Monthly Archives: June 2010

5 Natural Ways to Lower Cholesterol

In my clinic people come to see me for all kinds of reasons.  One of the reasons people often see me is because they have high cholesterol.  High cholesterol has been linked to heart disease and is seen as one of the main causes of preventable death in this country.

This theory that high cholesterol actually causes heart disease by itself has many holes in it.  However, the pharmaceutical companies would like you to believe that if you lower your cholesterol you will significantly reduce your risk of having a heart attack or a stroke.  The evidence does not support this statement.

Cholesterol is not an independent risk factor for heart disease.  So what does that mean?  It means that high cholesterol alone is not enough to cause heart disease.  There are many other factors that must be present in order for heart disease to occur.  The main risk factor is inflammation.  This inflammation can be measured in a simple blood test.  The tests you should request from your doctor are called hs-CRP and homocysteine.  Both of these are inflammatory markers and they give a good indication of your risk factor for a future cardiovascular event or heart attack/stroke.

The theory that high cholesterol alone causes heart disease is flawed.  For example, there are large populations of people that have very high cholesterol and heart disease is almost nonexistent in their culture.  The Eskimo tribes of the Arctic are great examples of this.  Also, research shows that 50% of people that have heart attacks have cholesterol that is considered too high (>200 mg/dl).  That means that the other 50% have cholesterol numbers that are within the normal ranges!

With that said, cholesterol does increase your risk for heart disease in the presence of other risk factors like inflammation.  It does not make sense to lower cholesterol alone and expect to be protected from heart disease.  It does make sense, however, to work on those levels in conjunction with reducing your other risk factors.  Today I will tell you of the best natural ways that you can lower your cholesterol.

For a quick reference here are the current medical guidelines for cholesterol.

  • Total cholesterol: Less than 200 milligrams per deciliter
  • LDL (“bad”) cholesterol: Less than 100 milligrams per deciliter
  • HDL (“good”) cholesterol: 40 milligrams per deciliter or higher (the higher the better!)
  • Triglycerides: Less than 150 milligrams per deciliter

The Best Natural Ways to Lower Cholesterol

1. Low Carbohydrate Diet

In my opinion everything should start with diet.  Study after study has confirmed that eating a low carbohydrate diet is much more effective in the short term and long term in managing cholesterol levels.  It sounds counter intuitive that eating a diet that is higher in fat reduces cholesterol levels but the data is there.  The mantra that eating fat raises cholesterol levels does not hold true.  It is actually the sugar (carbohydrate) that causes cholesterol levels and triglyceride levels to sky rocket.  I routinely put my patients on low carbohydrate diets to reduce cholesterol and have yet to see it fail.  The only problem is that sometimes their cholesterol levels become too low!  Low cholesterol is just as problematic as high cholesterol.

2. Exercise

This one might be a no-brainer, but it must be incorporated.  Exercise has many benefits, but specifically it is known to raise the HDLs and lower the LDLs.  It also improves heart muscle function, mood, cognitive performance, bone strength and many other factors associated with overall wellness.  I can’t stress exercise enough.

3. Plant Sterols

Also known as phytosterols, these naturally occurring substances are found in high amounts in vegetable oils.  They are mostly undigested and act by inhibiting your absorption of cholesterol in the following way – they prevent cholesterol from being emulsified in the gastrointestinal track.  When fats, like cholesterol, are not emulsified the body cannot absorb them.  Because plant sterols are not absorbed, they have very little, if any, side effect.  They work wonders for people with high cholesterol.  My advice would be not to purchase these over the counter.  In speaking with some nutrition companies I have found that these are rather difficult to put into supplement form so buying them over the counter from a discount brand is unlikely to produce the results you are looking for.  Purchase them from a doctor trained in functional medicine and who works with a reputable nutrition company.  They may be slightly more expensive, but you get what you pay for.  Here is a link to my website and the companies that I use.

4. Niacin

Niacin, or vitamin B3, is another great natural way to lower cholesterol numbers.  It is found in red meat, chicken, turkey and beans among other things.  It is extremely safe with the only side effect being a temporary flushing effect in the skin shortly after taking it.  This can be avoided by purchasing a non-flush niacin.  It has been shown to reduce LDL (bad) cholesterol and increase the HDL (good) cholesterol.  Doses are different for everyone and can range from 500 to 5,000 mg per day taken one to two times per day.  It has been shown to reduce heart attacks by 27% and stroke by 26%.

5. Fish Oil

Fish oil is great for a lot of things.  While it does not directly impact total cholesterol levels, it does reduce triglyceride levels in the blood and raise the HDL level.  Triglyceride is a measure fat in the blood.  It usually has implications on total cholesterol levels.  Fish oil is so effective it has been made into a drug by GlaxoSmithKline called Lovaza.  It is ridiculously expensive at $175 for a one month supply.  (Read my blog about it here.)  The dose offered from Lovaza is also much too low at 1 gram per day.  An effective dose is about 4-6 grams per day.  You should also buy this through a reputable nutrition company as many cheap brands contain mercury, PCBs and other toxins.  (Read my blog about that here.) A one month supply of a quality fish oil will probably cost between $25-$35 depending on how much you need to take.  Much better than $175!

Lowering cholesterol by itself is not a full proof plan for protection against heart disease.  It must be part of a total approach because high cholesterol by itself is not dangerous.  However, it is useful if you lower your other risk factors. My advice to my patients is not to rely solely on a pill if you want to reach your goal.  You must change your diet as well.  Low carb, as mentioned above, is the way to go.  If you combine the best of these two approaches you should be able to hit your target cholesterol in no time.


Filed under Diet, Public Health

4 Simple Ways To Help You Lose Weight

One of the major health issues facing Americans today is obesity.  As a matter of fact more than two thirds of Americans are overweight or obese.  In my clinic we see lots of people who simply want to lose weight and get healthy.  While every case is a little different there are several things that you can do that will greatly improve your chances of losing weight and certainly get you feeling better.  Below I’ve listed somethings that are critically important in our program for people to get fit and most importantly, stay there.

1. Increase Your Activity Level With Exercise

This one seems like a no brainer, but when I talk to people about exercise I find that they don’t really understand what is necessary for them to actually see results.  I always ask people what they do for exercise.  For women, one of the standard answers is, “I have a young child at home and that gets me plenty of exercise.”  For men, a standard answer is, “My job is very physical so I don’t need to exercise.”  Other general answers patients give me for the dreaded exercise question include, “I walk to dog every day,” or “I like to garden on the weekend,” or “I don’t have time to exercise.”

Now, I can certainly appreciate that taking care of a young child can be fatiguing.  I can also understand that a physical job like construction is taxing.  I also know that walking the dog and gardening might seem like exercise, but if we examine these a little closer we will see that they do not qualify as exercise unfortunately.

Taking care of a young child and a job in construction are something that must be done every day (or almost every day).  At one point both of those might have burned you enough calories to qualify as an increase in your activity level.  However, after doing these things over and over again, your body figures out a way to to expend the least amount of energy possible while still performing those tasks.  This means that they no longer qualify as “exercise.”  Take this example.  If you went to the gym and you wanted to start getting in shape you might start by running on the treadmill.  You might start my running just a single mile.  Over time this single mile would no longer be difficult for you and would no longer qualify as exercise or produce the results you are looking for.  The same principle applies to your daily activities.

So to see the results you want, you must include exercise into your activities.  You don’t need to exercise every single day but at least several times per week.  Patients often tell me there is no time in their day for this.  The fix for this is simply that you must make the time.  No magic solutions for that one.

The exercises that I like people to include are weight training with high intensity interval training for cardiovascular health.  Weight training has many benefits.  It raises the amount of calorie you burn when you are at rest, it improves strength which reduces injury and it helps keep bones healthy and strong.  The high intensity interval training is cardiovascular work mostly using your body weight for resistance.  Often times this work is no more than a single 8-10 minute session after a weight training session.  The benefits are well studied and the shorter duration work out is equivalent to much longer workouts that are purely cardiovascular in nature.

2. Improve Your Diet

Again, this one sounds so simple, yet when done incorrectly will lead to poor results.  I always recommend that people reduce carbohydrate in their diet.  For a jump start I generally recommend that people get no more than 20-40 grams of carbohydrate per day.  For a little perspective on that, a single slice of whole wheat bread has about 15 grams of carbohydrate in it.  I also recommend that they get ketone strips from the local pharmacy.

Ketones are a by product of fat metabolism.  When you are exclusively burning fat for energy (as opposed to sugar) ketones will be excreted into your urine.  You may test this with ketone strips.  Simply pass them through a stream of urine several times per day and compare the color coded strip with the reference chart of the bottle.  You will want to see a trace to small amount of ketones.  This ensures that you are burning your body stores of fat for energy.

A diet low in carbohydrate will also help you gain control of a hormone called insulin.  People who have diets high in carbohydrate over produce insulin.  This is problematic because insulin is a storage hormone.  It causes your body to store energy in the form of fat.  Obviously if you produce too much of this hormone you will tend to store fat very easily.  Insulin is released in response to carbohydrate in your diet.  Reduce the carbohydrate and you reduce your fat storing hormone!

As a side note, continually over producing insulin will lead to diabetes and all the health complications associated with it.  Do not take insulin over production lightly.

3. Take Fat Burning Supplements

Many supplements tout their ability to lose weight for you.  No supplement will lose the weight for you.  To do that you will have to do the first two steps above.  There are, however, supplements that will help you lose weight.

One great example is something called carnitine.  It is available from many sources.  It works because carnitine is necessary for the body’s cells to transfer fat into the mitochondria.  This mitochondria is the power house of each cell.  It is what produces energy so the cell can keep up with it’s daily activities.  In order for it to burn fat it needs carnitine.  It is simple to take and is available in capsule form.  It is also very safe, unlike many other weight loss supplements.

Y0u may also benefit from taking supplements to stabilize blood sugar and reduce insulin production.  These are available through reputable supplement companies and I would urge you to see a doctor that specializes in functional medicine to find these types of supplements.

4. Check Your Thyroid

The thyroid can be thought of as the thermostat on the metabolism.  If it is under active your metabolism will be under active as well.  This means you will tend to gain weight very easily among other symptoms like lethargy, insomnia and general low energy.  Checking the thyroid is simple to do through a blood test.  I routinely check my patients on it.

There are several things to look for.  Many times physicians will order something called a TSH or thyroid stimulating hormone.  TSH is a brain hormone that tells the thyroid to secrete it’s hormone.  TSH is inversely proportional to thyroid function.  That means that the higher the TSH the lower your actual thyroid function is.  The reference ranges for most labs for TSH are 0.30-5.0.  This range is far too large.  A more appropriate range is actually 0.3-3.0.  In my practice if a patient’s TSH is above 2 I like to treat them and help them optimize thyroid function.  Other things that need to be checked are the actual thyroid hormones called T3 and T4.  Sometimes those are low, but the TSH is normal.  If the only test ordered is a TSH you might miss the fact that your thyroid is under active.  I also like to see something called the thyroid antibodies.  Sometimes people have antibodies to their own thyroid which reduces its effectiveness.

This list is by no means all inclusive.  It does, however, provide you and insight into the first few steps that go through my mind when someone asks for my advice in helping them lose weight.  We have been very successful in helping people get fit and achieve their weight loss goals.  It is not something that can be done for you, but the reward for achieving your goals is a great one.


Filed under Diet

5 Superfoods You Should be Eating

In my office we talk about diet with every single patient that comes in.  We advise them on many aspects of diet.  Some people wish to lose weight.  Other wish to control chronic pain.  Still yet others just want to know how to be as healthy as they can be.  Despite the differences in what people desire out of their diet plans, there are always common themes between them.

There are foods that I advise people eat on a regular basis because they are inherently good for human physiology.  These foods pack a big bang for their buck in terms of nutrition.  They are “nutrient dense” as we say.  Below I have compiled a list of my top 5 food recommendations that I think everyone should consume regularly.   Enjoy!

1. Eggs

Ahhh, the persecuted egg.  For many physicians the egg is the enemy.  You will hear, “You can’t eat eggs, they’re too high in cholesterol!” True, eggs contain cholesterol but cholesterol is not your enemy.  Modern medicine, taking its cues from the pharmaceutical industry, would have you believe that cholesterol is the cause of heart disease.  I am here to tell you that it is not.  Inflammation is the cause of heart disease.  Your body uses this cholesterol in an attempt to quell the inflammation.  This inflammation is caused by eating a diet high in refined carbohydrates, not high cholesterol.  Not a single large scale study has shown that by reducing cholesterol you reduce mortality rates.  None. So the egg is actually a very healthy food.  It provides a great protein punch, has great vitamins like B12 and vitamin D and best of all it is easy to prepare.  So enjoy your eggs, they are a great option for breakfast or hard boiled as a snack.

2. Avocado

Avocado truly is a super food.  It is loaded with vitamins and healthy fats.  These healthy fats are used for many things in the body including cellular repair and energy.  Avocado is also a great way to maintain the health of your skin and your hair because if its great fatty acid profile.  It’s rich in B vitamins, contains vitamins E and K and has much more potassium than a banana.  It’s also loaded with fiber which is important for maintaining a healthy colon.  Like I said, super food.  Eat it raw with some salt and pepper, grind it up to make guacamole, put it in a salad or as a garnish to your hamburger (with no bun of course).  There are a million ways to eat this wonderful food.

3. Coconut

This is another misunderstood food.  Coconuts are sometimes touted as unhealthy because of their fatty acid profile.  There is research that these unfavorable views go all the way back to World War II when all of the tropical oils were seen as bad because they came out of the Pacific and were a major export of Japan.  Today they are gaining popularity but some medical professionals point to the fact that coconuts are high in saturated fat as a negative.  Again, they are correct but it really is only a half truth.  Most of the saturated fat from a coconut is in the form of something called a medium chain triglyceride.  These MCTs have great benefit.  They are used for energy in the body and have been shown to increase weight loss.  Coconuts are also anti-fungal.  If you suspect you have a fungal or yeast overgrowth, coconut consumption might help.  Coconuts are sometimes hard to find, but the oil is a cinch.  Use the oil to cook with and you can gain all the benefits of consuming actual coconut.  Many companies sell the oil and some even remove the flavor if that does not appeal to you.

4. Almonds

While many nuts are good for you, almonds are great.  They contain a good source of carbohydrate and protein and a great source of healthy fat.  They are rich in vitamins such as E and they also have good amounts of magnesium, potassium, zinc, iron and fiber.  They are a great heart healthy snack and even have been shown to aid in weight loss.  Eat them raw, roasted or chopped up on your favorite salad.  They’re great any way you can get them.

5. Cold Water Fish

Fish is another food that has great benefit.  They contain high levels of omega-3 fatty acids.  These fats are potently anti-inflammatory and reduce the risk of a host of diseases including heart disease, cancer, diabetes and Alzheimer’s.  The importance of omega-3s in the diet cannot be overstated.  I like to shoot for 4,000-6,000 mg per day.  To do this you will likely have to supplement with a capsule or oil, but getting it in your diet as well is a must.  There are some things to look for when you buy fish.  Always buy wild fish.  Farmed fish are fed grain to fatten them up quickly and this changes their fatty acid composition negatively.  Consume smaller fish.  The larger fish have a higher potential to have levels of mercury that are unsafe.


Filed under Diet

9 Popular Meals Not To Eat

The Center For Science in the Public Interest is an advocacy group dedicated to improving the health of this nation.  According to their website their mission is stated as follows:

The Center for Science in the Public Interest (CSPI) is a consumer advocacy organization whose twin missions are to conduct innovative research and advocacy programs in health and nutrition, and to provide consumers with current, useful information about their health and well-being.

They recently posted a list called the 2010 Xtreme Eating Awards.  In it they cite the extreme caloric content of foods found in common restaurant chain meals.  You might be amazed at how much you’re eating when you visit some of these very popular chains.  Below is the list.

1. Five Guys Bacon Cheese Burger –

This behemoth has 920 calories!  And that’s just the burger!  Add in fries and a drink (and who doesn’t) and you very well might have a whole day’s worth of calories at lunch.  For a little perprective on this, one egg, for example, has about 70 calories in it.  Eating this burger (yes, just the burger) would be like eating a baker’s dozen eggs.  You wouldn’t do that would you?

2.  The Cheesecake Factory Chocolate Tower Truffle Cake –

This is truly amazing.  This bad boy is 1,670 calories.  It’s dessert which implies you’ve already eaten an entire meal.  Suppose your meal had a respectable 400 calories in it.  The desert would push you over 2,000 calories for a single meal.  I’m assuming you’d like to eat again during that day which would push you way over the top.  I’m not a huge calorie counting guy because eating food is a hormonal process and getting a hold of the hormones is what is critical to long term health.  But when we’re talking about these kinds of excesses calories matter.  One cannot consume 4,000-5,000 calories per day and expect to be healthy.

3. California Pizza Kitchen Tostada Pizza –

This guy sounds healthy on the surface.  It touts all the fresh vegetables that it contains.  The caloric content is through the roof.  The individual size contains 1,440 calories and that’s without steak or chicken on it.

4. Cheesecake Factory Pasta Carbonara –

Carbohydrate heaven!  If you’ve read my blog before you know that I’m not a huge fan of carbohydrate laden meals.  This one definitely fits that mold.  This ridiculous dish contains 2,500 calories!  That’s one meal.  Depending on your activity level, a day of 2,500 calories might not be that bad.  But 2,500 in one meal is entirely too high.

5. P.F. Chang’s Double Pan-Fried Noodles Combo –

Chinese food is notorious for hidden calories and excess.  This is no different.  This contains 1,820 calories for a single serving.  The problem with these foods is that they don’t look like they have that many calories in them.  True, they are large servings but they’re not something most people can’t sit down and finish in one meal.  They sneak in the calories.

6. Outback Steakhouse New Zealand Rack of Lamb –

This doesn’t sound that bad on the surface.  Lamb is generally good for you.  But this one is not.  The problem with this one is that the sides are outrageously high in calorie.  The lamb is “served with garlic mashed potatoes and fresh seasonal veggies.”  However, the total caloric content for this meal is 1,820 calories.  Again, this is so sneaky you wouldn’t even know you were getting this many calories unless you looked it up before you went to the restaurant!

7. Chevy’s Crab & Shrimp Quesadilla –

Seafood is healthy, right!?  Sometimes, but not this guy.  It packs 1,790 calories for an individual serving.  I like shrimp and crab just as much as the next guy but not for 1,800 calories.

8. California Pizza Kitchen Pesto Cream Penne –

Oh California Pizza Kitchen.  You’ve made the list 3 times.  You are clearly not concerned about anyone’s health.  This is another pasta dish that pack a wallop.  It has 1,350 calories, and that’s without a protein source.  Pasta is one of those things that has been touted as healthy because it’s low in fat but rarely are those dishes actually healthy.  It is a common mistake that many people make when they go to a restaurant.

9. Bob Evans Cinnamon Cream Stacked & Stuffed Hotcakes –

These look like desert.  They should be desert and they should be about 75% smaller.  It contains 1,380 calories.  It’s loaded with nothing but refined carbohydrate and sugar.  A sure recipe for increasing your insulin levels beyond anything nature ever intended.  Eat this every morning and you’ll have diabetes in no time flat.

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How, exactly, does exercise help us?

Below is a great article from the NY Times.  Please see my comments at the end.

NY Times Article

What does exercise do to your body? It may seem as if science, medicine and common sense answered that question long ago. But in fact the precise mechanisms by which exercise alters your body — at a deep, molecular level — remain poorly understood. A number of analyses of the effect that exercise has on heart disease, for instance, have concluded that working out lessens a person’s chances of developing heart problems far more than scientists can account for. They understand the physiological reasons for about 60 percent of the reduced risk. The rest is a mysterious if welcome bonus.

But a new study that gauged the metabolic effects of exercise may significantly advance our understanding of what’s going on inside a body in motion. During the experiment, scientists actually saw how much being fit changes your ability to incinerate fat, moderate blood sugar and otherwise function well. They also uncovered proof, at once inspiring and cautionary, of just how complicated and pervasive exercise’s consequences are.

In the experiment, published late last month in Science Translational Medicine, researchers from Harvard University and other institutions relied on a mass spectrometer to enumerate specific molecules in the bloodstreams of people who’d been exercising. The molecules were metabolites, which drive or are the byproduct of metabolic changes in the body. Metabolism is, of course, the chemical process of keeping yourself alive. All of the biochemical processes that feed and nurture cells constitute your metabolism. What the researchers wanted to know is, how does your metabolism change during and after exercise?

For the work, the scientists drew blood from a group of normal, healthy adults, as well as from a separate group who’d been referred for exercise testing because of shortness of breath or suspected coronary-artery disease. This group was relatively unfit. Each of the groups was told to exercise for about 10 minutes on a treadmill or a stationary bicycle and then had more blood drawn. Finally, the scientists also examined blood samples from a group of runners who had finished the 2006 Boston Marathon.

What they found was that after 10 minutes of treadmill jogging or stationary-bicycle riding, the healthy adults showed enormous changes in the metabolites within their bloodstream, as did the less-fit group, although to a lesser degree. In particular, certain metabolites associated with fat burning were elevated. The fit adults showed increases of almost 100 percent in many of these molecules. The less-fit group had increases in those same metabolites of about 50 percent. As for the marathoners, their blood contained up to 10 times more of the fat-burning markers.

These findings suggest that exercise has both “acute and cumulative” effects on your body’s ability to use and burn fat, says Gregory Lewis, a cardiologist at Massachusetts General Hospital in Boston and an author of the study. After only 10 minutes of exercise, even the least fit showed evidence that their bodies were burning fat; the more fit, the more metabolic evidence of fat burning.

The researchers then took a number of the metabolites that had been elevated by exercise and infused them into mouse muscle cells in a laboratory dish. Almost immediately, the metabolites, in combination (but not individually) ignited a reaction that resulted in increased expression of a gene involved in cholesterol and blood-sugar regulation. In other words, the metabolites weren’t just marking activity that was happening elsewhere in the body; they also may have been sparking some of that activity directly. “That was exciting to see,” says Robert Gerszten, the director of clinical and translational research for the heart center at Massachusetts General Hospital and another author of the study. The result implies that exercise has complicated, chain-reaction metabolic effects; activity causes actions within cells that release metabolites, which, in turn, act on genes in ways that change your blood levels of fatty acids and blood sugar. These levels of fatty acids and blood sugar then play a role in your risks for heart disease, diabetes and other conditions.

Dr. Lewis cautions that his group’s work is still preliminary. “This is just a chemical snapshot,” static and limited, of a person’s bloodstream after exercise, he says. Even with mass spectrometry, not every type of metabolite can be captured, and the role of some of the metabolites that were uncovered remains unknown. But the experiment does reinforce the lesson, which we all know whether we heed it or not, that the human body needs to move.

via Phys Ed: A Workout for Your Bloodstream – Well Blog –

Dr. Court’s Comments

I think we’ve known for a very long time that exercise is beneficial for overall health.  The precise mechanism by which this works was, and to a large degree, still is a mystery.  But this work sheds a little light on the subject.

I think what is very interesting about this article is that the effects are cumulative.  The more the exercise, the more efficient your body becomes.

I have many patients who come to me for various reasons to improve their health.  I always recommend exercise as part of their programs.  Progress, however, is slow sometimes.  People may not see the results they expect as soon as they would like.  After all we live in a world where we want everything and we want it yesterday.

This research explains why people often do not see results for a period of time and then a slow build up of their health occurs over a long period of time.  For example, a diabetic patient requires months to totally gain control of their blood sugar.  Even if they do everything correctly – they eat right, take the right supplements and exercise, results are often slow and consistent rather than fast and spontaneous.

It is clear from this research that people who are in the best shape get the best results from their work out.  They burn more fat, regulate blood sugar more efficiently and produce energy at a higher level than someone who is just starting an exercise program.

While this may seem frustrating if you’re just starting a workout routine it really is good news.  It means you have no where to go but up!  It also means that you can continue to get better and better with your exercise program.

What is also fascinating about this research is that the chemicals that produce these wonderful results work in combination with each other but not by themselves.  This illustrates how the body must work holistically to get the best results.  There is no magic bullet that will work to improve your health.  You can certainly help it along with the right supplements, but nothing will replace the importance of good old exercise.

So remember – exercise is good but the more you do it (with in reason) the more benefit you get from it.  Don’t be discouraged by slow results.  It’s just your system revving up for the next step!

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Healthiest States in America – Where does your state stand?

My blogs often focus of how unhealthy America is.  This is a bit of a switch.  Below you will see what states are considered the healthiest states ranked from #1 to #50.  I am happy to see my state (Vermont) is number one.  It must be all the work I’m doing is paying off!

The list below was taken from the 20th edition of America’s Health Rankings.  It takes into account obesity rates, smoking rates and exercise tendencies among other things to calculate it’s results.  See the full report here.

  1. Vermont
  2. Utah
  3. Massachusetts
  4. Hawaii
  5. New Hampshire
  6. Minnesota
  7. Connecticut
  8. Colorado
  9. Maine
  10. Rhode Island
  11. Washington
  12. Wisconsin
  13. Oregon
  14. Idaho
  15. Iowa
  16. Nebraska
  17. North Dakota
  18. New Jersey
  19. Wyoming
  20. South Dakota
  21. Maryland
  22. Virginia
  23. California
  24. Kansas
  25. New York
  26. Montana
  27. Arizona
  28. Pennsylvania
  29. Illinois
  30. Michigan
  31. New Mexico
  32. Delaware
  33. Ohio
  34. Alaska
  35. Indiana
  36. Florida
  37. North Carolina
  38. Missouri
  39. Texas
  40. Arkansas
  41. Kentucky
  42. West Virginia
  43. Georgia
  44. Tennessee
  45. Nevada
  46. South Carolina
  47. Louisiana
  48. Alabama
  49. Oklahoma
  50. Mississippi

New England clearly has something figured something out.  With 6 states in the top 10 it is by far the healthiest region in the country.  This is likely due in part to the outdoor lifestyle that many people lead in this part of the country.  Getting out and staying active is one of the best ways to stay healthy.

The South has major issues.  It occupies 8 of the bottom 10 spots.  Diet is a major factor there, although socioeconomic factors cannot be ignored.

Health care in this country is at a crossroads and I think reports like this are beneficial to get an idea of what works and what does not.

In my opinion three things need to happen to reduce health care costs:

  1. Change our model to practice true prevention.
  2. Increase exercise programs for adults and children.
  3. Move away from the low fat paradigm and towards a low carbohydrate one.

If we can meet those three criteria, health, not just health costs, will improve.


Filed under Diet, Public Health

My Trip Down the Cereal Aisle

Food marketing really is quite amazing.  They can take food that is not all that much better for you than candy and make it seem as if it’s the most wholesome product you could possibly purchase.  This is a large part of the problem in terms of the health of US citizens right now.

Unfortunately, many people don’t know about true nutrition so they rely on information they read on boxes and bags to assess what they should consume.  The problem is that they believe what they read and the marketers know that.  Their assessments are incorrect not because what they are reading is incorrect but because it is cleverly misleading.

Recently my wife and I were at the grocery store.  I told her that I wanted to take a stroll down the cereal aisle.  She knew what I wanted to do right away.  As I strolled down the cereal aisle I took pictures of several different kinds of cereal.  Some offenders are worse than others, but none of them are particularly good for you.

Cereals tout themselves as healthy in many ways.  Some say they are good for your heart.  Some claim to provide enough calcium and vitamin D for a whole day (with milk of course).  Still others tell you of their whole grain goodness.  While they may be telling the truth in those statements they are inherently misleading.  Cheerios does contain whole grain.  Other cereals do provide the recommended daily value of calcium and vitamin D.  However, that doesn’t mean they are good for you.  McDonald’s cheeseburgers might provide enough B12 to satisfy your daily need, but they aren’t health food.

Let’s have a look at these cereals together:

Cinnamon Toast Crunch

Mmmm…Cinnamon Toast crunch.  Sugary goodness.  But at the top it says whole grain and calcium guaranteed!  Consumers see this and it triggers an automatic response in their brains.  “Whole grains and calcium are good for me,” says the consumer.  But is a sugary cereal like this actually healthy?  I think not.  Let’s continue.

Reese's Puffs

This one also promises whole grains.  It doesn’t go as far as guaranteeing calcium or vitamin D but does say that it’s a “good source.”  Reese’s Puffs are nothing more than a cereal version of candy.  Marketers know that these cereals appeal to children because they taste like the candy.  Guess what?  They’re about as healthy as the candy too.

Cocoa Puffs

This too guarantees whole grains and calcium.  It also sneaks in the word ‘naturally’ on the box.  See it in the upper left corner? Forget the fact that it says ‘artificially’ there too.  Marketing geniuses know you don’t actually see that word.  All you see if the natural part.  Our brains are designed to scan for important information by reading only the first word or two to get the gist of what it says  They know that when you read that box all your brain sees is ‘naturally’ and it equates that with healthy.

Lucky Charms

Ahhh, Lucky Charms.  Using a character to get to children.  This is one of the classics.  They also make the claim about calcium and whole grains.  Most of this cereal is sugar.  I mean, it has marshmallows in it for goodness sake.

Apple Jacks

All this claims is that it is a ‘good source of fiber.’  It must be really bad for you if that’s all they could come up with.


While Cheerios are probably the least offensive on this list, they still aren’t good for you.  This one cleverly designs a heart shaped bowl to hold their cereal indicating that it’s good for the heart.  It also claims it can help lower cholesterol which certainly would be appealing to some people.  The problem is eating Cheerios alone is not enough to lower cholesterol.  You need other factors to do so.

I took a peak at the nutritional information for Cheerios as well.  I found that it contains 20g of carbohydrate but actually 26 grams are consumed if you have your cereal with milk (and who doesn’t).  Twenty-six grams of carbohydrate is equal to more than 5 teaspoons of sugar! Would you eat that for breakfast?  I hope not.  This is also per serving of cereal.  One serving is just one cup of cereal.  Not sure what that looks like?  I have a little perspective for you.

1 cup of cereal in a bowl. It's a little hard to tell just how much is in there, but it's not a lot.

For a little more perspective, this is the same cereal poured into two very small champagne flutes. It doesn't even fill both of them!

Most people do not eat just one cup of cereal.  They fill up there bowl and add some milk.  Kids and adults are likely getting twice what it says on the back of the boxes because they don’t know what a cup looks like.  It is obviously not a lot of food.  If you eat 2 cups instead of 1, it’s like consuming 10 teaspoons of sugar for breakfast.  That’s more sugar than a soda!  Disturbing isn’t it?

As healthy as the marketing people make it seem, cereal is not a health food.  It should be consumed on rare occasions, if at all.  I recommend that my patients consume nutrient dense eggs for breakfast.  They have lots of good vitamins in them, and are a good source of protein and healthy fats.

The cereals are enticing because they appear to be healthy with all the claims on the front of the boxes.  Don’t be fooled by the clever marketing.  Eating a sugary cereal truly is no better than drinking a soda or eating a candy bar for your first meal of the day.


Filed under Diet, Public Health

Swine Flu Pandemic? How Big Pharma used its power to scare the world

Remember the swine flu?  Last year it was all you heard about on the news.  Each evening we were shown statistics that gave us an up-to-the second tally of deaths linked to H1N1.  “Experts” were encouraging everyone to get the vaccinated against this serious threat.  Local clinics were swamped with terrified people demanding the vaccine for their entire family.  All of this was because the World Health Organization (WHO) declared that the swine flu was a world wide pandemic.

Now the British Medical Journal (BMJ) has published an article accusing the World Health Organization of conflicts of interest with regard to H1N1.  The authors accused the organization of exaggerating the severity of the virus, and of taking advice from experts with ties to vaccine- and antiviral-producing pharmaceutical companies.

Almost exactly one year ago Dr Margaret Chan, the director general of the World Health Organization announced to the world that there was pandemic in full effect.  She told us that she had consulted with leading scientists, doctors and virologists to make her decision.

The WHO offers advice to governments for situations just as these.  If there is a major pandemic they advise governments on how to handle it.  Following the WHO’s advice, governments bought billions of dollars worth of vaccines, oseltamivir (Tamiflu) and zanamivir (Relenza).  And according to the BMJ, the vast majority of it is sitting unused.

The First Sign that Something was Up

For some reason, the WHO changed the definition of ‘pandemic.’  In response to the chicken flu outbreak in 1997 in Hong Kong, the WHO began to organize a pandemic preparedness plan.

The WHO’s first influenza pandemic preparedness plan was stark in the scale of the risk the world faced in 1999: “It is impossible to anticipate when a pandemic might occur. Should a true influenza pandemic virus again appear that behaved as in 1918, even taking into account the advances in medicine since then, unparalleled tolls of illness and death would be expected.” (From the BMJ)

The WHO is rightfully concerned about a flu pandemic of that scale.  An estimated 50 million people, about 3% of the world’s population (1.6 billion in 1918), died of the disease. A total of 500 million, or 1/3 were infected.  How could the WHO compare the swine flu last year to the 1918 flu?  They aren’t even close.

The WHO has been accused of removing the words “enormous numbers of deaths and illness” from the definition of pandemic.  I guess if you remove those words the 1918 influenza pandemic and the swine flu “pandemic” of 2009 could be categorized together.

Maybe, just maybe, this is the problem

The initial preparedness program was written entirely by people who stood to gain from frightening the world into stockpiling antiviral drugs (namely Tamiflu and Relenza).  Roche, is the manufacturer of Tamiflu, and GlaxoSmithKline, manufacturers Relenza.  Both companies had employees on the committees advising Dr. Chan on whether or not to issue a pandemic warning.  On the initial preparedness program it said:

“R Snacken, J Wood, L R Haaheim, A P Kendal, G J Ligthart, and D Lavanchy prepared this document for the World Health Organization (WHO), in collaboration with the European Scientific Working Group on Influenza (ESWI).” What this document does not disclose is that ESWI is funded entirely by Roche and other influenza drug manufacturers. Nor does it disclose that René Snacken and Daniel Lavanchy were participating in Roche sponsored events the previous year, according to marketing material seen by the BMJ/The Bureau. (From the BMJ).

Why are these antiviral drugs considered so important in a pandemic?  Because vaccines are likely to take months to be available in the numbers required for a true pandemic of the scale that hit in 1918.  These antivirals could be life saving if a truly virulent strain of flu emerged.  They would also be a windfall of revenue for the pharmaceutical companies making them.

Of course, there are many natural remedies that boost immunity very effectively, but they are not marketed because they don’t have the big money of Roche or GlaxoSmithKline behind them.  That’s for another blog though.

The WHO says it checked into the backgrounds of the people it relied on to make its guidelines which called for countries to stockpile antiviral drugs.  It says it investigated the financial ties of these scientists to the pharmaceutical industry.  But, according to the BMJ they are refusing to release the information they gathered in their investigations.  This lack of transparency is concerning.

Because of these recommendations that the WHO put forward, mostly established by scientists with significant ties to Big Pharma, Roche and GlaxoSmithKline made $12 billion on antiviral drugs with the lion’s share going to Roche and Tamiflu ($10 billion).

And all this for drugs that should have never been approved for use in the US! An FDA advisory committee originally recommended that Relenza not be approved because it had safety concerns and showed very little benefit over placebo in US trials.  The FDA did not adhere to the advice of its committee (it is not required to) and approved it because “they would feel better if there was something on the market in case of a pandemic,” and  “it wasn’t a scientific decision.”  This is according to Dr. Michael Elashoff who was a former employee of the FDA, and was the statistician working on the Relenza account.  This fact, according to Dr. Elashoff paved the way for Tamiflu’s approval later that same year.

Dr. Chan wants the WHO’s work on H1N1 examined.  She asked for an independent review of how the WHO handled H1N1 in January.  Hopefully this will produce some results, but I doubt it.

Traditional medicine is filled with conflicts on interest from Big Pharma.  This is just another example.  The swine flu was not a major pandemic and according to the WHO “the overwhelming majority of patients experienced mild symptoms and made a rapid and full recovery, even without medical treatment.”  If that was the case, and I believe it was, why did they instruct countries to stockpile billions of dollars worth of pharmaceuticals?  I think the answer is clear.  Big Pharma was able to strategically place scientists on influential panels to sell drugs.

During the swine flu “pandemic” I recommended that patients take a little extra vitamin C, D, and A, get plenty of rest and eat as healthy as possible.  Those recommendations are far safer than running out and vaccinating yourself or prophylactically taking Tamiflu, both of which have serious side effects.  Remember, a conservative approach is almost always the best way to tackle a problem.

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Filed under Big Pharma

Fruits and Veggies to Eat and to Avoid

My posts have recently focused on pesticides and their effect on human physiology in a variety of ways.  See Solving Childhood Obesity – Part II – Chemical Exposures, Toxins causing ‘grievous harm,’ cancer panel says, or Baby Bottles and BPA – You need to know the facts… for just a few examples.

The pesticide problem in this country is obviously a major one that contributes to everything from obesity to cancer.  The problem?  Most of our exposure to these pesticides is through eating the most nutritious foods – fruits and vegetables.

The Environmental Working Group recently released the ‘Dirty Dozen’ of fruit and vegetables that contain the highest pesticide counts.  They also provided a list of fruits and vegetables that are less problematic when consumed.  I have reprinted the list below.

The ‘Dirty Dozen’ – Only Consume From Organic Sources

  1. Celery
  2. Peaches
  3. Strawberries
  4. Apples
  5. Domestic blueberries
  6. Nectarines
  7. Sweet bell peppers
  8. Spinach, kale and collard greens
  9. Cherries
  10. Potatoes
  11. Imported grapes
  12. Lettuce

You May Consume from Non-Organic Sources

  1. Onions
  2. Avocados
  3. Sweet corn
  4. Pineapples
  5. Mango
  6. Sweet peas
  7. Asparagus
  8. Kiwi fruit
  9. Cabbage
  10. Eggplant
  11. Cantaloupe
  12. Watermelon
  13. Grapefruit
  14. Sweet potatoes
  15. Sweet onions

I always recommend that my patients eat as much as possible from organic sources.  I am, however, a realist and know that it is almost impossible to find all of your food from organic sources.  Even I don’t eat everything organic.

In the first list you see that they are all ready to eat.  You could pick any one of those dirty dozen right off the tree or vine and pop it in your mouth and enjoy.  However, that means that the pesticides are also applied directly to the skin of the fruit or vegetable.  The skin of these fruits and vegetables are soft and the pesticides are absorbed directly into the flesh of the produce.  Washing does you no good.  In fact, the tests were conducted only on produce that had been washed with a USDA high-power pressure water system.  The Environmental Working group found that you could potentially reduced your pesticide exposure by 80% by avoiding the dirty dozen or only eating them from organic sources.

In the second list you see fruits and vegetables that are consumed only after the tough skin has been removed.  The Environmental Working Group found little to no pesticide in the flesh of this produce.  I still recommend that you eat these organically because of the other benefits of organically grown produce.

Conventional wisdom has been that as long as you wash your produce you protect yourself from the dangers of pesticide exposure.  It always seemed naive to me to assume that spraying pesticides on the outside of our produce had no effect on the inside of it.  Now we have proof that at least soft skinned produce absorbs these dangerous chemicals and transfers those neurotoxins to us.

There is no better way to get your vitamins, minerals and antioxidants then by consuming fresh produce.  However, make sure you eat as organically as possible to avoid unnecessary pesticide exposure.


Filed under Diet, Environmental Health, Public Health

What is Functional Medicine?

I get this question a lot from perspective patients.  Routinely I will speak with potential patients on the phone before they schedule their appointment.  It allows me to get a general sense of the issues they are dealing with and whether or not I think I can help them.

Inevitably I end up using the term “functional medicine” somewhere in our conversation.  Most people don’t know what that means.  They’ve heard the term medicine before.  However, they always associate it with traditional medicine.  By that I mean going to your family doctor with a complaint and they give you some pill (pharmaceutical in nature) that takes away the symptom.

I’ve also spoken with many other types of physicians who don’t know what functional medicine is.  They assume there’s one way to treat disease and it’s with drugs.  Fortunately, that’s not true.  Modern medicine is a reactive practice.  They wait for disease to develop before treating it.  Here is a scenario that occurred today in my office:

Dr. Vreeland: “Hi Mrs. Smith, how are you today?”
Mrs. Smith: “I’m doing ok, but I brought some blood tests I’d like you to look at with me.”
Dr. Vreeland: “Sure, let’s have a look.  Well it looks like your blood sugar is running a little high.  This is suggestive of pre-diabetes.”
Mrs. Smith: “Yes, I saw that and asked my family doctor about it.  He said he wouldn’t treat it until diabetes developed fully.  I didn’t like that answer.”

This is a scenario that plays out over and over again in my office almost every day.  There is no proactive solutions given to most patients in modern medicine today.  Everything is about treat disease once it develops instead of preventing it in the first place.

Mrs. Smith will not go on to develop diabetes because she is now working with on her diet, exercise program and is going to take the appropriate supplements to prevent her from heading down the long, dangerous road that diabetes creates.

Traditional Medical Approach to  a Common Condition

Traditional medicine focuses on the symptoms of the health problems that one might face, not the cause of the symptoms.  For example, someone with fibromyalgia is almost always treated symptomatically.  They are given pain medications to help cover up the pain; they are given sleep medications to help them sleep at night; they are given reflux medication to reduce their reflux – the list goes on and on.  Unfortunately, none of those medications is addressing the causes of any of those symptoms.

Functional Medicine Approach to a Common Condition

Functional medicine wants to know why you are experiencing these issues.  The pain in fibromyalgia is caused by an aberrant processing of sensory information in the central nervous system.  Through a program of neurological rehabilitation you can change the way you brain interprets sensory information.  Over time this effectively reduces pain levels.  Sleep disturbances are often a result of low levels of serotonin in patients with fibromyalgia.  To correct this a supplement called 5-HTP is given.  This allows the body to replace the depleted stores of serotonin which is actually the cause of the problem.  Reflux may be caused by a hiatal hernia – a condition in which the stomach slips through the diaphragm.  Through a simple manual reduction this hiatal hernia can be reduced and the symptoms of reflux go away.  Providing a drug to these patients that reduces acid production does relieve the symptoms but does nothing to address the hiatal hernia so they become dependent on the drugs.

First and foremost functional medicine is about being proactive with regards to your health.  Should a condition develop functional medicine seeks to fix the physiology not cover up the symptom.  A person who has no symptoms because they are covered up by pharmaceutical agents is still a sick person, they just don’t know it.

My advice to most people is to be as preventative as possible when it comes to your health.  Do everything you can to prevent as much as you can.  The best way to treat a disease is to prevent it in the first place.  This is what functional medicine is about.


Filed under Public Health