Hello world!

May 4th, 2009

Welcome to Dr. Alan Frischer official blog! Dr. Alan FrischerThis blog is about everyday healthy lifestyle.


August 16th, 2013

Most of my readers know that I am a huge fan of exercise. But what about those among us who are not? Are you over 50, with an interest in making a change in your life and health? Here are a few clues about where to begin.
You’ve heard this before. Our core muscles help us to keep our balance, and as we age, these core muscles weaken. This makes falling and breaking bones far more common. Exercise improves safe living by building these core muscles, which improves coordination and endurance, mobility, flexibility, and balance. It allows us to get out with friends and family in new and exciting settings. Exercise helps us to maintain or lose weight, increase energy, improve our heart health, strengthen bones, reduce the impact of illness and chronic disease, improve sleep, boost mood and help with self-confidence. It’s good for the brain; slowing memory loss, cognitive decline, and dementia.
Have you heard (or used!) these common myths?
“There’s no point in exercising because I’ll grow old anyway!” The act of exercising helps build strength and make us feel and look younger. Regular exercise lowers the risk for many conditions, including heart disease, diabetes, hypertension, colon cancer, and obesity.
“Elderly people shouldn’t exercise because we need to save our strength!” Research shows that a sedentary lifestyle leads to less energy, and results in seniors having more hospitalizations, doctor visits, and using more medication.
“If I exercise, I might fall down and hurt myself!” Regular exercise builds bones, muscles and stability, and therefore reduces the risk of falling.
“It’s too late to start now!” Research shows that we can start at any point, and receive many benefits.
“I’m disabled and can only sit!” No worries here; there are sitting exercises that can improve muscle tone and promote cardiovascular health.
What, then, is the best exercise program for you? The clear answer, of course, is the program you will stick with! How do you get there?
If you are just starting out, consult with your doctor. Do you have chest pains or shortness of breath? Do you have a heart or lung condition, bone or joint problems, unexplained dizziness or fainting? Are you currently taking blood pressure or heart medication? Any of these need further evaluation before you embark on a new plan.
Set realistic goals. What are your expectations? Where do your abilities lie? Is your goal to age gracefully and build your strength and energy, or is it to complete a triathlon? Choose an exercise plan that fits, being realistic with regard to your health and medical issues. If you have had a knee or hip replacement, for example, running may not be for you!
Should you purchase equipment? There is a lot of good used equipment out there – just think of those exercise bikes that now serve as clothes hangers! Or, you may require just a sturdy armless chair and a few weights (two water bottles or soup cans will do in a pinch, or purchase some 2, 3, 5, and 8 pound weights). See that you have proper athletic shoes that offer good support, and comfortable, loose fitting clothing.
Set up a schedule and stick to it! Begin slowly and build endurance from there. Ants make their ant hill one grain of sand at a time, and that’s how you will build your endurance. Consistency is the key; figure out which days of the week will work for you, and what time of the day. We all know that the longer we stick to a schedule, the easier it gets.
Set up safety guidelines in terms of pulse rates and respiration. Your doctor can help you with target numbers. Perhaps you will start with two days a week and increase a day at a time as endurance and comfort build. Ultimately, three to five days per week is ideal. The duration of a workout can be quite reasonable; thirty minutes may be a good daily goal. Try splitting your workout into three 10-minute segments, spaced throughout the day. Don’t be in a hurry – start slowly and get used to it before increasing the time.
Walking is a great exercise. It’s low impact, can be done nearly anywhere, and doesn’t require special equipment other than a good, well-fitting pair of walking shoes. If possible, find a walking partner. The motivation, comfort, and camaraderie will be a big motivation to stick with it. Riding a bike is terrific – if this is safe for you, it’s a great cardiovascular exercise (and can even be done in your own living room!). Running is fantastic. It does, however, require good joints, especially the knees.
The biggest roadblock is your own motivation. Let your personality guide you. If you are a sociable person who needs plenty of encouragement, running or walking may not be for you (unless you join a group). Consider group swimming, water aerobics, senior fitness, yoga or Tae-bo. Martial arts such as Tai Chi and Qi Gong can increase balance and strength. Check with your local YMCA or senior center for classes. Is there a sport that will keep you motivated, such as tennis or bowling? (My mother loves her bowling league and recently bowled 198 at age 85). Grab a friend and challenge each other to keep going. Always be on the lookout for ways to stay motivated: Listen to music while exercising. Window-shop while walking through the mall. Play a competitive game. Take photographs on a nature hike. Make new friends in an exercise class. Watch a great movie while on the treadmill.
Avoid overexertion, and stop if you develop swelling, shortness of breath, dizziness, extreme tiredness or pain. Sudden intense exercise can be a challenge to the heart.
As we age, an active lifestyle is more important than ever. Regular exercise can help boost energy, maintain independence, and manage pain or symptoms of illness. An active lifestyle will even reverse some of the signs of aging. It is clear that it is good for our mind, body, memory and even mood.
Most importantly, let’s enjoy ourselves. Life is short. Figure out what you enjoy and stick with it – and even better, do it with someone you care about. I challenge you to think about what forms of exercise will excite you. Staying active is probably the best predictor of successful aging, and that’s a goal worth sweating for!


August 16th, 2013

A dear friend has severe arthritis of her knee – but that’s not what today’s column is about. Desperate to avoid knee replacement surgery, and tired of relying on pain medications, she has been looking for alternatives. Her acupuncturist led her to an ancient treatment that has seen a recent resurgence.
Let’s address the subject of leeches and their use in medicine. The field is known as biotherapy: the use of living animals to aid in diagnosis or treatment. Maggots are another example, but I’m sure that you’ll agree that leeches are enough for now. To be honest, I should admit upfront that my original goal was to research this subject thoroughly, and then be able to legitimately and scientifically make fun of my friend for allowing leeches to latch onto her body and suck her blood. After educating myself, do I still feel that way?
Well, it’s complicated. Here in the United States leeches are making a comeback. In 2004 the FDA gave their official stamp of approval for leeches to be used as a medical device.
The leech is a blood-sucking animal that is related to the earthworm and lives in fresh water. It has a rear suction cup that helps it to move and cling, and a front suction cup with three sharp jaws that make a Y-shaped bite. Once latched onto a host, it can feed on blood from 20 minutes to six hours, multiplying its body weight several times. So far, it sounds like a simple parasitic relationship: the leech is the only one benefiting. What’s in it for us? Leech saliva is made up of more than 30 different proteins, and they are effective for numbing pain, reducing swelling, and keeping blood flowing. (Note how these attributes also enable the leech to keep feeding.) In fact, it was the discovery of one of its anticoagulant proteins that led to a useful alternative medication for those patients who cannot use the common blood thinner, heparin.
Leeches have been used through the ages to treat everything from headaches to ear infections to hemorrhoids. Egyptians used leech therapy 3,500 years ago. The Greek philosopher Hippocrates wrote in the 5th Century BCE of using leeches to restore health by rebalancing the body’s four basic humors. Other popular eras for leeches include the middle ages and the 19th Century.
The use of leeches in modern medicine started 30 years ago, with the advent of reconstructive microsurgery. Maintaining blood flow is a major issue during these surgeries; if congestion isn’t cleared up quickly, the blood will clot, arteries will become plugged, and tissues will die. The leech became valuable when doctors were faced with the difficulties of reattaching minute veins. In 1985, a Harvard surgeon was having great difficulty reattaching the ear of a five-year-old child; the tiny veins kept clotting. He used leeches and the ear was saved.
Today, trauma doctors at Johns Hopkins, the University of Maryland and other hospitals routinely use leeches as a temporary measure to keep blood flowing as new vessels grow in damaged tissue. Treatment with leeches can keep blood moving in and out of a new skin flap. They can get blood flowing to reattached fingers. Because leech saliva works as a natural anesthetic, some doctors are looking to use them to ease pain. For my friend, it’s possible that they can lessen the pain and inflammation of her osteoarthritis, where cartilage has been worn down and bones are grinding against each other.
Because leeches can pick up parasites, bacteria or viruses from a patient, medicinal leeches are raised in a sterile environment, and are used on only one host for only one treatment. Their first human meal is also their last meal. Depending on the wound size, a doctor might apply anywhere from one to six leeches.
Are there downsides to leech use? Their bites are quite painful. Sometimes they slip and reattach themselves in unwanted places. No matter how helpful they may be, there are many of us who would have trouble allowing a blood-sucking worm to bite into us. For the squeamish, scientists have come up with a mechanical device that looks like a small bottle attached to a suction cup, delivers an anti-clotting drug to damaged tissue, and then gently sucks as much blood as needed.
Whether or not leeches will play a role in your future, they certainly are one more interesting alternative to conventional medical care. As for my friend, perhaps I owe her an apology…but I suspect that won’t stop the teasing!


April 15th, 2013

After enduring a partner’s nighttime noises, do you find yourself asking, “Why do we snore?” Snoring can become a quality of life issue, interfering with not only the sleep of the snorer, but of everyone else nearby. Snoring can lead to poor sleep and daytime fatigue, irritability, and increased health problems (not to mention relationship problems!). Thankfully, sleeping in separate bedrooms isn’t the only remedy for snoring.
The sound of a snore is typically produced while inhaling, by vibrating structures in the upper airway (including the tongue, soft palate, uvula, tonsillar pillars and pharyngeal walls). The result is a rough, harsh noise made in our sleep as we breathe. It varies in frequency, pitch, and intensity.
How common is snoring? It depends on who is asked and how we are asked, but figure that roughly 44 percent of men and 28 percent of women are habitual snorers. The fact that men actually have narrower air passages than women may help to explain the difference. Snoring can be hereditary, because a number of physical features, including a narrow throat, a cleft palate, deviated septum and enlarged adenoids or tonsils are causes. The likelihood of snoring rises with age, weight gain, having a family history of snoring, being out of shape, alcohol consumption, allergies, asthma, being a mouth breather, nasal obstruction, use of muscle relaxants, and smoking.
So, what can be done?
Sleep position: To lessen snoring, the best sleep position is on the side, and the worst is on the back. Propping up with a wedge-shaped pillow can help.
Stop smoking: Snoring among smokers is very likely, because smoking causes airways to be blocked by irritating the membranes in the nose and throat.
Exercise: Working on other muscles can also help to tone the muscles in your throat, which in turn can lead to less snoring.
Lose weight: Even a little weight loss can eliminate some of the fatty tissue at the back of the throat, a cause of snoring.
Avoid alcohol, sedatives, and sleeping pills: These relax the muscles in the throat and can interfere with breathing. Some prescription medications lead to deeper levels of sleep, which can make snoring worse.
Establish regular sleep patterns: Bedtime rituals can lead to better sleep, and often minimize snoring. Large meals (or heavy snacks) two-three hours before bedtime can be disruptive to your sleep patterns.
Devices: Various devices have been developed that are helpful for some. One is a strip (“Breathe Right,” for example), which is attached to the outside of the nose like a bandage, and lifts and opens the nasal passages to improve air flow. Oral appliances (fitted by a dentist) and continuous positive pressure devices (CPAP) have been useful.
Surgery: Various surgeries may be a last resort when sleep apnea or other underlying causes are involved.
Don’t ignore the psychosocial issues related to being in a relationship with a snorer. Even the most patient amongst us may draw the line at sleep deprivation. No matter how much sleep we lose, however, it’s important to be sensitive: your partner may be feeling vulnerable and even embarrassed about this issue.
*It’s not intentional. Although it’s easy to feel like a victim when you lose sleep, remember that your partner isn’t ruining your sleep deliberately.
*Avoid lashing out. Sleep deprivation can be aggravating and even unhealthy, but approach the problem in a non-confrontational manner.
*Choose the right timing. Avoid the middle of the night or the early morning when you’re both tired.
*Use humor; laughing about it (not teasing) eases tension. Remember, snoring is a physical issue that your partner has little control over.
If you snore loudly and heavily and are tired during the day, if you stop breathing, gasp, or choke during sleep, or if you fall asleep at inappropriate times, like during a conversation or a meal, then please see your doctor.
Snoring causes more lost sleep and irritability than most of us realize. Let’s close with the words of composer and novelist Anthony Burgess, “Laugh and the world laughs with you; snore and you sleep alone.”

“Computer Hospital Intensive Care Operator”

February 24th, 2012

The doctor was controlled by a joystick, moved on three wheels, had a built-in stethoscope, and a flat screen as a face. Chico (a far more manageable name than “Computer Hospital Intensive Care Operator”) allowed doctors and other medical workers at Miami’s Jackson Memorial Hospital to virtually examine patients, speak to them, and access their digital files – even from miles away. As our population ages, and the healthcare professional shortage becomes even more serious, video-conferencing robots like Chico may represent one face of medicine’s future.

Years ago, when I first joined the staff at Downey Regional Medical Center, I was often greeted by a robot traveling through the halls and in and out of elevators, delivering food trays. That robot is no longer in use at our local hospital, but more sophisticated robotics are finding inroads into healthcare. You may be surprised at some of the applications being used.

Certainly, robots have proven their abilities in hospitals to perform relatively straightforward tasks such as washing floors, cleaning equipment, and carrying hot meals to patients’ bedsides. Robots are used in hospital pharmacies to count, bottle, and deliver medicines to the wards. Robots are used to lift and rotate bed-ridden patients, saving the backs of nurses.

When we think about ideal medical care, most of us imagine a concerned, compassionate and intelligent human practitioner. However, it is clear that some of our jobs can be done better by our non-human counterparts, and that machines can free up humans so that we can do other jobs better.

One significant area where robots have exploded onto the healthcare scene is in training. A group of medical students who were trained to perform a pelvic exam on a robotic simulation stood out from their non-simulator trained peers when working with real women. The training made them comfortable with the exam and they were able to focus more on the patients. Haptic (sense of touch) devices are also becoming commonplace in surgical training programs, including simple laparoscopic workstations that allow students to palpate (touch), incise, or suture virtual tissues and organs.

In order to serve remote areas and environments such as aboard military ships or rural areas, Virtual Presence Robots (VPR) have been developed and tested. A physician or floor nurse directs the robot to examine a patient while speaking with and viewing that patient on a monitor. Robots have the ability to visit the bedside and to record the pulse, blood pressure, and breathing of patients who require frequent and ongoing surveillance.

Telesurgery can also serve these remote areas. A skilled surgeon might assist a local surgeon (tele-assistance), teach the surgeon (tele-mentoring), or conduct critical portions of surgical procedures (tele-surgery). Surgeons utilize tele-strators placed over the operative site to describe a proposed action, much as a sports announcer might use such a device to explain a play or highlight a player during a broadcast!

Surgical robots can perform procedures, including general, urologic, gynecologic, lung, and heart. The da Vinci surgical system, for example, can improve a surgeon’s performance because it is more stable that the human hand, yet as flexible as the human wrist. The actual surgeon, however, will not yet be found out on the golf course – he or she directs while viewing on a monitor.

Robots are used in some orthopedic surgeries to mill perfectly round holes in the shafts of fractured bones, improving the bonding of metal replacements in hip and knee joints. These robots, much like those in a car assembly line, have one specific task.

Robots have been tested as surgical assistants. The “Robo-Nurse” dubbed Penelope was developed to hand instruments to surgeons at the operating table, wipe them clean, and make them available for further use. Penelope was also developed to count instruments, so lost instruments and sponges would be a thing of the past. Robots have provided constant and steady retraction of organs and skin during surgical procedures. Although robots have been tested in this area, they have not received wide acceptance by doctors and nurses to date, and Penelope is currently unemployed. Penelope, welcome to the recession…

Indeed, robots are diligent, precise and consistent. They create high quality products. Unlike humans, they are tireless. They do not take lunch or other breaks; vacations or sick leave; or incur costs for worker compensation or medical insurance.

However, they do cost a lot of money, they break down, and they have no intuition…yet. Human surgical nurses, for example, perform a wide range of critical functions that require advanced scientific training, including monitoring surgical and nonsurgical practice, sterile technique, and the patient’s condition; intervening in the case of an emergency; and advocating for the patient generally. Nurses use critical thinking to save lives. Relieving healthcare practitioners of various tasks does allow them to perform more specialized jobs, but clearly, no combination of metallic parts, microchips, and binary files could replace the empathetic touch or clinical intuition of a human healthcare practitioner. At this stage, at least, robots are not replacing humans, but rather assisting them.

Please contact my robotic assistant with any questions…just kidding!


January 21st, 2012

My wife and I recently returned from a wonderful weekend up in Sonoma County, where we indulged in a little wine tasting. While I’m actually not much of a drinker, learning about wine and winemaking is always fascinating. Upon our return, we’ve plunged into this season of holiday parties, with alcoholic drinks being served at most. All of this has started me thinking about the physiology of how alcohol affects our bodies.

Whether or not we are aware of it, the first sips of an alcoholic beverage result in the immediate impairment of brain function, and the more that we drink, the more that function deteriorates. The rate of deterioration may be affected by how empty or full our stomach is; our gender, age and weight; and race. Certain medicines, such as aspirin, slow the breakdown of alcohol and greatly increase the blood alcohol level. Cognitive abilities such as conduct and behavior are the first to go. There can be a mild euphoria and loss of inhibition. The most vulnerable brain cells are associated with memory, attention, sleep and coordination.

Alcohol affects the heart. Our pulses quicken after very little is consumed. Alcohol is a vasodilator, meaning that it makes the blood vessels relax in order to allow more blood to flow through the skin and tissues. This results in a drop in blood pressure, so in order to get sufficient blood to organs and tissues, the pulse speeds up. After a significant intake of alcohol, the heart develops “holiday heart syndrome,” in which the heart goes into an irregular rapid heart rhythm (atrial fibrillation). This can lead to weakness and shortness of breath, and an increased risk of stroke.

The lungs are involved because alcohol speeds up the breathing rate. However, at higher levels of intoxication, the stimulating affects are replaced by an anesthetic effect, which actually depresses the central nervous system. (Note that as our blood passes through our lungs, a proportional amount of alcohol passes into the air that we exhale. This is why Breathalyzers can accurately detect the blood alcohol level.)

The digestive system is affected. As a rough guideline, it takes as many hours as the number of drinks consumed to burn up the alcohol. Alcohol is absorbed through the stomach and small intestine. Even small amounts can irritate the stomach lining, and larger quantities of alcohol can block absorption of essential vitamins and minerals. Only a few weeks of heavy drinking can lead to pancreatitis.

The kidneys are affected because alcohol is a diuretic. It promotes urine production, which then leads to dehydration. Due to this stimulation, the kidneys are working overtime.

Alcohol affects the skin. It increases blood flow, making us feel warm and look flushed. Since it also dehydrates, it increases the appearance of fine lines.

The destructive effects of alcohol on the liver are well known. Large quantities can lead to both acute and then chronic liver disease. It is in the liver that alcohol is metabolized, and as it breaks down, its by-products (including acetaldehyde) are formed. Some of these by-products are even more toxic to the body than the alcohol. Even a single episode of heavy drinking affects the delicate balance of enzymes in the liver and fat metabolism. Over time, drinking can lead to the development of fatty globules that cause the liver to swell, ultimately leading to cirrhosis.

On top of all of this…is the hangover! Its precise cause is unclear. There are many theories, including hypoglycemia, dehydration, acetaldehyde intoxication, and glutamine rebound. Some symptoms may actually be due to alcohol withdrawal. They include fatigue, headache, body aches, vomiting, diarrhea, flatulence, weakness, elevated body temperature and heart rate, hyper-salivation, difficulty concentrating, sweating, anxiety, dysphoria, irritability, sensitivity to light and noise, erratic motor function, tremors, trouble sleeping, severe hunger, halitosis, and lack of depth perception. Hangovers may include psychological symptoms including depression and anxiety. Symptoms usually begin after the intoxicating effects of alcohol wear off; typically, a hangover is experienced the morning after a night of drinking. Of course, these symptoms vary from person to person, and it’s possible that up to 30% of drinkers may actually be resistant to hangover symptoms.

With long-term heavy drinking, the picture gets pretty ugly. It leads to a drop in testosterone, impotence, testicle shrinking, infertility in both men and women, and permanent damage to the brain by damaging the connections between nerve cells. It is a depressant, and can trigger anxiety and lethargy. It leads to anemia, and is linked to an increased risk of a number of cancers. Drinkers can die from bleeding ulcers, or from swollen blood vessels in the intestine. Eventually drinking can lead to “alcohol dementia,” poor coordination, cirrhosis, and liver and kidney failure.

So as we bid farewell to 2011 and welcome in 2012, let’s remember to practice moderation and treat our body with the respect it needs and deserves. Let me also take this opportunity to remind all of you not to drink and drive.

Happy holidays to you all!

Vitamine D

January 21st, 2012

Lately, when I perform physical exams, I’ve been including Vitamin D levels with the routine lab tests. Very frequently, these levels come back low. Is this important? What does it mean to have a low Vitamin D level, and what impact does that have on our health?

Vitamin D is actually a group of five fat-soluble vitamins known as D1, D2, D3, D4, and D5. Of these, D2 and D3 are the most important to us. Known as the sunshine vitamin, Vitamin D is synthesized in the body from sun exposure, and is also consumed in the diet from food and/or supplements. Vitamin D is well known for preventing rickets in children and osteomalacia (softening of the bones) in adults. Together with calcium, it protects adults from osteoporosis.

Some of us live in areas with very little sunshine, or restrict our sun exposure for health-related reasons. To make up for that, we can increase our intake of Vitamin D-rich foods, including some fish (salmon, mackerel, tuna, sardines), fortified milk and fortified orange juice, beef liver, and eggs. Vitamin D supplements are also readily available, and it is included in most multivitamins. Note that because Vitamin D is a fat-soluble vitamin (as are Vitamins A, E, and K) it is stored in the liver and fatty tissues, and does not need to be replaced every day. Because it is stored, however, it poses a greater risk for toxicity if too much is taken. Nevertheless, I generally recommend that adults take a Vitamin D supplement of 1,000 IU per day.

The beneficial effects of Vitamin D on health are not all clearly proven, but current studies indicate that:

•It is crucial for the absorption and metabolism of calcium and phosphorus, which have various functions, especially that of maintaining healthy bones.

•It plays an important role in immune system regulation. During months of little sunshine when our production of Vitamin D is low, there is a higher prevalence of flu and other viral infections. Many factors may be in play, and researchers are investigating further.

•Researchers have found a correlation between Vitamin D levels and memory function. It may play a role in helping us maintain our mental agility. Stay tuned!

•There may be a correlation between levels of Vitamin D and adolescent and abdominal body fat. This has opened the doors to more studies on using Vitamin D supplements to aid weight loss.

•Low levels of Vitamin D have been linked to more severe asthma attacks in children. Taking supplements has been linked to fewer and milder attacks.

•Various studies link low levels with some cancers, but supplements do not appear to help.

•Low blood levels of Vitamin D are associated with increased mortality in general. Vitamin D3 supplements appear to decrease all causes of mortality, especially in elderly women.

•Also under investigation is the theory that Vitamin D might have a protective effect against multiple sclerosis. Multiple sclerosis occurs at high rates in regions of the world with long periods of little sunlight, and thus far less Vitamin D production in the body.

However, too much of a good thing can be harmful! Vitamin D toxicity, also called hyper-vitaminosis D, is a potentially serious but treatable medical condition. Toxicity comes, not from too much sunlight, but from too many supplements. The body can generally handle up to 10,000 IU (International Units) per day, but sustaining that level of intake for several months may lead to toxic symptoms.

We are more likely to become toxic if we have certain underlying problems, such as hyperparathyroidism. Symptoms of Vitamin D toxicity include nausea, frequent urination, weight loss, poor appetite, constipation, weakness, irregular heart rhythm, kidney stones, headaches, dehydration, fatigue, irritability, and muscle weakness. Treatment includes stopping all supplements and restricting calcium intake in the diet.

I wish for all of us good health and plentiful Southern California sunshine!

Nutrition Facts

May 2nd, 2011
So many of us are keeping a watchful eye on our sodium, fat, or calorie consumption. How do we know what we’re eating? Is there a simple way to understand the contents of the food that we buy?

The Nutrition Labeling and Education Act (NLEA) was passed in 1990, requiring all packaged foods to display nutrition information. These labeling requirements have since undergone multiple amendments, and today, labeling is required for most prepared foods, including breads, cereals, canned and frozen foods, snacks, desserts, and drinks. Labeling for raw produce (fruits and vegetables) and fish is voluntary.

The Nutrition Facts food labels list the percentages supplied based on an average 2,000-calorie (and sometimes 2,500 as well) a day diet. The Daily Values used were originally based on 1968 recommended dietary allowances for each nutrient for men and women of any age, and have been periodically revised to incorporate more current research. However, newer revisions are still necessary.

Here’s an example of the label that appears on most packaged foods:

When evaluating the information on your nutrition labels, keep in mind that higher amounts for vitamins, fiber, and protein are good, but for saturated fats, cholesterol and sugars, lower numbers are more healthful. Remember that most Americans don’t get sufficient amounts of dietary fiber, vitamin A, vitamin C, calcium, and iron in their diets.

How do grams relate to calories? Carbohydrates and protein contain about four calories per gram. Fat contains about nine calories per gram. So, if only grams are listed, multiply four or nine times the number of grams, and the result will be total calories.

Pay special attention to the serving size and the number of servings information listed at the top of the label. All information on the rest of the label is based on a single serving. The serving size tells us the size of that single serving; for example, one serving of chicken noodle soup is considered to be 1/2 cup. This information can be very misleading, as a half-cup of soup (even after it is mixed with water) is not what many of us would picture as a full serving! Note that if a small package of cookies contains six cookies, but the serving size is just two, then the entire package contains triple the calories and other values listed.

It is also important to note that one chicken soup serving is one-half cup of the condensed soup as it comes in the can, and not one-half cup of the soup after it has been mixed with water. Depending on the product, the serving size may be measured or counted before or after preparation. Here, the serving size is before preparation, and since the number of servings is 2.5, you can simply consider that regardless of the amount of water used when preparing the soup, if you consume the entire can, you have eaten two and one-half servings (and that doesn’t include any crackers!).

The middle portion of the Nutrition Facts food label contains information about calories, fat content, amount and type of carbohydrates, and amount of protein. It shows the amounts in grams (g) or milligrams (mg), and the percentage of the daily value (the amount recommended every day) for each of these nutrients.

You will note that trans fats are listed without a percentage next to them. This is because experts have not agreed on a reference value for how much can be safely consumed. These fats raise blood LDL (bad cholesterol) levels, which increase the risk of heart disease. There is no reference value for sugar, either. Be aware that the sugars listed include both naturally occurring sugars (as in fruits), as well as processed sugars. Diabetics and others among us who are concerned about sugar intake should be certain that sugars are not listed as one of the first few ingredients. Processed sugars may appear as corn syrup, high fructose corn syrup, fruit juice concentrate, maltose, dextrose, sucrose, honey, and maple syrup.

We also find sodium information located in this middle section, rather than with the other minerals down at the bottom of the label. You can see that only a single serving of condensed chicken noodle soup has 37% of the daily value for sodium. If you consume the entire can, you will have eaten almost the entire recommended amount of sodium for the whole day!

Glance at the amount of fiber contained, and you may not be surprised to see that chicken noodle soup from a can contains very, very little.

The bottom portion of the Nutrition Facts label displays the vitamin and mineral content. The FDA requires that information on calcium, iron, vitamin A, and vitamin C be included. Food manufacturers may add information about other vitamins like niacin or folic acid if the product contains any significant amounts. This bottom portion is not always present on smaller items, but it is a good reminder of our general needs, based on that 2,000 or 2,500 calorie per day diet.

The information contained on these tiny labels is imperfect. It doesn’t break down our dietary needs by gender, by age, or by particular health condition. It doesn’t address conflicting research and current opinions in the nutrition and health care field. However, if your goal is to use this limited information as a guideline, then it can be a great tool to help find the foods that fit into a balanced and healthful diet.

Read carefully, and eat smart!

Organ Donor

March 15th, 2011

Every one of us has the opportunity have our organs donated upon our death. How do we make that decision? What factors should we consider? There is a clear need, but bioethical concerns cloud the issue. Interestingly, organized religion poses few obstacles. Let’s explore together.

Organ transplants save lives every day. If a transplant is not possible due to organ condition or match failure, the organ can still be used forresearch or education. Researchers use normal as well as diseased organs and tissues for study, and vast numbers of people benefit from the resulting medical advancements.

The world’s major religions accept the concept of organ donation in at least some form. Most religions, including the Catholic Church, support organ donation on the grounds that it constitutes an act of charity and provides a means of saving a life. Some religions impose restrictions on the types of organs that may be donated, or on the means by which organs are to be harvested or transplanted.

For example, due to their prohibition of blood transfusions, Jehovah’s Witnesses require that organ be drained of blood prior to transplant. Muslims require that the donor provide written consent in advance. Orthodox Judaism considers organ donation obligatory if it will save a life, as long as the donor is considered dead as defined by Jewish law.

A few groups do oppose organ transplantation or donation, including many who follow Shinto practices, and Gypsies.

There is an enormous shortage of donor organs.This could not be truer than with the increasing need for kidneys. Kidney failure is brought on by rising age, diabetes and hypertension, and all three of these categories are growing in size. Spain boasts the highest organ donation rate in the world, with 35.1 donors per million people. This rate compares to 24.8 donors per million in Austria, and 22.2 donors per million in France. The Spanish transplant system is one of the most successful in the world, but it still can’t meet the demand, and 10% of those needing a transplant die while still on the transplant list. Under Spanish law, every death can provide organs unless the donor expressly specified otherwise (while still living!).

Organ donation is becoming an important bioethical issue. For example, prisoners here in the United States are not discriminated against as organ recipients and are equally eligible for organ transplant as the general population. In 1976, the Supreme Court ruled that withholding health care from prisoners constituted “cruel and unusual punishment.” Of course, many are uncomfortable that an organ transplant and follow-up care can cost the prison system up to $1 million, and that an organ transplant to a prisoner may well deprive another citizen of that organ and a possibly life-saving surgery.

Another ethical issue involves whether to give liver transplants to alcoholics who may be in danger of relapse. Should organ transplants be allowed for drug abusers, those with reckless lifestyles, older patients, etc.? With a limited supply of organs to transplant, these become complicated and difficult bioethical social issues.

Because demand for organs far outpaces supply, a black market, often referred to as transplant tourism, exists. Black markets are, by their nature, unregulated, and not surprisingly the rich take advantage of the poor. Those who support a black market argue that the poor are in desperate need of the money. Follow-up studies have actually been conducted on those donors who sold a kidney in countries where organ sales are legal. These studies show that a majority of donors have extreme regret, and if given the chance to repeat the procedure, they would not.

In addition, many study participants reported an actual decline in economic status following the procedure, despite income from the donated organ.

Even more frightening black market cases have involved suspected cases of organ theft, including murder. Supporters of a legal organ market claim that the black-market system encourages such tragedies, and that regulation could prevent them. Opponents claim that such a market could encourage criminals by making it easier to claim that a stolen organ was legal. Needless to say, this issue is far from resolved.

In 1999, eBay was involved in an organ scandal. An auction for “one functional human kidney” reached a bid of $5.7 million before it was blocked by eBay. In the United States, the sale of human organs is punishable by up to five years in prison and a $50,000 fine.

An exciting but hugely controversial new field has arisen with great potential for providing organ supplies: cloning. A cloned organ would run no risk of rejection, since it would be a perfect match. However, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own.

Consider the ethics of cloning an entire person for the express purpose of being destroyed for organ procurement! Currently, stem cell research is investigating using cloned stem cells to grow only a new organ. This research shows enormous promise, despite the bioethical and religious issues still unresolved.

There is simply no replacement for having available a real human body when it comes to teaching and research. I would urge all of us to give organ or full body donation serious consideration. It will truly help in the discovery of cures for many debilitating conditions such as cancer and Alzheimer’s disease, in the development of new medicines, in the study of human anatomy, and in perfecting new surgical procedures.

As a medical student, one of my most important classes was Human Anatomy and Dissection, and I clearly recall that each donation was highly valued, and treated with the utmost humanity, compassion and respect. Many years have passed, and my oldest daughter just finished the very same human anatomy course in her own medical school. She describes a ceremony held before the course began, attended by both medical students and donor families, where the donor families were personally thanked for their amazing and precious gift.

Here are some steps you can take to become an organ donor:

•Register with your state donor registry: www.DonateLifeCalifornia.org/register/

•Sign a donor card and carry it with you until you renew your driver’s license, at which time your decision can be designated on your driver’s license.

•Talk to your family now about your decision to donate. Help them to understand your wish to be an organ and tissue donor, before a crisis occurs.

I wish you and future generations the gift of a long and healthy life!


January 27th, 2011

As the cliché goes, laughter is the best medicine. But is it really? Is there evidence to support such a claim?

It turns out that the research is full of good hard evidence that too much stress results in increased levels of ACTH, cortisol, epinephrine, and norepinephrine; the so-called “stress hormones”. This is not normally a good thing. The question remains as to whether humor can decrease stress, positively impact the stress hormones, diminish pain, improve the strength of the immune system, and consequently improve quality of life. This has been a persistent topic of discussion for decades in both the lay and professional medical literature. Certainly, laughing is more affordable than medication, herbs, massage, or lengthy therapy!

Unfortunately there is little conclusive evidence that laughter specifically changes these body chemistries. However, the data is encouraging:

Laughter has been shown to reduce pain, in at least two ways. It serves as a distraction, and causes the release of endorphins, which reduce the sensation of pain.

Laughter may boost the immune system. There appears to be an increase in “killer” antibodies and t-cells – both of which fight infection.

Laughter relaxes the muscles and even tones the facial muscles.

Blood pressure has been shown to decline following bouts of laughter.

Finally, apparently no researcher has found a single harmful effect from laughter. It’s cheap, and available.

So, it is highly likely that laughter boosts immunity, lowers stress hormones, decreases pain, relaxes muscles and lowers blood pressure. Laughter adds joy and zest to life, eases anxiety and fear, relieves stress, improves mood, strengthens relationships, enhances teamwork, helps to defuse conflict, promotes bonding, and likely attracts others to us.

Here are some strategies for all of us to work on during this upcoming year:

•Don’t avoid dealing with your stress. Stress is a major impediment to humor and laughter.

•Laugh at yourself. Share embarrassing moments and take yourself less seriously.

•Laugh more at situations rather than bemoan them. There is often humor to be found even in bad situations. See the irony and absurdity of life!

•Surround yourself with reminders to lighten up. Put up a funny poster, or keep toys on your desk. Choose a computer screensaver that makes you smile.

•Pay attention to children and emulate them. They are truly the experts of play, taking life lightly, and laughing.

•Keep things in perspective. Many things in life are beyond your control. Remember the Serenity Prayer, and that you do not control the behavior of others. I always appreciate my patients’ willingness to carry the weight of the world on their shoulders. It is admirable but unrealistic, unhealthy, and perhaps even egotistical!

Good health and humor to you all, and have a very happy New Year!

I wish you the best of health.


January 18th, 2011

Doctor, how much water should I drink? I hear this question every day. We all know that enough water is essential for good health, yet everyone’s needs are different. It’s a simple question, with a not so simple answer!

Water makes up about 60% of our body weight and is the principal chemical component in the body. Every system depends on it. Water flushes toxins out of vital organs; carries nutrients to the cells; and moisturizes the nose, ears, throat, blood vessels, and tissues. Minor dehydration will result in thirst, loss of appetite, dry skin, skin flushing, dark colored urine, dry mouth, fatigue, weakness, chills and head rushes. More dehydration leads to increased heart rate, increased respiration, decreased sweating, decreased urination, increased body temperature, extreme fatigue, muscle cramps, headache, nausea, and tingling in the limbs. Once dehydration reaches 10%below normal levels, fluid loss becomes an emergency and can be fatal. Signs include muscle spasms, vomiting, racing pulse, visual changes, painful urination, confusion, difficulty breathing, seizures, and unconsciousness.

We lose water through breathing, perspiration, urine and bowel movements. Clearly, there is some ideal amount of water needed to replace these fluids and keep the system running correctly. The simplest approach is known as the eight by eight rule. Drink eight glasses of eight ounces of water per day. This is based on the replacement method: an adult urinates about six ounces of water per day, and we lose roughly an additional four cups each day through breathing, sweating, and bowel movements. Food accounts for roughly 20% of our total fluid intake, so if we consume about eight cups of water or other beverages a day along with a normal diet, we will typically replace the fluid lost. This is pretty general, but will normally suffice.

Another method is to look at the toilet bowl! If you drink enough fluid so that you rarely feel thirsty and produce about six cups or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate. Since we don’t typically measure our urine output, simply check the color.

Now that we have a general rule of thumb, let’s explore factors that may change our specific requirement. Regular exercise, whether or not we sweat, demands that we drink extra water to compensate for the fluid loss. In general, drinking 1 ½ to 2 ½ extra cups of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour requires more, and if you tend to sweat heavily, even more fluid replacement is required. Sport drinks are more useful than water after heavy exercise.

The environment affects fluid requirements. Hot or humid weather will increase sweating. Spending time in heated buildings causes the skin to lose moisture. High altitudes (over 8,200 feet) may trigger increased urination and more rapid breathing, using up more fluids.

Women who are pregnant or nursing require more hydration. Pregnant women are advised to drink about 10 cups daily and women who are nursing need about 13.

Illness and various health conditions change the formula for fluid replacement substantially. Fevers, vomiting, diarrhea, bladder infections and kidney stones are examples of conditions that require us to drink more. On the opposite end of the spectrum are congestive heart failure, liver failure, and kidney failure, where fluid restriction is often necessary.

Remember that milk, juice, soup, and fruits and vegetables all contain some of the water that we need. Alcohol and caffeinated beverages (some sodas, coffee, tea, etc.) act as diuretics, however, and cause some fluid loss as well.

Is it dangerous to drink too much water? There is actually a condition known as water intoxication, which can be caused by a psychological condition known as psychogenic polydipsia. When too much water enters the body’s cells, the tissues swell with the excess fluid. The result is a potentially dangerous decrease in sodium concentration.

Here are some simple guidelines to help avoid dehydration:

• Drink a glass of water with each meal and between meals

• Hydrate before, during and after exercise

• Try substituting sparkling water or other beverages for alcoholic drinks or sodas

• Work with your physician to determine the proper amount of fluid consumption for your specific needs.

I wish you the best of health.