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?
Monday, December 27, 2010
Monday, November 22, 2010
Notes on "The Park Avenue Diet Show: Inflammation: an Introduction"; November 21, 2010
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.
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.
Monday, November 15, 2010
Note on "The Park Avenue Diet Show: What Should I Have for a Snack?"; November 14, 2010
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 !
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 !
Monday, November 8, 2010
Notes on "The Park Avenue Diet Show: Diabetes Mellitus"; November 7, 2010
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.
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.
Monday, November 1, 2010
Notes on "The Park Avenue Diet Show: Trick or Treat?"; October 31, 2010
"Trick or Treat?" is not usually a question applied to health topics. But there's a first time for everything. Last night was the world premiere of a one-time-only quiz show with that name as part of "The Park Avenue Diet Show".
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!
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!
Monday, October 25, 2010
Notes on "The Park Avenue Diet Show: The Only Thing Constant is Change"; October 24, 2010
“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.
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.
Monday, October 18, 2010
Notes on "The Park Avenue Diet Show: All About the Abs"; October 17, 2010
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.
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.
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