About stoneagedoc

Pediatric infectious diseases specialist, author and public speaker. After 35 years in clinical practice including 40 years in academic pediatrics I now share that experience in helping others to enjoy a long, healthy life without the burden of chronic disease.

In the news

Low-carb vegetables and fruits

          One of the drawbacks of the ketogenic diet is that most versions allow almost no fruits or vegetables, especially during the induction phase that usually takes about two weeks. That eliminates the kinds of nutrients that our bodies are designed for – phenols and flavonoids and similar nutrients that protect us against inflammation and cell damage, as well as fiber that we need for a healthy gut.

A strict ketogenic diet allows for 50 grams or less of carbohydrate, less than you would get in a BLT sandwich. And that means that for the rest of the day you could only have protein and fat in your diet. There is a happy solution however.

Some vegetables have little carbohydrate because much of their bulk consists of water and fiber. They include things like bell peppers, asparagus, avocado, tomatoes, spinach, broccoli, cucumber, kale, cabbage and mushrooms. (You can find how much carbohydrate there is in a serving of your favorite food at Google – or just ask Siri). In other words, you can still get the plant nutrients in vegetables if you pick the right ones. Root vegetables like potatoes, beets and carrots have more carbohydrate – a medium baked potato has 50 grams of starch that rapidly breaks down into sugar — but an occasional small serving won’t destroy your diet.

Fruits are another matter. They are bred to be sweet, which means sugary and even a medium-sized banana has about 30 grams of carbohydrate, a medium orange has about 25 grams and an apple about 20.

But here’s the good news: you don’t need to go full keto in order to get its benefits. In addition to those I listed above, things like kale, Brussels sprouts, eggplant, zucchini, cauliflower and green beans are low enough in carbohydrate that you can have one or two servings every day with lunch or dinner and not feel like a martyr – or annoying your family with bad breath!



Here’s another annoyance of aging. Unfortunately it’s one of those that has no remedy: thin, fragile skin           

As we age we inevitably begin to lose some of the fatty tissue and connective tissue beneath the skin, especially on the back of the hand and on the forearm. Skin becomes paper-thin and a light brush against a doorway peels away some skin. Oral or topical steroids, drugs like prednisone, bring it on faster.

Retinol, a prescription drug, or fish oil supplements might help but the best solution is simply to protect susceptible areas. When you work outdoors wear light gloves and a long-sleeved shirt, even in warm weather. They can be a protective barrier.

This kind of injury is so common after the age of about 65 that you might want to have a couple of band-aids in your wallet or purse. It’s cheap, unobtrusive insurance.



I recently did a TV interview that covered a variety of health-related topics, especially the concept that most of the so-called age-related diseases are actually lifestyle-related. Click on the following link, https://www.facebook.com/SeniorStayOrGo/videos/2576759122420057/

Upcoming presentations

Wednesday, February 5th at 1:00 p.m., the Serra Mesa Library, 9005 Aero Drive, San Diego, Health benefits of wine and chocolate, just in time for Valentine’s Day. Wine and chocolate are derived from plants and thus contain nutrients that have specific health benefits. Not all forms of these pleasurable foods are healthy, however. Learn which claims are legitimate and how to select the healthiest kinds of wine and chocolate. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Friday, February 7th at 1:00 p.m. at the Temecula Higher Education Center, Osteoporosis: calcium is not the answer. Osteoporosis is not an inevitable consequence of aging and taking calcium will not delay its onset. Learn the single most important thing that you can do to maintain a healthy skeleton. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 13th at 1:00 p.m. Coronado Library, Health benefits of wine and chocolate, Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 19th at 1:00 p.m., Stagecoach Community Center, Carlsbad, Serendipities that affect your life and your health, Accidents happen but the outcome is not always bad. Scientific breakthroughs from the Big Bang theory to cataract surgery, from penicillin to post-it notes, from vaccines to Viagra, have come from efforts directed to a different objective. Simple mistakes have led to miraculous discoveries, several of which affect each of us every day of our lives. Sponsored by Osher Lifelong Learning Center. To register see their web site at http://www.csusm.edu/el/olli or call 800-500-9377.

Thursday, February 20th, 1:00 at the Oasis Grossmont Center, Keeping your wits: ten ways to prevent dementia and Alzheimer’s disease. Most forms of age-related dementia, including Alzheimer’s disease, can be avoided or delayed by following a prudent lifestyle. Ten simple measures will preserve brain function and even improve it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Tuesday, February 25th, 12:30 at the University Community Library, 4155 Governor Drive, San diego.  Shingles, a better vaccine is here. Shingles, whose medical name is herpes zoster, is occurring more often as our population ages. For most victims it’s uncomfortable but for many it results in pain that can last for years, sometimes results in blindness and is associated with stroke and heart attack. A much more effective vaccine that was released in December, 2017 is nearly twice as effective as the previous one. Learn how it begins, who is at risk and how we can avoid it. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Wednesday, February 26th at 1:00 p.m. at the Point Loma Library, A day in the life of a Gold Rush physician, Sponsored by OASIS.  It began with a nugget no larger than a thumbnail but it transformed the United States. Physician-adventurers followed the gold, bringing old ideas as well as newly-emerging medical discoveries. It was a unique period in history that tested a physician’s skills and stamina. To register see their web site at http://www.oasisnet.org.

In the news

The Wuhan Coronavirus: a perspective.

            The world is on edge because of a new virus that has emerged from China where it has sickened nearly 12,000 victims and claimed the lives of 259, according to official Chinese figures. As of this writing on January 31st there have been no reported deaths outside of China and only 7 nonfatal cases in the United States.

Financial markets have reacted as if this is a Black Swan event –an unexpected event of large magnitude, a random, catastrophic and massive disaster that can affect perhaps millions of lives. This does not, in my view, qualify as a Black Swan event.

The very cautious approach of health officials is justified in spite of the low – so far – mortality rate of only about 2 percent. Two other coronaviruses had much higher fatality rates: 9.6 percent for SARS (Severe Acute Respiratory Syndrome, 2002-2003) and 38 percent for MERS (Middle East Respiratory Syndrome, 2012-present). The Wuhan virus may yet turn ugly but the latest statistics are encouraging.


There have been more than 6,000 cases of Coronavirus infection worldwide since about September 2019; there have been more than 8,000 deaths due to influenza just in the United States in that time. There will be no vaccine to prevent Coronavirus in the near future but there is one to prevent the flu. The latter vaccine is far from perfect but it dramatically reduces the likelihood that persons who become ill will need to be hospitalized or will die from the secondary bacterial infection that is so often the actual cause of death.

A little more than a century ago an influenza pandemic (i.e. worldwide) killed at least 50 million persons at a time when the global population was about one-fourth what it is today. It’s extremely unlikely that such a catastrophe – a true Black Swan – will occur again. In 1918-1919 many people were overcome because of malnutrition. Remember that these were the years when The Great War came to an end. There were no antibiotics back then and most fatalities were due to infection by bacteria of the types that are almost always susceptible to today’s antibiotics.

A hundred years ago doctors didn’t even know what viruses were. In contrast, the Wuhan Coronavirus has already been identified, a diagnostic test is available and work has begun on a vaccine. Is this a Black Swan? Not at the moment but it should be a reminder that we should take advantage of all the vaccines that are available to us and wash our hands frequently, especially after having been out in public.


Avoiding another annoyance of aging: muscle cramps.

These painful spasms can occur at any age but they seem to be more frequent as we get older. To make things worse they often occur at night, spoiling a restful sleep. There are several causes but most of the time they can’t be explained.

Dehydration – the lack of adequate fluid intake – is one of the causes that we can do something about. Because thirst is not a sufficient sign of the need for fluids in older persons we need to have a more reliable indicator, and we do. Your urine should always be light yellow with only a mild odor; dark, smelly urine means that you are getting behind in fluids. Of course, taking more fluid late in the day means that you’ll probably have to make an extra trip to the bathroom during the night but it’s worth it not only to prevent cramps but also to avoid developing kidney stones.

Maintaining moderate physical activity throughout life has many benefits, one of which is healthy blood flow to your muscles. That supplies your muscles with nutrients and oxygen and removes accumulated waste products that can increase the likelihood of developing cramps. After you exercise (and not before!) you should do some stretching movements.

Some persons have low levels of calcium or magnesium. Muscle cramps can also be a sign of diabetes, liver disease or thyroid problems. If you have frequent muscle cramps it’s worth a trip to the doctor to rule them out.

Sometimes chewing on a Tums tablet will relieve the pain.











In the news

Ketogenic and low-carb diets are not the same

Low-carb diets have been around for a while, popularized by Dr. Robert Atkins. It’s surprising to some but ketogenic diets have been around a lot longer – about 200 years longer. Nearly complete restriction of any form of carbohydrate was an attempt to postpone the inevitable fatal outcome of diabetes, which until fairly recently consisted only of type 1, caused by the complete destruction of insulin-producing cells in the pancreas. It was a rare patient who survived more than a few months until the discovery of insulin in 1921.

In that same year, a diet that severely restricted carbohydrates and conversely increased the intake of fats was found to dramatically reduce the frequency of seizures in persons with epilepsy. That was the mainstay of treatment until effective prescription drugs became available.

When the intake of carbohydrates is reduced to 50 grams or less per day, about as much as is in a couple of Oreo cookies or two bananas, the body uses fat for fuel by turning it into ketones. The brain can only use sugar (glucose) or ketones for fuel. In theory, that uses up stored body fat, leading to weight loss.

Scientists are still not certain why ketosis reduces seizures or even why it leads to weight loss although “using up” fat for fuel makes sense. It’s a lot more complicated than that.

Low-carbohydrate diets such as Atkins or South Beach, especially in their more recent versions, do not rely on the production of ketones. In fact, a later version of The South Beach Diet doesn’t even include the term “ketosis” in the index! A truly ketogenic diet is so hard to maintain and comes with so many side effects that few dieters can maintain it for more than a few months, most not even that long.

In the next blog I’ll describe which foods to avoid if you want to go low-carb. Don’t worry – you won’t feel like you’ve just entered a monastery!


          Another annoyance of aging: falls

Falls are among the most frequent and the most serious problems seniors face and there a couple of reasons why they affect us so gravely. The first is that osteoporosis has become so common, affecting about one woman in five in the U.S. and about one in twenty men. When a hip fracture occurs, about twenty-five percent of patients will not survive a year.

An aging population increasingly requires prescription blood-thinners because of conditions such as atrial fibrillation, coronary artery disease, certain types of stroke and deep vein thrombosis (blood clots in large veins, especially in the legs). When the clotting mechanism is compromised, even a seemingly mild head injury can result in severe disability or death. Such was the fate of the above-mentioned Dr. Atkins.

You might consider some changes in your home. Get rid of scatter rugs; put non-skid strips in the bath and shower; install night lights and lighting strips; hand-holds in the bath and shower. (And all these improve your home value!)

This is one more reason to exercise. Physical activity not only strengthens muscles so that you can pick up your feet higher to avoid tripping, it prevents the loss of those nerve endings that enhance balance.

One more thing: we become more sensitive to alcohol as we get older. Alcohol is a major factor in falls among the elderly.









Happy New Year!

Upcoming presentations

Tuesday, January 28th at 10:45 a.m. at the Rancho Santa Fe library. The health benefits of wine and chocolate. Wine and chocolate are derived from plants and thus contain nutrients that have specific health benefits. Not all forms of these pleasurable foods are healthy, however. Learn which claims are legitimate and how to select the healthiest forms of wine and chocolate.

Friday, January 31st at 2:30 p.m. at the LIFE program at Mira Costa College in Oceanside, The annoyances of aging. Growing older is inevitable but many of the physical and mental challenges that seniors face are not. More than twenty such topics that range from decreased energy to liver spots, irregular sleep to poor memory can be postponed or even avoided completely. Details at http://www.miracosta.edu/life.

In the news

Is this really our future?

“The obesity rate will soar above 50 % in 29 states.” “…no state will have an obesity prevalence below 35%…” “…about one in four adults are projected to have severe obesity,” which is usually 100 lb. of excess weight. This is the staggering prediction for the year 2030 from the Harvard T.H. Chan School of Public Health in Boston.

Hmmmm! Seems to be a disconnect here as I write this at the end of the holiday eating cycle while announcing a presentation about wine and chocolate! However, if you Google Goscienski make it a gainless holiday you’ll find some redeeming advice, and an ounce of dark chocolate — my usual recommendation — has only 150 calories.

The hazards of obesity are well described even in the lay press. It leads to coronary artery disease, type 2 diabetes, dementia and fourteen types of cancer, and it is a contributing factor in a myriad of other health problems. Is it really beyond our control?

There are two (relatively) painless steps that we can take to rein in weight gain. The first is to eliminate our intake of refined starch and sugar and to replace them with vegetables (not French fries!) and fruit, nearly all of which contain only 50-100 calories per serving! The upside is that they are not only filling but they provide vitamins, minerals and other nutrients that are virtually non-existent in packaged foods.

Eighty percent of Americans don’t get enough exercise but in spite of the crowds we’ll see in the local gym this week – and never again – exercise really doesn’t contribute much to weight loss. Does that surprise you? Consider that brisk walking for an hour will burn about 300 calories, about as many as there are in a slice of apple pie and about half as many as you’ll get in the average restaurant dessert. One of the benefits of exercise is that when you seriously reduce your calorie intake the weight that you lose will consist almost entirely of fat; if you don’t exercise while on a low-calorie diet of any type, much of the weight loss consists of muscle. That’s a lousy trade-off!



Continuing our series on the annoyances of aging: dizziness and fainting

       These have multiple causes but they should NEVER be ignored. Not only are they often the first symptom of a serious medical condition, the fall that often occurs during one of these episodes can lead to a hip or skull fracture, either of which can really ruin your day!

A common reason is a side effect of medication for lowering blood pressure but other causes include an abnormal heart rhythm, low blood sugar or dehydration. If you have ever felt light-headed or dizzy after standing up from a seated position or lying down it may indicate orthostatic hypotension; it’s not serious but it’s still an  indication for getting checked out by a physician.

The bottom line: dizziness and fainting are not normal and always require medical evaluation.

In the news

Work out; get happy!

Since I first began my career in lecturing and writing on matters of health and fitness more than 20 years ago I have doggedly insisted that if persons exercise with moderate intensity four or five days a week, within two or three weeks they’ll feel so much better that they won’t want to stop. A recent article in the online publication by Blue Cross/Blue Shield of North Carolina bears this out – and then some.

The article by Michelle Rogers offers several reasons. The first is that exercise increases blood flow to the brain. Approximately one-quarter of the blood sent from your heart with each beat goes to the brain, providing oxygen and nutrients and removing accumulated waste products. But in addition the extra blood flow causes the release of endorphins and serotonin, chemicals that provide a feeling of well-being.

Physical activity also increases the delivery of blood to muscles and thereby removes chemicals that accumulate during stress and that can negatively affect the brain.

A growing number of studies show that persons with major forms of depression who exercise show improvement in a matter of weeks, either with exercise alone or in addition to prescription medication. Considering that antidepressants often cause considerable side effects, anything that leads to at least a reduction of dosage should be considered.

You have probably heard of “runner’s high”, the euphoria that long-distance runners experience. Fret not – you don’t need to become a marathoner. The feel-good effects of exercise have been documented to occur with only short bouts of exercise a few days per week. Brisk walking fills the bill and won’t leave you needing knee replacements by the time you get that first Social Security check.

The lesson: get moving and get happy.


Another annoyance of aging: dehydration

One of the challenges of getting older is that by the time we reach the half-century mark (!) the thirst mechanism doesn’t work as well to warn us that we need to take in more fluid. That helps to explain why so many seniors succumb to dehydration during extremely hot weather. Dehydration is another reason why we feel fatigued. When our fluid intake lags our thinking gets fuzzy and dulls the signal that we need a refreshing drink. As a result, most seniors experience dehydration from time to time.

There is another risk to frequent episodes of dehydration: kidney stones.

Forget about those mathematical formulas that tell you to take ________(fill in the blank) ounces of fluid __________(fill in the blank) times a day. Ambient temperature, humidity, activity level, prescription medications and medical issues can be so variable that the math is meaningless.

The solution is absurdly simple: drink enough fluid (preferably plain water) so that your urine is consistently a light yellow color with only a slight odor. Dark, smelly urine increases the risk of kidney stones. Don’t overdo it either. If your urine looks like tap water and has no odor it puts you at risk of convulsions, a condition that is commonly seen in long-distance runners at the end of a race when they overdo rehydration.

Dehydration also increases the risk of heart attack and stroke, and for travelers on long trips there is an increased risk of forming blood clots in the legs – deep vein thrombosis, also known as economy class syndrome.

Although plain water should be your beverage of choice, any kind of liquid will do. Keep in mind that most foods consist of 80-90 percent water. And yes, a glass of wine or a bottle of beer will help to prevent dehydration, in case you need an excuse.






Upcoming presentation

Tuesday, December 10, 12:30, Mission Valley Library. Immunizations: The good, the bad and the future. Vaccines have been around for centuries and they are responsible for the eradication of several deadly diseases. They are not entirely benign, however. Immunization is no longer only for children. There are at least two adult vaccines that can save your life. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

In the news

We underestimate the need for exercise.

Humans have evolved to require moderately intense physical activity every day, a concept that we discussed in this blog nearly a year ago. Now we have more compelling reasons to be active, in other words, to exercise.

A research team in Norway looked at the lifestyles of more than 23,000 young people and monitored their activity periodically for 22 years. They found that those who were inactive were twice as likely to die during the study and nearly three times as likely to die from heart attack or stroke compared to their fellow Norwegians who were physically active.

What does “physically active” mean? It’s not really intense – 150 minutes per week (2 ½ hours) of moderately intense exercise, being able to just about break a sweat, or 75 minutes (1 ¼ hours) per week of vigorous, intense, aerobic activity. Those who got religion, that is to say that they began to exercise more often and with greater intensity during the study, had survival rates between the figures noted above.

The 150-minute figure is interesting for two other reasons, just coincidentally. Another study showed that persons with prediabetes who walked for about 2 ½ hours per week were much less likely to cross the line to type 2 diabetes in the following several years. In still another study, women with osteopenia, the stage of bone loss that precedes osteoporosis, gained bone mass during the course of about one year with 2 ½ hours per week of vigorous walking.

Does it help to exercise even more than 2 1/2 hours a week? Yes, as we learn from senior athletes, especially those            who compete in various sports. But it’s nice to know that even moderate activity has real benefits.



Another annoyance of aging: alcohol intolerance.

          About the time we approach the end of middle age we notice that we feel the effects of alcohol after fewer drinks than in the past. It bruises our ego a little but there’s more to it. We’ve known for a century or so that driving under the influence of alcohol is responsible for tens of thousands of deaths each year. Alcohol-related falls are also a major problem, especially when so many seniors are on blood-thinning medications and even a relatively minor bump on the head can lead to fatal bleeding within the brain.

So why are we more sensitive to the effects of alcohol? The major reason is that we have a smaller percentage of body water in which the alcohol can be diluted, so our blood levels – and hence brain levels – are higher than they would have been a few decades ago.

The obesity epidemic is having an effect. Most Americans have lost muscle mass by the time they reach middle age and it has been replaced by fat. As with lower percentages of body water, lower muscle mass also results in less volume in which to dissolve the alcohol.

To a lesser extent we have lower concentrations of the enzymes in the stomach and liver that help us to break down alcohol.

The lesson is clear: two glasses of wine or the equivalent should be the limit for most mature adults. You might even have noticed that you’re not quite the same after only one glass of wine. My solution is simple: stop at two glasses and switch to water. It’s good bet that no one will even notice – because they’re still drinking alcohol.











Variety is the price, not the spice, of life

Tens of thousands of years ago, when our body chemistry was evolving, humans had a choice of hundreds of different kinds of plant and animal foods. That is what nature has designed for us so why are we squandering such abundant variety? A more important question: can we afford to ignore the cornucopia that our bodies require for good health?

Our lack of nutritional diversity is obvious in the produce section of any supermarket. Count the vegetables. You’ll find between 30 and 40 – but not really. There are three or four varieties of carrots, lettuce and cabbage and perhaps four or five varieties of tomatoes. The differences between them are really pretty small compared to what our Stone Age ancestors enjoyed thousands of years ago.

Nothing illustrates this better than birds and their eggs. How many species of birds (and their eggs) would you have encountered back in the Stone Age? Certainly more than the only two in our modern markets: chickens and turkeys and only the former provide us with eggs. How boring!

Ninety percent of the worlds’ food supply comes from only 17 plant species. When we discarded the rest we also lost the diversity of protein, vitamins, minerals and antioxidants that a varied diet produces, to say nothing of scores of different flavors. When the first farmers limited their food supply mostly to cereal grains that are easy to cultivate, harvest and store, they became more prone to disease, had smaller stature and shorter lifespans.

A first step in regaining diversity might be to explore genuine ethnic foods – Chinese, Indian, South American and Vietnamese. Take your time to explore your favorite produce department. I’ll bet that you’ll find at least three or four vegetables and fruits that you’ve never tried. It’s a start.

Continuing the Annoyances of Aging: loss of appetite.

          If you’ve noticed that your interest in food has decreased or that you feel full earlier than a few years ago, the most likely reason is that you have become less active and your body just doesn’t need as many calories. Of course if your appetite has not changed in spite of your being less active, you’re likely to gain weight, something that is quite typical in the modern age.

Along with gray hair and wrinkles we begin to lose our sense of taste and smell, so food just doesn’t seem as appetizing. I consider that a plus; nature is accommodating our decreased need for calories.

Several different prescription medications can depress the appetite, including pain relievers such as acetaminophen (Tylenol), opiates, blood pressure medications, antibiotics and chemotherapy.

Sometimes the loss of appetite is a sign of a medical problem and there are two that are rather subtle and have few other symptoms: thyroid disease and depression.

When there are other symptoms such as weight loss, increasing fatigue, a change in urinary pattern or persistent cough it’s time for a doctor’s visit. With early treatment conditions such as diabetes, heart disease and even cancer are likely to have a favorable outcome.