked thinking”, a concept best explained by the master himself in an outburst I witnessed at one of his free-wheeling seminars. The moment an audience member said “I feel sad when…” he rejoindered with “I make myself sad when…” This is quite a distinction: the latter allows for the possibility that we can gently reprogram our thinking patterns in more positive and productive ways.

The current term “personal mythology” owes much to these revolutionary ideas. It defines an individual’s unique system of values, some productive, others counterproductive, and yet others delusional. As a physician I have seen many patients whose health care hangs tenuously in the balance but “don’t need to get a check-up because I feel okay.” The rules they are following are self-made, and their rationalization is always self-validating: this is beautifully rendered in French as honi soit qui mal y pense. The road to ill-health and nutritional self-destruction is often paved with these philosophical errors, and it was Albert Ellis who showed me that “crooked thinking” can have both psychological and physical repercussions.

I add another layer of meaning to his philosophy, namely that how we look (our weight, our bodily physique, our hair, clothing, and skin) and how we behave (our self-confidence and our interpersonal skills) are also amenable to change—not just how we think. External characteristics, rather than merely being superficial window-dressing, can influence our emotions—and therefore we need to affect change in two directions: inside-out and outside-in. This is an expansion of the approach Dr. Ellis mastered, and I am honored to have been profoundly influenced by this unique genius.

Fanfare for the Common Malady

2008-02-21T12:42:00.000-08:00

After several decades of medical practice and an eclectic education in the science and art of healthcare, this physician/philosopher can truly say "I've seen it all." Of course, strictly speaking, that's not true, since Harrison's Textbook of Internal Medicine is several thousand pages long--there's enough pathology to last a lifetime, so to speak. Would you like to hear about some of the esoteric and exotic things I've seen? Of course, you would.

In 1965 I was a teenage volunteer at Maimonides Medical Center, working as a clerk in the dialysis unit. When the brilliant nephrologist in charge (Dr. Donald Snyder) learned that I wanted to be a physician, he took it upon himself to teach me how to take a blood pressure. In those days, we used a sphygmomanometer, an antiquated device with a column of mercury and an inflatable cuff. After listening to Dr. Snyder's careful instruction, I was told to take the blood pressure of the first patient to come into his clinic. "Pump it all the way up" he added. I did what I was told and recorded a blood pressure of 300 over 130. "You'll never see that again" Dr. Snyder remarked, and he certainly was correct. Fortunately, after dialysis, the patient's blood pressure normalized.

As long we're on the subject of astronomical elevation of vital signs, might I also mention the fastest respiratory rate I ever witnessed? 24 times per minute, due to an aspirin overdose. Or the most rapid heart rate? 240 beats per minute, part of a "thyroid storm," fortunately a rarity. Normal blood glucose is approximately 80-100; my all-time record was approximately 2700 (due to a hyperglycemic, hyperosmolar coma). The most spectacular and frightening cardiac arrhythmia I witnessed was torsade des pointes, an out-of-control spiraling of the EKG that looks like a DNA double-helix.

Lest you think that these startling experiences were merely passive observations, allow me to tell you about the first clinical skill I ever performed. Most medical students begin their hospital training by learning how to obtain a blood sample or start an intravenous infusion. This lucky student, during his first overnight shift, happened to walk by a room where attempted CPR was unsuccessful but the supervisory professor still wanted the interns to learn an extremely dramatic last resort--administering adrenalin through an eight-inch intracardiac needle. If you've seen John Travolta and Eric Stoltz perform this procedure on Uma Thurman in Pulp Fiction, you know what it looks like. If you haven't, I won't upset your stomach. The professor pointed to me, said "Let him do it", and I did what I was told--several days before I learned how to attach EKG electrodes.

Rare infectious diseases? How about tularemia, an extremely rare bacterial infection a Brooklynite caught from his pet rabbit? Or disseminated meningococcemia? "You'll never see this again" I was correctly told in 1977. Scarlet fever? I never saw it--I had it! Even on a vacation in Morocco, medical rarities fascinated me: I followed a leper around the Marrakech marketplace, stunned at his characteristic facial features and what I refer to as "the terrible power of illness". This was also evident on the single occasion I saw a patient with neurofibromatosis (incorrectly called the "Elephant Man's disease") and another individual with dextrocardia (not really an illness, since organs that develop as "mirror images" usually function normally.)

Why discuss these extraordinarily rare conditions? Perhaps to gain a sense of perspective on common maladies such as hypertension, diabetes, and heart disease. These chronic illnesses are most definitely debilitating and life-shortening, yet many people minimize their "terrible power" because they are so prevalent. Being overweight or obese invites over 20 serious illnesses into your body, and even one can change your life plans drastically. Medical rarities seem exotic and interesting, like tropical orchids or spectacular comets. Common illnesses, no matter how mundane they may seem to you, are the real problem, especially when you have the power to diminish or avoid them.

Universal Health Care

2008-02-17T13:01:00.000-08:00

What is universal health care? And why is it the subject of so much debate during a presidential election?

This purposely vague, somewhat-utopian concept takes the earthly form of access to medical consultations, testing, and treatments—regardless of an individual’s ability to pay and his or her current health status. Sounds like a plan, so be sure to vote for the candidate whose double-talk and blather most closely resemble your own views on the subject.

Can we deconstruct this term before proceeding further? Health, as defined by the World Health Organization in 1948, is “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Health care, according to UNICEF in 2001, embraces “preventive, curative and palliative interventions, whether directed to individuals or to populations.” Universal, as defined in the aforementioned political debates, refers solely to the United States, not, thankfully, to the entire solar system and distant galaxies.

Universal health care represents an effort to minimize the cost of office visits, medication, surgery, and hospitalization to the individual consumer. Because the threat of injury and illness seemingly affects all people equally, a one-size-fits-all system appears ideal. Of course, logic needs to be temporarily suspended for this idea to resonate: drivers, smokers, mountain climbers, and diabetics all have varying risks to different body parts.

Part, if not all, of the appeal of universal health care is that the term presupposes that health care is something that is done to us. We, seemingly, are passive entities upon whom physicians, nurses, their assistants, pharmacists, and psychologists bestow their wisdom and experience. Of course, they might recommend weight loss, exercise, smoking cessation, or serious introspection, but these are unnecessary when there is an endless amount of money to cover any subsequent medical expenses.

Even in the somewhat “universal” area of infectious diseases, disparity exists despite a human desire for homogeneity. Does the influenza virus affect all of its victims uniformly? Contrast the able-bodied businessperson with a nursing-home resident who might easily develop a secondary bacterial pneumonia. Who will decide which patient to vaccinate, or is universal access to vaccines also “guaranteed”?

Health care, in contradistinction to its current misdefinition, is something that is done primarily by us. A country where 66% of the adult population is overweight or obese is an unlikely place for grand, utopian medical initiatives to flourish. Perhaps 2009 will see the transformation of the United States into Shangri-La—the mythical kingdom where no one ages. If it doesn’t happen that way, be sure you redefine health care as a personal issue, delineated by the boundaries of your own body—and unaffected by mountebanks of any political party.

Extra Caramel

2008-02-09T12:30:00.001-08:00

Midtown Manhattan is not spared the presence of several famous fast-food franchises, one of which happens to be across the street from my home. On a recent cold morning, I decided to try their coffee, avoiding the synthetic admixtures that resemble bagels, donuts, and croissants.
Imagine my surprise when my neighbor on line, a young overweight adolescent, ordered her breakfast: “a caramel mocha latte, with extra caramel.” Thoughts raced through my head: “To this we’ve come.”-- “What hath God wrought?”—“Yick.” Recent houseguests, two German naturopaths, had prepared for me a breakfast of curried vegetables and millet. From the sublime to the ridiculous, you say?

Allow me to transport you back a few years, when I was asked to give nutritional advice on Breast Cancer Awareness Day for a major network news show. What foods would be the best choices to lessen the risk for this dreaded disease? This is as foolish a question as exists, since the answer, for most Americans, is less food.

As repeated studies have demonstrated, visceral fat, an “organ” deep inside the abdomen, is responsible for abnormal production of estrogenic hormones. Weight correlates with breast cancer risk, a fact well known to the American Cancer Society. Therefore, unless I missed something when studying logic at Yale University, the best way to minimize this risk is to lose weight.

This was too sensitive an issue for the television producers, and my appearance was cancelled. Certainly you’ve seen more controversial material on the air, whether mind-numbing violence, hysterical political blather, or inappropriate sexual content. Is it a badge of honor to be censored because of a statement in the textbook of internal medicine?

Or is it better to allow free reign to individuals who want an extra boost of caramel in the morning to start their day? Vitamins? Minerals? Amino acids? Who needs them when you’ve got corn syrup, thickening agents, and emulsifying additives?

A recent bill proposed in Mississippi recommended that obese people should be denied service at state-licensed restaurants: http://www.thesmokinggun.com/archive/years/2008/0201081fat1.html
Yea or nay? How much micromanagement would you be willing to allow? “Sorry, sir, we cannot allow you to have salt or catsup with your burger.” “Ma’am, it’s a salad or nothing.” “Put down that slice of pizza and step away from the counter.”

Is it an inalienable right to make unwise food choices? Would communities be more responsible if they policed their residents’ health-related affairs? Should I have said something to the young woman who asked for extra caramel? If the latter case, you know the answer: she might not have enjoyed her morning drink but instead poured it over my head.

The Truth Will Set You Free !

2008-02-01T11:39:00.000-08:00

"You can't handle the truth" shouted the angry officer memorably portrayed by Jack Nicholson in A Few Good Men. I've sometimes had the same thought in my quest to deliver objective, life-saving information to patients, friends, and media audiences. Let's stipulate that in matters of art, music, and food, there are usually no right or wrong choices: de gustibus non disputandum est, as they said in ancient Rome.

In the world of academic medicine, however, proper logic, statistical analysis, and reasoned extrapolation are indispensable components of scholarly opinions. This was my environment from 1975 to 1983, the years I spent as a medical student, extern, intern, and resident at Maimonides Medical Center in Brooklyn, New York. My professors included pioneering cardiologists like Sterling Jonas, David Dresdale, and Adrian Kantrowitz. Dazzlingly brilliant clinicians such as Norman Brunner and Nathaniel Plotkin seemingly knew every word in the textbooks of internal medicine.

It was not enough for students to have the answer to every question asked on morning rounds or the noon conference; often, a direct citation of a particular study, medical article, or editorial was necessary--chapter, verse, and word, as it were, not unlike the duties of a biblical scholar.
May we contrast this education with the sensory bombardment you endure every day, listening to "advice" from "health reporters" whose hospital experience may be limited to watching bedpans emptied on a popular medical/soap-opera television show? How about the unsolicited "pop-ups" on your Internet browser that give you the latest "nutritional" information? Stop by your local bookstore and count the number of "health books" written by television personalities, whose unique qualifications make such trifles as a college diploma, medical degree, and hospital experience totally unnecessary.

Sad to say, scientific reality is very much a part of human illness--and therefore a set of basic truths, whether we are willing to face these or not. "Where ignorance is bliss, 'tis folly to be wise"--except if you are an overweight diabetic, in which case retinal hemorrhages, dialysis, and impotence might become part of your daily routine. The "truth" that "you can eat whatever you want" with no consequences will eventually become a distant memory.

How do you know that a particular "diet" works well? From promotional advertising? From the testimonials of a few well-paid "patients"? From the mere fact that the products are sold in your local box-store or pharmacy? Do you also believe the claims of every car manufacturer? Do you see every movie released because there are a few good reviews cited in the ads? On Election Day, do you break the handle in your voting booth as you cast your ballot for every candidate? How could you disbelieve any of them?

When I discuss the "success rate" of various famous "diet" programs in a radio interview--as reported by the Journal of the American Medical Association, the British Medical Journal, the Annals of Internal Medicine (none are available at your supermarket check-out counter)--I watch the host's facial expression change into that of a child who has just discovered the truth about the Easter Bunny. The disconnect between the perceived "reality" and the actual truth is a chasm wider than Grand Canyon, even though the data is easily found on the Internet or in any medical library.

If knowledge is power, Americans have a steep learning curve as far as health matters are concerned, especially regarding weight loss. There is enough misinformation to fill several [incorrect] textbooks. Perhaps we should resurrect an expression from the 1960's: "Everything you know is wrong." Yet the more we look for the truth, particularly where our lives are at stake, the better and longer are lives can be. Critical thinking will pay off more when it is applied to critical issues--and there is nothing more important than your own health, safety, longevity, and happiness--all of which are bound inextricably to each other...and to the truth.

20 Years Ago

2008-01-26T04:22:00.000-08:00

In 1988, after four years of intense work as an emergency room attending physician at Cabrini Medical Center, I had made no future plans for my academic career. That January, I was working in a small clinic in Downtown Manhattan with several distinguished cardiologists, surgeons, and other specialists. One of the cardiologists told me that a famous doctor needed an excellent internist to join his practice and that I should apply; he gave me no details but kept recommending an interview. I refused several times.

Finally, more to appease my colleague, I offered to meet him at his office and then we would take a cab to this physician's office-I still had no idea where I was going. And on a snowy January afternoon, we indeed got into a cab, and my cardiologist colleague told the driver "400 East 56th Street" which was, in fact, my home. I assumed that the cardiologist had made a mistake--but as we pulled up my driveway, he told the cab to stop not at the front door but at the nearby medical practice--The Atkins Center.

At precisely 6 p.m. I met the person who had arranged the interview, someone I knew from books and television, the most famous "diet-doctor" ever. His offer to join his practice was certainly a surprise: I didn't accept immediately, and in fact it took several months of persistent phone calls by Dr. Atkins himself--and then a visit to Maimonides Medical Center, the hospital of my internship and residency. I asked Dr. David Grob, to this day the greatest physician and teacher I have ever met, what I should do. To my great surprise, he said "Take the job." I couldn't believe my ears, but because I felt that Dr. Grob was wise and brilliant, I followed his advice.

Twenty years later, I have handed in the draft manuscript for The Park Avenue Diet, a "diet" book unlike any other in publishing history, a veritable lifestyle manual. My thoughts have evolved considerably since 1988, especially about the relatively straightforward therapy we call weight loss. And the nutritional landscape has also changed, not for the better. We will be exploring topics of interest in this blog, following the latest scientific stories, and finding a pathway to better health and longer life. I hope you will be entertained, enlightened, and lightened!