Carvings July 1, 2026

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In the news

The exercise-cancer connection

            Physicians have recognized for decades that persons who engage in regular, moderately intense exercise have lower rates of cancer than non-exercisers. There are two reasons for this. First, exercise strengthens the immune system that can snuff out abnormal cells before they can multiply and produce cancer.

            Another reason is that exercisers do not become overweight or obese, whereas fat deposits produce two cancer-promoting factors, estrogen and inflammatory chemicals. Obesity, in fact, is associated with at least fourteen different types of cancer.

            In recent years, cancer specialists have become aware that exercise keeps cancer from returning in those who have received treatment. In 2024 the International Society of Exercise Oncology was formed to help organize the more than 2100 cancer exercise programs in the United States and to further their expansion.

            As I have noted numerous times in these posts, regular, moderately intense exercise is a fundamental requirement for good health. Yet, only about twenty percent of Americans exercise at least four or five times a week. The majority do not exercise at all. If those 80-20 numbers could be reversed cancer would no longer be the second leading cause of death, and deaths from heart disease and stroke would plummet as well.

Lifestyle

            In the early decades of my pediatric career I treated children for diseases that are virtually absent today. They ranged from common ear infections to infrequent but devastating meningitis, from uncomfortable mumps to sometimes fatal measles. Vaccines deservedly get the credit for the near elimination of those heartbreaking illnesses. Unfortunately the anti-vaccination movement is tragically undoing some of these advances, as shown by the surge in measles and whooping cough in recent years.

            One group of vaccines that is available for adults as well as children is the pneumococcal vaccine. A major cause of ear infections (otitis media) in children and pneumonia in adults and children is a bacterium called Streptococcus pneumoniae, commonly called the pneumococcus.

            The first attempts at creating a pneumococcal vaccine began over a hundred years ago but it wasn’t until the 1980s that a truly effective vaccine became available. Methodological advances and the vagaries of the bacterium itself have led to numerous formulations, each one capable of thwarting more and more strains.

            Use of the vaccine in children has led to a significant decline in the incidence of ear infections and a marked reduction in pneumonia, meningitis and blood stream infections. The adult vaccine has sharply reduced the incidence of pneumonia in adults. Widespread use of the pneumococcal disease in children has led to the emergence of herd immunity among adults. 

            The effectiveness of the pneumococcal vaccine and the absence of significant side effects should encourage every adult over the age of 65 to receive it but only about seventy percent of seniors have done so. Universal acceptance would almost completely eliminate pneumonia in the elderly population, a condition once described by Sir William Osler as “the old man’s friend”. Before the availability of antibiotics, pneumonia, often caused by the pneumococcus, quickly and relatively gently ended the lives of older persons who would otherwise have suffered through weeks or months from diseases such as cancer, stroke or heart failure.

            Because the vaccine has undergone so many changes since 2000, persons who received the vaccine several years ago should consult with their physician regarding the need for another dose. We no longer need the old man’s friend

Carvings June 15, 2026

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In the news

Multivitamins – again!

            It’s a never-ending controversy – is it worth taking a daily multivitamin/multimineral? A recent study funded by the National Institutes of Health (NIH) among about 1,000 healthy adults showed that taking a daily multivitamin/multimineral for two years slowed down the biological aging process. The improvements were small but statistically significant. The effects were greater among those whose aging markers were less healthy.

            There are so many variables in this type of study that make it difficult to interpret. Perhaps an AI program will ultimately come up with a clear answer but that might be asking too much even for AI. How the human body utilizes nutrients in the diet and supplements varies not only according to one’s genetic pattern, but even according to one’s microbiome, the vast numbers of microorganisms that live in and on our bodies.

            More than twenty years ago the American Medical Association, in two articles in their journal (JAMA), acknowledged  that everyone would benefit from a daily multivitamin/multimineral. In the two decades since then do you think that the Standard American Diet (SAD) has improved?

            I take supplements for one reason: I can’t be sure that my diet includes what I need every day. I sometimes skip meals and I don’t always get the recommended ten servings of fruits and vegetables. How about you? Taking a supplement that contains the recommended amount of vitamins and minerals – and avoiding excess amounts — is simply insurance.

            NOTE: I have noted in past posts that today’s supermarket fruits and vegetables have fewer nutrients that those of a half-century ago, a phenomenon that has been documented by agricultural colleges and described in the book by Jo Robinson, Eating on the wild side, available (of course) on Amazon.

Lifestyle

            During a two-month stay in Italy I couldn’t help but notice that Italians are noticeably thinner than Americans. The difference became quite obvious when I watched groups of tourists follow their pennant-waving guide (who was aways slender). Invariably, they spoke English or German.

            The food was, as expected, marvelous, but only rarely were the restaurant portions so large that there was no room for dessert. Those desserts weren’t very big either, and often consisted mostly of fruit.

            Pasta? Of course, but pasta – even in the United States – does not raise blood sugar as much as you might expect. And in Italy it is often just a small side dish. I had pizza at least once a week. Typically the crust was about as thin as a crepe, topped with tomato sauce. The whole thing had about as much cheese as a single slice of an American pizza. Our favorite place had the aforementioned wafer-thin crust topped with slices of prosciutto cotto – cooked ham- that was sliced so thinly that I could literally see the tomato sauce underneath.

Note: a touristy pizza place, obviously catering to Americans, had a thick crust and loads of cheese.

            I walked, and walked, and walked, usually two or three miles a day. My apartment, on the third floor, had no elevator, a rarity in those 500-year-old buildings in Tuscany. Bicycles, few of which were electrified, were everywhere. It was common to see persons who were clearly in their seventies or older, breezily threading their way among the crowds of tourists. However, teenagers rode motorized bikes and scooters, making me wonder if they will be as fit as their grandparents in the future.   

Carvings March 15, 2026

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In the news

Revamping our dietary patterns

                It’s painfully clear that the Standard American Diet (SAD) is killing us by the millions and crippling us with conditions such as osteoporosis. Whatever your feelings are about the current administration, they are clearly on the right track to encourage Americans to begin eating normal food. The new food pyramid is not perfect but it’s an improvement over the old one, now with its emphasis on plant-based foods. I know, I know – I’d rather see the salmon above the steak but the latter does have an appropriately small space compared to the broccoli, carrots, and tomato. Let’s not quibble. Almost one-half of the new pyramid consists of veggies, fruit, berries and nuts.

                The place to start is breakfast, which for many persons consists of a sugary cereal. If you can’t give up breakfast cereal you can at least switch to the kind without added sugar or other processed ingredients. Eggs are fine but start cutting back on “egg helpers” such as bacon, sausage, ham, hash browns. Those are the foods that raise cholesterol, not the eggs, which are entirely innocent of that crime.

                If you need something sweet, how about one or two pieces of fruit, say half a grapefruit and a banana. Fruit juice is okay but why bother when whole fruit has less sugar, more fiber and much more satisfying “mouth feel” and is probably less expensive.

                Many Americans, especially seniors, don’t get enough protein. A morning breakfast shake that includes a scoop of powdered protein, some frozen berries, a little (!) fruit juice and some plain yogurt (more protein, as well as calcium, is tasty and filling and will get you through the morning without having to have a Danish or a donut with your coffee break.

Lifestyle

Continuing ethnoid: the salt issue

                Sodium, in the form of table salt, is a critical nutrient but taken in excess it contributes to high blood pressure. Two centuries ago it was almost the only means of preserving food and the result of a very high intake was a correspondingly high incidence of stomach cancer. In Japan, where the intake of sodium is nearly twice that in the United State – itself a higher intake than nature prefers – the incidence of stomach cancer is considerably higher than in other countries.

                In spite of the high sodium content in soy sauce and miso soup, most of the Japanese cuisine, with its emphasis on seafood and vegetables, is quite healthy. Considering that the Japanese people are the longest living on the planet, we should learn from their example. One caveat however: the youngest generation in Japan is destined to live shorter lives than its elders because of its adoption of the Western diet.

                Four items on the Chinese American menu that are particularly high in sodium are General Tso’s chicken, wonton soup, egg drop soup and vegetable stir-fry. White rice is a common staple in southern China but not in most of the country, where the folks enjoy a wide variety of vegetables that are only rarely found on Chinese restaurant menus in the United States.

 

Carvings March 1, 2026

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Our diet is our destiny

                Full credit for that statement goes to Dr. William G. Wilkoff in his column of September 10, 2025. Dr. Wilkoff points out quite clearly that “Food — not lack of exercise – fuels obesity.” That was the title of an article on National Public Radio.

                To be sure, exercise does matter. When we cut back drastically on calories it’s important to exercise regularly – meaning a minimum of four times a week, with moderate intensity, for at least one hour. The reason? When we cut back significantly on calories it’s not the fat that the body draws energy from. First, energy comes from glycogen, the carbohydrate stored in the liver and muscles. Next, the body begins to burn protein – almost entirely from muscle – as well as from stored fat. Without exercise, almost half of the pounds lost during a weight-loss regimen come from muscle.

                If you have worked out on a treadmill or stationary bike at your local gym you may have already noticed a distressing fact: roughly one hour on one of these machines burns only about 300 calories – about as many as you will get in two scoops of ice cream.

                The ideal rate of weight loss is about two pounds per week. Losing more than that leads to fatigue, cravings and irritability. Two pounds of fat is equivalent to about 7,200 calories, or about 24 hours (!) on that treadmill!! On the other hand, you can reduce your calorie intake by 7200 calories a week by eliminating a daily dessert (which average 300-500 calories per serving – see below), replacing pasta, rice, or potatoes with a fiber- and nutrient-rich vegetable like broccoli, peas, cauliflower, beans, etc., and limiting your wine intake to only one small glass (four ounces) instead of two five-ounce glasses.

                By losing only two pounds per week even a morbidly obese person (more than 100 pounds over standard weight for height) will be back to normal in two years or less. That will likely reduce high blood pressure, lower the risk of complications of diabetes and certainly improve self-image. 

Lifestyle

Thoughts on desserts

                From what I have observed over the years, most of us have at least one dessert a day, typically with the evening meal. There is no need to give up desserts forever – a highly unrealistic goal – but a few relatively minor changes can significantly lower one’s total weekly caloric intake.

                There are three things to consider: type, size and frequency.

                Outside of the tourist areas, European desserts often consist only of a piece of fruit – not a whole one, mind you – with a small slice of hard cheese. If it is a sugary kind it’s about the size of your thumb, gone in a mouthful, or at most, two. The desserts served in our restaurants average about 500 calories; some of our most popular establishments offer1500 calorie desserts. As an example, a slice of apple pie a la mode has 400-600 calories.

                Don’t go cold turkey on desserts if you are used to having one every day. Do without dessert just one day a week for a month, then two, then three. At the end of three months that’s 1500 calories a week, or two pounds a month. Right on target for a healthier lifestyle!

Carvings February 15, 2026

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Is it an ethnic cuisine – or ethnoid?

                What would life be like in America without ethnic foods – Italian, Chinese, Japanese, Greek, Vietnamese, etc.? I only wish that more cultures were represented – Russian, for example, or German or Chilean. I’m sure that you can find these lesser-known venues in our larger cities, but they are uncommon elsewhere.

                On the other hand, many of our favorite restaurants serve what I call ethnoid, not ethnic foods. (-oid from the Greek, meaning similar) Catering to American tastes, they are usually  sweeter, saltier, more meat-laden and huge.

                This week I’ll discuss Italian food – specifically, the true Mediterranean diet. You won’t find it at your local pizza parlor. Outside of the tourist hotspots in the home country, Italian pizza is quite simple: a thin crust, a layer of tomato sauce and a smidgin of cheese. The amount of cheese that we find on a single slice of American pizza would suffice for about two days for a family of four in rural Italy. It is a garnish, not a major part of the entrée. Only occasionally does it come with pepperoni or sausage. 

The True Mediterranean diet consists mostly of vegetables. There is no significant beef industry in the 21 countries that touch upon the shores of the Mediterranean Sea, largely because it is so expensive both in terms of money and in environmental resources. Goats and young sheep are much less costly for both. Until a few decades ago they had no refrigeration either, which is why cheese, not milk, is the major dairy product. Fish and other products of the sea are major suppliers of protein.

Consider a favorite menu at the Olive Garden – A Tour of Italy: 1500-1800 calories,93 grams of saturated fat and 3,210 milligrams of sodium. And that doesn’t count the breadsticks, the wine or the dessert. The Olive Garden does have a number of very healthy items and if you like it – and I do – be sure to read the fine print on the menu.

The True Mediterranean Diet is a favorite of healthcare advocates. Scores of scientific articles attest to its cardiovascular and anticancer benefits. And of course, it includes a glass of red wine.

Carvings February 1, 2026

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Babies are paying the price

                There is a deadly trend throughout the world: failure to immunize children against crippling or fatal diseases. In spite of overwhelming evidence that vaccines have saved hundreds of millions of lives in the past century, parental refusal and anti-vaccination zealotry have led to an appalling decrease in vaccination rates and a corresponding increase in childhood diseases.

                The Pan American Health Organization (PAHO) notes that in 2026, pertussis (whooping cough) cases in the Americas will exceed the 66,000 cases that occurred in 2024. The mortality rate among very young infants varies between 1 and 5 percent, the variation largely related to poverty, malnutrition and quality of healthcare. I personally watched an infant die from pertussis while I was in medical school. It was a heart-rending experience.

                In 1926 there were 202,000 cases of pertussis in the U.S. A little more than 1,000 cases were reported in 1976, a fifty-year low. Since then there has been an unrelenting increase: 48,000 cases in 2012, and 15,000-30,000 in subsequent years. Much of the blame can be placed at the feet of Andrew Wakefield, whose fraudulent (and subsequently retracted) 1998 publication that linked the MMR vaccine to autism accelerated the anti-vaccine trend.

                Following a brief respite during the COVID pandemic, when extreme social distancing reduced the spread of pertussis and other respiratory diseases, the upward climb has resumed.

                Infants below the age of six months are the most vulnerable since full protection only occurs after three doses of the vaccine. Booster vaccination during pregnancy is the most effective way to protect babies. In addition, grandparents and other potential caregivers and visitors should stay away from young infants if they have even minimal signs of a “cold” or other respiratory infection. Unfortunately, the prior strategy of booster vaccination for close contacts is shown to be ineffective in protecting infants.

                The anti-vaccine movement jeopardizes the health and safety of the most vulnerable among us. They are voiceless victims.

Carvings January 15, 2026

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In the News

Finally – a more sensible Food Pyramid.

            First comes a symbolic leap – the pyramid is inverted. That’s an attention-getter! But less symbolic and more practical is the array of foods across the top. Broccoli, carrots –not quite everyone’s favorites but carrying important nutrients, including carotene and zeaxanthin for healthy vision. The steak could hardly have been relegated to a position down the pyramid considering Americans’ unquenchable taste for red meat (and the clout of the beef industry). The accompanying saturated fat, once condemned as a major cause of coronary artery disease, has been rehabilitated. In my opinion, its hazards cannot be ignored, but having beef, lamb or pork a couple of times a week is not likely to shorten one’s life. There are many other foods that will.

What’s not there: processed meats, refined flour and all forms of sugar. There is overwhelming evidence that overindulgence in the latter two is mainly responsible for the current epidemics of obesity and type two diabetes and the former is associated with cancer. Food pyramids of the past placed junk foods, sweets and sugary drinks at the top, suggesting that they could be part of a healthy diet. They cannot. It is my fervent hope that as a follow-on to the revision of these dietary guidelines there will soon be legislation that will gradually eliminate them from the food scene.

Almost hidden between a carton of milk and a can of green beans is a flask of oil. Is it olive oil or a cooking oil – presumably an omega-6 variety? Both are healthy but the Standard American Diet (SAD) contains too little of the former and too much of the latter. On the other hand, sources of omega-3 fats are represented by the salmon and shrimp. So is tuna, in that little blue can between the egg – no longer a cause of elevated cholesterol – and the avocado, perhaps the healthiest item in the entire pyramid.

Whole grains are at the bottom. Strictly speaking they are not unhealthy, but we should be aware that humans evolved without them.  The old pyramid displayed not only bread, but a large sack of white flour, white rice and a pretzel. They are gone.

There is much, much more to the guidelines than I have mentioned here. I commend the creators of the new version for their willingness to finally tackle the core problem of the nation’s declining health.

The full report, which is an easy read, can be found on Google: dietary guidelines 2026. Go to the realfood.gov link.

Lifestyle

Stop falling!                                              

            A major cause of falls, even in middle age, is the loss of muscle that is the curse of the affluent, technically advanced lifestyle. Without labor-saving devices and powered vehicles, your grandparents, from childhood through their later years, had no choice but to use muscle power to get anything done. It was a blessing, not a curse. With few exceptions, today’s Medicare recipients began losing muscle mass in their mid-twenties at the rate of nearly one percent per year. If muscles mass diminishes by a third to a half, the body sees no need to maintain as much bone mass to support it, so bones become less dense and more fragile.

            There are other factors that increase the risk of falls. As we get older our alcohol tolerance decreases as our muscle mass diminishes and we are often on the verge of dehydration; there is less body water in which to dilute the alcohol. Most seniors take one or more prescription drugs, some of which lead to drowsiness or dizziness, and some of these medications are potentiated by alcohol.

            As old age creeps up on us slowly we need to make some changes in order to avoid falls. It may be time to get rid of scatter rugs. Have a non-skid mat in the tub or shower. Put night lights in the hallways and bedroom. Wear slippers, not socks, when you take off your shoes.  

            A broken hip might not be life-threatening but a cracked skull certainly is.

Carvings January 1, 2026

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Happy New Year!

In the news

Is a pill the answer?

                The new year is going to see a surge in the oral forms of Ozempic and similar drugs for control of type 2 diabetes and for weight loss. The injectable forms of GLP-1, in spite of their inconvenience compared to oral medications, have been very popular because they are effective and they have relatively few serious side effects.

                The availability of a new class of drugs for the control of type 2 diabetes is welcome. That disease, which is entirely lifestyle related with very few exceptions, is a threat to the financial stability of the healthcare system. If the CDC projection is correct, more than half the U.S. population will be burdened with this disease by 2050 and the cost will reach over one trillion dollars per year.

                What are the practical aspects of the new pills in regard to weight loss? Some studies show a weight reduction of 10-15 percent; the best that I have seen in one trial was 27 pounds. That degree of fat loss does matter. It lowers the risk of coronary artery disease, stroke and the complications of type 2 diabetes.  That’s not the end of the story. A 250-pound person who loses 27 or 30 pound is still obese. They have lowered their risk but they have not eliminated it. The benefits are not permanent. Approximately two-thirds of users will regain their weight within only one year after stopping medication.

                There is nothing easy about trying to lose weight. The new pill has not changed that.

                The hardest “pill” for Americans to swallow is a change in lifestyle. Prescription drugs will help along the way, but only a reduction in caloric intake will eventually eliminate a decades-old accumulation of fat. Nor is exercise the answer. To exercise without cutting food intake is folly. However, it is extremely important to exercise regularly when on a calorie-reduction diet in order to prevent the loss of muscle mass that would otherwise result.

                The holidays are a lousy time to cut back on calories, but the holidays are over. Consider just throwing away all the goodies that were foisted upon you by loving friends and relatives. (A confession: I will not throw away my daughter’s fruit cake! Everything else goes.)

Carvings December 15th, 2025

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In the news

Another win for chocolate

            Well, not exactly. A recent study from Birmingham, England among a small group of volunteers showed that the harmful effects on blood vessels that occur during prolonged sitting can be offset by drinking cocoa. The researchers didn’t use dark chocolate, but a specially formulated cocoa drink that had a high level of flavonoids, the micronutrients that help to maintain the health and flexibility of blood vessels. In short, it was not the kind of hot chocolate mix that is so popular at this holiday time.

            Excellent sources of flavonoids include fruit, berries, nuts and tea, including green tea and herbal teas such as chamomile. These are all far superior to the sugar-laden hot chocolate mix that you’ll find at your local grocery store.

            Sitting, even for short periods – two hours in the study noted – has adverse effects on the flexibility of blood vessels and blood pressure. Decades of such inactivity inevitably lead to the kinds of cardiovascular diseases (heart attack and stroke) that are two of the three leading causes of death in Western society. Unfortunately, many occupations necessarily require long sessions at a desk. Wouldn’t it be nice to know that we can possibly offset at least a little of sedentary living’s hazards by some healthy snacking and sipping?

Lifestyle

            In the previous blog I promised to address the “I don’t have time to exercise” issue. Pardon my being blunt, if not outright crass, by pointing out that those making that argument will have plenty of time – but later – while in rehab, recovering from a heart attack or stroke, or getting around in a wheelchair while waiting for a prosthetic leg to arrive. Gross! I know, but it’s a fact.

            The most obvious lifestyle change is to substitute some TV-watching time for at least one hour of physical activity about four or five times a week. Even that relatively small input of time has been shown to significantly improve your chances of avoiding a cardiac catastrophe. And anyway, the news never changes – only the places where it’s freezing/flooding/quaking/erupting or how many people have been shot/stabbed/arrested.

            Then there are the many other ways of activating your muscles and improving your heart and lungs: stealth exercise. Take the stairs instead of the elevator – up and down. Do you find yourself driving around the parking lot to find the closest one to the entrance to the gym? The gym?!? If you park at the farthest corner of the lot you’ll get a warmup and a cooldown, you’ll never “lose” your car and your car door is less likely to get dinged. Stand up when you’re on the phone. Let your dog take you for a walk three times a day instead of twice on weekends.

            Exercise as if your life depends on it. It does!

Carvings, December 1, 2025

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In the news

I hope that I’m preaching to the choir

        As you know from recent blog posts, the influenza vaccine, though it does not always prevent the flu, is important because it decreases the severity of an infection, likely avoiding hospitalization. You may also recall that an episode of influenza significantly increases the risk of a heart attack or stroke, while the vaccine has just the opposite effect. Another point to emphasize: influenza weakens the immune system, which is the reason why deaths from the flu are almost always due to secondary infection, not viral infection.

                Infectious disease experts warn that this year’s flu season will probably be more severe than most because the current strain is more potent. This is already evident in Australia and the UK. That makes getting the vaccine especially important this winter.

Lifestyle

What hardly anyone knows about exercise.

                The title of this blog might seem somewhat pretentious but the evidence is all around us. Surveys over the years are pretty consistent: about eighty percent of Americans simply do not engage in any form of exercise. An interesting coincidence: eighty present of Americans are overweight or obese. Are they the same eighty percent. Ya think?

                The human body has evolved to require several hours a day of moderately intense physical activity. Before the Industrial Age there was no way around it. Getting to or from anywhere required walking. (Lest you think that riding horseback didn’t require physical activity, be assured that a ride of any distance is a pretty good workout.) Craftsmen used only hand tools; the most mundane household chore required lifting, carrying, chopping, etc..

                Moderately intense physical activity has two major effects: it burns calories and it opens dormant blood vessels. If we use up all the calories we take in there aren’t any left to be turned into fat. That’s obvious but what is not so obvious is that those fat stores are factories (fattories?) for churning out inflammatory chemicals that are the drivers of coronary heart disease, ischemic stroke, type 2 diabetes, cancer and osteoporosis. Another interesting coincidence: none of those conditions exist in pre-industrial societies – not one, except for some cancers!

                When your heart pumps vigorously in the course of intense physical activity, every blood vessel in the body, even those that are “resting”, opens up to accommodate the flow. That ensures that every cell receives oxygen and nutrients and gets rid of accumulated waste products. The ebb and flow of blood also keeps those blood vessels flexible so that they can handle the sudden stress of the kind that might precipitate a heart attack or stroke. 

                Twenty-five percent of the blood that exits the left side of the heart goes to the head, nearly all of it to the brain. Simply put, well-fed brain cells last longer.

                The excuse that I hear most often is “I don’t have time”. I’ll address that issue in the next post.