Upcoming presentations

Tuesday, April 9th at 12:30 p.m., the Dove Library on El Camino Real in Carlsbad, Avoid the annoyances of aging, a discussion of those pesky things that take the fun out of growing older.  And yes, most of them can be avoided.

Wednesday, April 24th at 1:00 p.m. at the San Marcos Library, The Health benefits of wine and chocolate. This has been the all-time favorite of my 75 PowerPoint presentations. I wonder why!

Friday, April 26th at 2:30 p.m. at the LIFE program at Mira Costa College in Oceanside, The antibiotic crisis: how we got here. Only three generations of humans have lived during the antibiotic era. This presentation describes how antibiotics were discovered, how they work, why they are becoming less effective and how we can protect ourselves from antibiotic-resistant microorganisms. Details at http://www.miracosta.edu/life.

In the news

Here we go again: eggs, cholesterol and heart disease!

Is your brain being scrambled by the eggs are healthy/eggs are not healthy studies that the media revel in? It’s like watching a tennis match as the ball goes back and forth.

The latest study reports that “higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of cardiovascular disease and all-cause mortality in a dose-response manner”. The subjects of the study “self-reported” their egg intake to the researchers.

A prospective study that included more than 28,000 persons in China reported that eating seven or more eggs per week was not associated with an increase in cardiovascular disease or all-cause mortality. In fact, the egg-eaters in that group had a nearly ten percent reduction in stroke.

Hmmmm! Neither study looked at “egg helpers” – my term for bacon, sausage, ham, butter and hash browns – which may be why eggs appear to raise cholesterol and heart disease. Several publications have revealed that as your dietary intake of cholesterol goes up your liver produces less cholesterol, a feedback mechanism that has been recognized for decades. It is also well established that saturated fat, which makes up a large percentage of those egg helpers, raises cholesterol levels, especially the harmful type.

Is it possible that the Chinese egg-eaters are more likely to have veggies with their eggs while Americans are more likely to combine them with bacon or sausage?

Eggs have healthy protein (about 5 or 6 grams per egg) as well as several vitamins and minerals. And no carbs! A veggie omelet made with frozen mixed vegetables is one of the healthiest breakfasts you can have.

Another tip: add a tablespoon of extra virgin olive oil as you’re scrambling the eggs. You’ll be getting some healthy monounsaturated fat and the pan will be easier to clean.


Keep that important stuff on ICE

       If you go to the emergency room they’ll want to know if you have any significant illnesses and will ask you what medications you are taking and the dosage of each.  What if you don’t know, can’t remember or are unable to communicate?

       ICEIn Case of Emergency is a list of your medical conditions and prescription medications that you can present to emergency medical responders. It can be a simple list carried in your wallet, a more formal ICE Medical Standard ID Card or a smartphone app that costs only 99 cents. The red ICE icon is easy to see on your cell phone for emergency personnel to access. Google ICE medical standard for details and materials.

Another program, the Vial of Life, provides a decal that can be stuck on a baggie to be placed on your refrigerator door and a decal for your front door. Into the baggie you can insert a form listing your current medical information and you could include a copy of your EKG, a Living Will and a recent photo of yourself. You can also store your information online at their free web site.  Google Vial of Life for details.

            Note: the information provided by both of these systems can be made available if you are away from home. ICE appears as an icon on your phone. Your Vial of Life information is online but it requires a username and password.









In the news

The ketogenic diet — again.

The ketogenic diet originated in the early 1920s when it was found that children with seizure disorders (also called epilepsy) improved considerably when their diet consisted mostly of fats and almost no carbohydrates. The kids also drove their parents nuts because of their intense craving for carbohydrates.

The Atkins low-carbohydrate diet is not as severe and it often works to help you to lose weight. Any diet that sharply limits refined grains and sugar is likely to result in weight loss. The downside is that Atkins dieters have a hard time limiting their carbs so drastically that they manage to go into ketosis – deriving most of their energy from fat in their diet and their own body fat. In addition to offensive breath odor, those who do adhere to the diet are often constipated and irritable – the latter effect making their family members unhappy.

The present-day ketogenic diet consists of only 2-5 percent carbohydrates and 70-90 percent fats. The rest is protein. It should not be confused with the Paleo Diet, which eliminates all cereal grains and dairy products but includes plenty of fruits and vegetables. The Paleo Diet provides plenty of plant-based vitamins and antioxidants but the ketogenic diet does not. A poorly-designed ketogenic diet can lead to complications such as fatigue, kidney stones and gout. A rare event in children who have been placed on the diet for seizures is cardiac arrest.

How about a compromise: the Mediterranean Diet that we described in the last blog. It has plenty of fat in the form of healthy olive oil but almost no saturated fat. More than half of its calories come from fruits and vegetables; dairy is in the form of cheese but only a little, mostly as a garnish; protein comes from fish and poultry – and an occasional meatball or two with a little pasta. This diet is documented to be heart-healthy, especially if you include a glass of red wine every day! No bad breath, no constipation and everybody is happy!


      It’s not a problem for most people but the subject comes up from time to time among my audiences and it’s one that I dealt with regularly during 35 years of pediatric practice: ear wax.

Some people have almost no ear wax; some persons have an abundance of it and it can be a problem. A physician whose view of the eardrum is obscured by wax can’t be sure if a child has an ear infection. We learn early in our training how to scoop it out but it’s not always easy. When it completely fills the ear canal it may impair hearing.

Your genes determine how much wax you form and what kind. It can be sticky and gooey or hard and crumbly, the latter being typical among Asians.

What NOT to do: never use Q-tips, bobby pins or anything else to blindly sweep the stuff out. I have seen punctured eardrums and dislocated ossicles (the tiny bones of the middle ear that are necessary to transmit sound) in persons who thought that a cotton swab can do no harm.

Over-the-counter drops to dissolve ear wax are a waste of money. There is a simple, inexpensive solution that I have never seen to fail: hydrogen peroxide. Simply place two drops in each ear canal once a day after showering or at bedtime. Let it drain out. About one week of daily treatment will break up the wax that will fall out while you sleep. I have had a couple of patients whose wax build-up was so long-standing that it took a full three weeks of daily hydrogen peroxide drops to eliminate all of it.

I hate to take business away from my physician colleagues but it’s not necessary to make regular trips to the doctor to flush it out. Your ears don’t need an enema – a few pennies worth of hydrogen peroxide (make sure it’s fresh) will do the job while you sleep.


Upcoming presentations

Monday, March 4, 1:00 p.m., National City Library, What have we done to food? The discussion includes GMO foods, irradiated foods and numerous other topics.

I have been invited to be a guest speaker at the 2019 Ancestral Health Symposium to be held at USCD, August 8-10. The topic will be Being a kid in the Stone Age, which gives interesting insights not just into what life was like 50,000 years ago but what we can learn from way back then that will help us and our children become healthier.

I’ll send more information when the program has been finalized.

In the news

Evolved to exercise

That is the title of an article in the January, 2019 Scientific American. To quote from the article: “Unlike our ape cousins, we have evolved a dependency on physical activity. We must move to survive.”

So how much do we have to “move”? A particular group of hunter-gatherers studied by researchers from the University of Arizona found that they logged more physical activity in a day than the average American does in a week – about 12,000 to 18,000 steps a day – and they have virtually zero coronary artery disease, high blood pressure or type 2 diabetes. And it’s not because they don’t live long enough; about 20 percent of hunter-gatherers live beyond the age of sixty.

It’s not practical for most of us to wear a pedometer that would help to know when we’ve reached a target of 10,000 steps a day, which many experts recommend. After all, what would you do if you were getting ready for bed and you realized that you had only taken 7,000 steps that day? Most of us would stop wearing the pedometer!

This is easier: spend at least 2 ½ hours a week doing moderately intense exercise – that means working up a sweat. Better yet – one hour a day at least four days a week. Studies show that 2 ½ to 4 hours a week will help you to maintain weight and to significantly lower the risk of type 2 diabetes. According to the Scientific American article it will also cause you to grow new brain cells, improve your memory and postpone the onset of age-related cognitive decline.



The final step (at least for now) to prevent dementia and Alzheimer’s disease: follow the Mediterranean diet.

       Nope – it’s not what you’ll find at your local pizza parlor. The true Mediterranean diet consists mostly (about 50 percent) of vegetables, including potatoes. (Not French fries!!) Not a lot of meat either and it’s mostly chicken and fish. Pasta, of course, but only about 3 ½ ounces at a meal.

A high adherence to a Mediterranean diet is associated with a low risk of Alzheimer’s disease. There are several reasons.

No refined grains (white flour) but mostly whole-grain baked goods. Almost no sugar either.

The high intake of plant foods means lots of antioxidants, which lower inflammation, a major driver of heart disease, stroke, cancer, type 2 diabetes and osteoporosis.

A higher intake of fish with its protective omega-3 fats.

Lots of healthy fat in the form of olive oil.

And of course, a glass of red wine every day!










In the news

Flu season isn’t over yet!

We’re still a couple of months away from the end of the flu season, but the virus doesn’t play by the rules! Although the official end of the season is in May, infections and deaths from influenza occur year-round. We may not have reached the peak of the season yet.

There is no substitute for the flu vaccine and it’s not too late to get yours if you have not yet done so.

At least four children have died from influenza so far. The best reason for YOUR flu shot may be to protect a child, grandchild or a visitor’s child.



Another step to prevent dementia and Alzheimer’s disease: go back to school

       Not only is it never too late to learn something new, but putting your brain back to work could give you several more years of clear thinking and a better memory.

Become bilingual: research over the past decade shows that those who speak a second language can delay the onset of Alzheimer’s disease by about SIX years. Those who know three languages can extend it even longer.

The good news – it doesn’t matter when you start!

If you are musically inclined – but especially if you’re not – taking up a new instrument also delays the dreaded dementia. And make it a different instrument. If you played the piano as a kid, learn the guitar; if you played a wind instrument back then, learn a keyboard instrument now.

Puzzles, games, a new craft hobby or a new genre of books all contribute to the establishment of new brain connections. But it’s important to engage in these activities on a regular, i.e., several times a week, basis.










Upcoming presentations

Monday, February 11, 1:30 p.m., Carlsbad-by-the-Sea Retirement Community, 2855 Carlsbad Blvd., Avoiding diabetes, 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 14, 10:30 a.m., Coronado Library, Health benefits of wine and chocolate, Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Friday, February 15, 1:00 p.m., Temecula Learning Center, Avoiding diabetes, 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 22, 10:00 a.m., Santee Library, A day in the life of a Gold Rush physician, Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Saturday, February 23, 11:00 a.m., Restoring a legacy: what we can learn from the Native Americans of San Diego County, Anza-Borrego Desert State Park Visitor Center, 200 Palm Canyon Drive, Borrego Springs, CA. http://www.anzaborregoarchaeo.org.

In the news

Lessons from the Masai

The Masai (also Maasai) of Africa have been popularized as existing only on the meat, blood and milk of cattle while avoiding plant foods. That observation by early anthropologists was incorrect. It is true that their cholesterol levels were surprisingly low for meat-eaters and they appeared to avoid heart disease. These unique tribespeople are not hunter-gatherers but pastoralists whose cattle have low levels of fat, and they eat more plant foods than was recognized.

Their daily intake includes soups or teas made with dozens of herbs and “snacks” derived from plant resins and gums. These plant-based materials contain substances that not only keep blood cholesterol levels low but have numerous compounds that have anticancer, antimicrobial, anti-diarrheal and clot-inhibiting properties. Some even kill the parasitic worms that are ubiquitous in Central Africa! Add to that their characteristic leanness and their high level of physical activity, it’s no wonder that they don’t die from heart attacks.

The lesson for us? Eating meat or drinking blood (!) and milk are less likely to cause heart disease as long as you have lots of plant foods in your diet and stay thin.



Another step to prevent dementia and Alzheimer’s disease: think better thin

       “Overweight in middle age is associated with dementia in old age.” Not an original statement by me but it’s from a medical journal article, one of many that show that obesity contributes to Alzheimer’s disease and dementia. Persons who are overweight have 4 percent less brain tissue and 8 years of premature brain aging; obese persons have 8 percent less brain tissue and 16 years of premature brain aging.

Considering that 40 percent of Americans are obese and that the projection for 2050 is 50 percent – probably an underestimate – what kind of befuddled society will the next couple of generations be living in?

The take-home message: do whatever you can to keep your weight at a level that is normal for your height and frame. To find out what that is, just Google what is normal weight for my height.










In the news

The fiber factor: more good news.

          A study published a few days ago in the journal Lancet supports what we have been preaching for years: a high-fiber diet lowers the risk of several diseases and it has no side effects.

            This is a meta-analysis that reaches back four decades and includes more than 200 research studies. Eating 25 to 29 or more grams per day of fiber-containing foods (whole grain bread and cereals, legumes, fruit) significantly increases lifespan by lowering the risk of heart disease, type 2 diabetes and colorectal cancer.

When you consider that it was only about a century ago that the average American ate 50 to 100 grams of fiber a day, the researchers’ idea of 29 grams being “high fiber” seems a little incongruous. Still, even that small (in my opinion) amount makes a difference.

Soluble fiber or insoluble – it really doesn’t matter. A diet that is high in plant foods and whole grains provides both. Yet there’s more to the fiber story. It helps to lower cholesterol, perhaps by binding to bile acids. By absorbing water fiber increases the bulk of the intestinal contents and it’s more than just keeping you regular and avoiding constipation, the bane of senior citizens. Regularity lowers the chances that you will develop diverticulosis, tiny outpouchings of the large intestine that sometimes progress to diverticulitis, inflammation that is always painful and that sometimes leads to perforation. If that’s not enough to motivate you to getting more fiber in your diet, consider that constipation leads to hemorrhoids. As I once heard a golfing buddy say, “Happiness is never having to use Preparation H.”


Avoiding dementia: cholesterol

The arguments over cholesterol never seem to end. There are at least nine different forms of cholesterol and even taken together they are only part of the heart disease/stroke picture. However, there is a clear and consistent association of a high LDL (Low-Density Lipoprotein) cholesterol – the bad kind – and both Alzheimer’s disease and vascular (involving damage to blood vessels) dementia. HDL (High Density Lipoprotein) cholesterol – the good kind – protects us from both forms of dementia.

Too bad it’s not really that simple! Persons with high LDL cholesterol are more likely to be obese and diabetic, two conditions that are also related to Alzheimer’s disease and dementia. Those who exercise regularly and with moderate intensity – that means working up a sweat – not only have a higher HDL but are much less likely to be obese and diabetic.

Although statin drugs do lower cholesterol and the risk of heart disease they are not tolerated well by many people.

It’s important to recognize that eating cholesterol does not raise your blood cholesterol level. Your liver, where cholesterol is manufactured, has a feedback system that reduces cholesterol when more is present in the diet. So go ahead and enjoy an egg or two most days of the week!  BUT!!! It’s those egg-helpers like bacon, ham, sausage, butter, hash browns, etc. with their saturated fat that raise cholesterol. Try a veggie omelet instead but it’s OK to have some of that other stuff now and then.

What you can do before taking a prescription drug:

Eat more oats, barley, legumes, avocados, olive oil, fish (or an omega-3 supplement).

Take Metamucil several times a week.

Lose weight.

Exercise (I’ll be that you knew I would say that!) That means about one hour four days a week, hard enough to sweat, including both aerobic (brisk walking or something similar) and resistance (weights, machines, elastic bands).



Upcoming presentations

Friday, January 18, 2:30 LIFE program at Mira Costa College, Oceanside. How to regain your youthful memory. Details at http://www.miracosta.edu/life.

Thursday, January 24, 1:00, OASIS Center, Grossmont Center. Keeping your wits; ten ways to prevent Alzheimer’s disease and dementia. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

In the news

Get in line for the new shingles vaccine

Shingles (herpes zoster) is an unpleasant experience but as more older persons are taking advantage of the available vaccines, fewer of them are having to suffer through it. The decline in incidence began with the first shingles vaccine known as Zostavax but it’s likely to accelerate with Shingrix, a completely new product that offers more than 90% effectiveness and whose protection lasts for at least four years.

There is new evidence that adds urgency to getting the vaccine: there is a significantly higher incidence of heart attack and stroke in persons who have had an attack of shingles in the preceding year.

The demand for Shingrix has been so high that it is now in short supply. Many pharmacies have waiting lists and the manufacturer states that it will be several months before they can catch up.

Although the new vaccine requires two doses (the second is given two to six months after the first) and the incidence of side effects such as arm soreness and malaise is more common, there is no doubt that it’s worth the inconvenience. Just a few days ago I encountered another person who has had recurrent pain in the area that was affected by shingles years ago. That’s a lot worse than a couple of needle jabs.

Here’s a suggestion for this year New Year’s Resolution: get the shingles vaccine before shingles gets you. The sooner you get on your local pharmacist’s waiting list the sooner you’ll be protected.


Another step to prevent dementia and Alzheimer’s disease

       All prescription drugs have side effects; there are no exceptions. Several types of medications have been associated with an increased risk of dementia. Although the risk is very small, it is real. Drugs that are used for allergies, insomnia, bladder problems and depression are valuable and they should be used when indicated but they should be taken in the smallest effective doses and for the shortest possible duration.

Sleep medications are often prescribed for insomnia but they should be taken for no more than two weeks, not for years. There are several steps that might resolve sleep problems without drugs.

Occasional use of medications like Benadryl or Tylenol PM may be justified but years-long use does increase the risk of Alzheimer’s disease and dementia.