Upcoming presentations

Thursday June 6, 10:30 a.m. at St. Paul’s Plaza, 1420 E Palomar St, Chula Vista. 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.

Friday, June 7th, 9:30 a.m. at the Oceanside First Presbyterian Church, 2001 S El Camino Real, Oceanside. 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 June 13th, 1:00 p.m. OASIS Grossmont Center, La Mesa. Restoring a squandered legacy. Considering the remarkable medical advances of the past century, human life expectancy should be steadily increasing. Instead, we are burdened by diseases that didn’t exist at the dawn of the Agricultural Revolution. This presentation describes a blueprint to reverse the epidemics of obesity, diabetes and other causes of premature mortality. Sponsored by OASIS. To register see their web site at http://www.oasisnet.org.

Friday June 28th at 1:00 p.m. at the Temecula Learning 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.

In the news

Tick season has arrived.

It’s more important than ever to take special precautions to avoid tick bites and summer is high season. These critters are responsible for several diseases of which Lyme disease and Rocky Mountain Spotted fever are especially serious. Lyme disease alone attacks about 40,000 persons a year; Rocky Mountain Spotted Fever (which is more common outside of the Rocky Mountains) is sometimes fatal, largely because it goes undiagnosed until too late. Ticks love grassy fields but they can thrive in any type of wooded or brushy area.

The best insect repellent is still DEET but it should not be applied to infants and not on the hands of children. Apply it to their faces with YOUR hands.

Wearing long sleeves and slacks with the cuffs tucked into the top of your socks doesn’t sound very comfortable in warm weather but it does prevent tick attachment. Toss your clothes into the dryer with the heat on high for a cycle after coming home from your hike to kill the ticks you can’t see. (Some are mighty small!)

Check yourself, your kids and your dogs after the hike. The scalp is a favorite hiding place but no part of the body is safe; don’t overlook the groin, the armpits and skin folds – even the bellybutton!

The key word in removing any tick that you find is S-L-O-W. Use sharp-pointed tweezers close to the skin and pull it up slowly. Don’t waste time with Vaseline, any chemical or heat from a match or cigarette. Clean the area with a vigorous soapy scrub. You can follow that with alcohol if it makes you feel better, but alcohol is second best to soap.

Antibiotics are not usually prescribed if removal of the tick has been accomplished in less than 36 hours.


The Naked Sandwich

John Montagu, the Fourth Earl of Sandwich would be surprised to know that his invention – if the legend is correct – has invaded nearly every menu in the Western world. The 18th century First Lord of the Admiralty, after whom the Sandwich (Hawaiian) Islands are named, reportedly asked for a helping of meat between two slices of bread to keep him going during marathon gambling sessions. Some historians are less generous to the Earl and claim that the sandwich goes all the way back to the 1st century B.C.

Two slices of bread contribute about 140 to 200 calories to our daily meal plan. A tablespoon-sized glob of mayo or butter adds a hundred more. A naked sandwich – no bread, butter or dressing – thus trims 300 calories off your lunch. If you can resist the temptation to make up the difference with a sweet snack or dessert you could lose a pound about every two or three weeks.

How do you hold the stuff together? A large leaf of lettuce. If you Google lettuce wrap you’ll find enough information to overload your recipe box, especially the BetterBytes site. Most varieties of lettuce don’t provide much nutrition except for small amounts of folate, vitamins A and C and potassium but a good sized leaf has almost no calories either. Lettuce provides what nutritionists call mouth feel to offset the relative dryness of bread.

It’s alright to add another slice of turkey or other lean meat to your naked sandwich. Those 50 or 60 calories will give you a boost of protein that will quell your appetite a lot longer than the bread you left behind.

If you’re making your own lunch, get creative with condiments. Sweet relish, chutney, cranberry sauce and mustard add plenty of flavor and not many calories. Try a little vinaigrette, soy sauce, salsa, chili sauce or a spoonful of capers to wake up your taste buds.

Need a bridge to the lettuce-wrap lunchstyle? You might find a soft tortilla easier to handle and it adds only about 60 calories more than lettuce. Pita bread makes for a nice variation but it has about as many calories as a couple of slices of white bread.

There’s more to this than cutting back on calories. Almost all sandwich breads are made from refined grains that are digested quickly and that boost our blood sugar. Several servings a day of quickly absorbed carbohydrates contribute to the current epidemics of obesity and type 2 diabetes. Whole grain breads are not much better but they do bump up our fiber intake.

Tens of thousands of years ago humans had no grain-based products at all and our bodies haven’t yet become completely adapted to them. If we’re going to eventually get back to the kind of diet that nature intended for us the naked sandwich is a sensible place to start









In the news

Recent surveys suggest that American kids are getting more exercise than they did a decade or so ago but adults are not. The common excuse: “I don’t have time to work out.” How do we solve that problem? The answer: stealth exercise.

There are plenty of opportunities to burn a few extra calories several times a day and to maintain muscle tone and they don’t require much time. Here are a few examples.

At work or when you shop, park at the farthest spot, not the closest. (You’ll probably find more empty spaces there and your doors are less likely to get dinged.)

Don’t drop the kids off or pick them up at the front door of the school, but about ¼ mile away. You’ll all get some exercise, you won’t get zero miles to the gallon while in the line of cars and you’ll probably save time.

Use a push mower for the lawn; no gas to worry about. Rake up your leaves and grass debris instead of using that noisy vacuum.

Elevators are for wimps! Use the stairs if you’re only going up a flight or two; get in the habit of walking down several flights.

At work, use the restroom that is the farthest, not the one closest to your office. Take a ten-minute walk before lunch. It will perk up your appetite.

Stand up when you use the phone. It burns only a few more calories than sitting but research shows that it gives your voice more authority.

These are just a few examples and you are probably already thinking of more. You might burn only about a hundred calories every couple of days but it adds up to about FIVE pounds a year. Priceless!



What’s in an osteoporosis cocktail?

The major component of bone is calcium but it’s only one of many nutrients that we require for a strong skeleton early in life and to prevent osteoporosis in our later years. If there is a deficiency of even one of those nutrients the complex processes that build and maintain bone will suffer. When this occurs in middle age and later it can lead to the thinning of bone that we know as osteoporosis.

One of the most common questions that I hear from persons in my audience – almost always a petite elderly woman – is “I take calcium. Why do I still have osteoporosis?” Calcium by itself will have no effect on bone loss or fractures. Several other nutrients are critical for bone health.

The Osteoporosis Cocktail is my term for the group of nutrients that bones require to maintain their strength – in addition, of course, to resistance exercise. Vitamins A, C, K and D, magnesium, protein and omega-3 fats are equally important. A deficiency of any one of these results in deficient bone. This is a perfect example of why a varied diet is essential, for they come from different sources.

Plant foods can provide most of them but Americans’ dismally low intake of fruits and vegetables fails to provide enough vitamins, protein and omega-3 fats. Whole grains are a good source of magnesium; refined flour is not. Omega-3 fats come from fish; flaxseed is good but it is an insufficient source. Animal meat provides the protein that plant foods used to provide; fish and chicken are better sources than beef or pork because they have little saturated fat.







Upcoming presentations

Wednesday May 8th 1:00 p.m. at the Point Loma library. Immunizations for adults. Vaccines aren’t just for children. Recent developments in this area can help seniors to avoid crippling, even deadly, diseases. But are they risky?

Thursday May 9th at 6:00 p.m. at the Fallbrook library. What have we done to food? GMOs, Yellow and Red dyes, HFCS, trans fats are only part of the story. The food industry is nothing like it was when your grandparents were growing up. Are we really at risk? Can we do anything about it?

Thursday May 16th at 6:00 p.m. at the La Mesa library. Health benefits of wine and chocolate. This has been the all-time favorite of my 75 PowerPoint presentations. I wonder why!

Wednesday May 22nd at 1:00 p.m. at the San Marcos library. All about salt. History, health and hype. You’ll never look at your salt shaker the same way again.

Tuesday May 28th at 12:30 p.m. at the Carlsbad Cole Library at Carlsbad Blvd and Hwy 5. 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.


In the news

Osteoarthritis is common among seniors but even relatively small amounts of exercise can slow down its progress, even just one hour a week. In a group of more than 1500 persons who already had some lower extremity symptoms of arthritis, those who consistently did some brisk walking for at least one hour a week were eight times less likely to have a mobility disability in four years. That’s good news for people who really don’t like to exercise and might give them incentive to become even more active.

This study, reported in the May issue of the American Journal of Preventive Medicine, confirms several earlier studies. Ten minutes a day is a good start but the real benefits of regular, moderately intense exercise, lowering the risk of heart disease, stroke and type 2 diabetes, come with about one hour per day, done at least four days per week.

Folks who have a full-time job and a family might find that much exercise hard to schedule but it doesn’t have to be done all at once. And in the next issue of Carvings I’ll discuss stealth exercise.


 “Never do anything for the first time.”

That advice was given to me decades ago by my brother, a U.S. Marine and law enforcement officer. Of course, everything we do has had a “first time” but he was referring to scenarios that he would encounter in his military and civilian careers, for which he would continually practice in real time as well as in his mind. We have applied this principle in our CPR training program, not just the repetitive and physically demanding chest compressions and rescue breathing but especially in the deployment of the AED, which requires some degree of eye-hand coordination.

In his book, Blink, Malcolm Gladwell (you might remember him as the best-selling author of The Tipping Point) describes what happens in an emergency situation. He gives several examples of the severe impairment of our physiologic reactions – visual and auditory misperception, alterations in our perception of elapsed time, loss of fine muscle coordination, impaired recollection, to name a few. He describes the problems encountered by persons attempting to make a 9-1-1 call, such as not being able to remember those numbers, fumbling with the keypad, not pressing the green transmit button on the cell phone screen, panic while attempting to describe the situation to the dispatcher, etc.

As those of you who have been in our CPR class already know, even in our make-believe scenarios, students often fail to send someone to call 9-1-1 when they recognize unresponsiveness. (Remember our grammar lesson? “No response call 9-1-1!” – dropping the first period.) Some students immediately begin chest compressions without checking to see if the victim is breathing. In manipulating the AED, in almost every class at least one student tries to apply an electrode to the chest while it is still stuck to the yellow plastic separator. These are not intellectual deficits, they are common reactions to a first-time stressful situation. Think of how much worse things could get in a real emergency!

As Gladwell so clearly points out in his book, responders can learn to avoid those performance deficiencies by training and practice – and practice, and practice.

We strongly recommend to our CPR students that they review emergency scenarios regularly – specifically, that they do so on a weekly basis, and that they get recertified every two years.  Several our our graduates have told me that they responded automatically to a collapse or other emergency as a result of their training, because it wasn’t “the first time.”

Thanks to brother Tom and Malcolm Gladwell.







In the news

A childhood vaccine that grownups should have.

          Measles has been in the news recently because of several large outbreaks, due primarily to the failure of parents to allow their children to be vaccinated. But there is another “childhood disease,” whooping cough, that has also become more common for the same reason.

Whooping cough, whose medical term is pertussis, is life-threatening to infants below the age of six months. It has an agonizing, sometimes fatal course. It is almost entirely preventable if the mother has received the pertussis vaccine in the prior couple of years, including during pregnancy. The antibodies that she passes to her child before birth provide protection during the six months that it takes for three injections of the DPT (Diphtheria-Pertussis-Tetanus) vaccine to reach protective levels in the infant.

Whooping cough is so named because of the unusual sound that a struggling infant makes in trying to take in a breath during severe coughing spells. In older children and adults there is no whoop; the illness takes the form of bronchitis – usually about three or four weeks of cold symptoms with moderate coughing and discomfort. If an unimmunized or incompletely immunized baby is exposed to an adult with pertussis, that infant can become seriously ill.

A strategy that works

Before the infant arrives, persons over the age of eleven in the household and any prospective visitor (especially grandparents!) should receive a DTaP booster. (The “a” designates a new version of the DPT vaccine.) Protection against pertussis lasts for at least five years; protection against diphtheria and tetanus lasts much longer, perhaps a lifetime, making it an even better deal.



Trans fats are gone. Do you miss them?     

Trans fats are chemically engineered vegetable oils such as peanut and cottonseed oil that prolong the shelf life of baked goods. Because they are uncontestably related to heart disease and stroke the U.S. government banned them, effective June 2018.

Food manufacturers growled and complained but many of them saw the writing on the wall and began to eliminate them in 2015 when the FDA announced the 2018 ban. Some companies removed trans fats from their products as early as 2006.

Denmark implemented a ban in 2004 and since then has seen a dramatic decline in the incidence of cardiovascular disease. On a smaller scale, people who lived in those parts of New York State where trans fats had been banned for three or more years were found to have significantly lower rates of heart attacks and stroke.

One less thing to worry about but some people fear that a ban on sugar will be next. Don’t bet on that one making it through Congress!


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!