Tuesday, September 3, 2013


Good food. And if you snack on nuts you may just skip the chips and Ho-ho's.

These are the nutrient-dense big daddies of the world of nuts.
High fiber. Protein. Vitamin E and Folic acid. Calcium, magnesium, potassium, zinc-- just the short list. No gluten should make the gluten sensitive and celiac disease folks happy. Almonds are frequently touted as heart healthy due to their mono-unsaturated fat content.

Uncharitable you say? I say this man knows nuts.

Brazil nuts
Are in the same family as blueberries and cranberries, oddly enough. I'm not really one for taxonomyy.
The trees reach 15 feet from 6 foot trunks. Impressive. So is the fruit. It is illegal to cut the trees down, purportedly. So they can be found here and there and where people live, walk their dogs, and park their cars. The large, heavy fruit can put a dent in your day, is what I'm getting at.
The nuts are the richest source of selenium. The National Cancer Institute list Brazil nuts here for their antioxidant quality.

People eat watermelon seeds?

More iron than beef, plus copper, manganese, magnesium, selenium, potassium and zinc. B vitamins. Mono-unsaturated fats.

A version of my favorite rack of lamb dish with a hazelnut crust.

In Scotland in 1995 a pit with hundreds of thousands of hazelnut shells was found. This was a hazelnut processing site 9,000 years ago.
Good fats and B vitamins, vitamin E, copper, and iron among others.

"Put the lime in and then you'll feel better." the Doctor

Holy wow coconut water has become big.
But this post is about the meat of the matter. The meat is high in potassium, phosphorous, magnesium, sodium, and calcium. The oils may reduce our demonized LDL cholesterol, and it has been shown of benefit in benign prostatic hyperplasia.
The water has been used in IVs due to its sterile environment within the shell, sugar and sodium content. Nut plasma!

Believe you me-- this link is here as a curiosity, not endorsement.
Macadamia nuts
So. Darn. Tasty. So. Darn. Expensive.
These nuts are 75% oil. So, the heart thing again. They contain many of the vitamins and minerals as the previous list entries, along with selenium and vitamin A.
But don't feed them to your dog.

Firstly, received wisdom:  Upon moving to the south from the mid-west my wife found it curious that pee-cans (particularly pies) were everywhere.  She made mention of the fact. One of her colleagues suggested she try a different pronunciation, as "We say pee-con, 'cause a pee-can don't belong at the supper table."
Good fats, vitamins,  and anti-oxidants like beta-carotene and xanthins.
Pee-con trees can produce for 300 years.


One of my favorite uses of pine nuts. Can be done veg or vegan. Maybe skip the basil.
Pine nuts
A personal favorite that comes with an anecdote:  In the southwest pine nuts are harvested from pinyon trees. In season they're sold in roadside stands. Unshelled nuts are popped into the mouth much as unshelled sunflower seeds elsewhere. But sunflower seeds don't have a hard shell. So every year I'd have one or two guys come in with jaw trouble. They would disturb their TMJ by cracking the shell with their teeth. Dentists everywhere would shudder.
Contains protein and fiber and more vitamin K than any other nut as well as many of the previously mentioned vitamins and minerals.  Also contains a dirty little secret you can read about here called pine mouth. Skipping pine nuts from China may be prudent.


This man insists you buy his nuts.
High fiber and less than 5 calories per nut, B vitamins and potassium, and we've been eating them for 7 millennia. They can increase your alpha- and beta-carotene levels, lutein levels and gamma tocopherol. They've been demonstrated to lower low density lipoprotein. A problem with them I worry about not at all can be found here.

Green beans love walnuts and walnut oil. Make it simple with toasted
nuts and flash fry the beans in walnut oil.

Walnuts contain the most anti-oxidants of any nut. They also contain the usual vitamins and minerals shared by the other nuts on this list.
In elementary school in the backwoods during the seventies one fall day I noticed several classmates hands were dark as if they had washed with furniture stain. Essentially they had. They'd been collecting walnuts.  You can make your own walnut stain.

Rest in peace Lt. Gen. Harry W.O. Kinnard, now four years passed on.

Monday, August 26, 2013

Don't Put That In Your Mouth!
Drinks The Kids Shouldn't

Is it convenience or surrender? We let our children consume whole lakes of this stuff every year.

Energy/sports drinks. Tooth Decay. Destruction, really.
40 percent of teens consume energy drinks. Over 50 percent consume sports drinks every day.
A dental study demonstrated that enamel damage is apparent after only five days exposure to energy and sports drinks. Tooth enamal damage is irreversible. Damaged enamel can't protect teeth. Think cavities. High acidity and plenty of sugar are a bad mix for teeth.
Want your offspring to eventually spring off on their own? Teeth and employment here.
Addition 8/29/13  Teeth and success again, here.

 The American Academy of Pediatricians recommends that children never consume energy drinks.
Energy ("energy"?) drinks contain caffeine and substances like ginseng, carnitine, taurine, guarana and yohimbe. These chemicals increase heart rate and blood pressure. They also appear to effect coronary artery dilation. So rate goes up, pressure goes up, but what should happen-- arteries enlarging to accomodate greater blood flow-- does not. The heart works harder with less oxyen supply.

Gatorade. Because this, that's why.
The original experimental  Gatorade was apparently not sugar laden. It was meant to essentially replace sweat, and it tasted like...sweat. It became a mixture of salt, sugar, and water, with a citrus-based flavoring and food coloring added. (side note: until this year Gatorade contained brominated vegetabe oil-- Yumm!)
When Susie and Sam are pouring sweat on the youth soccer field, like the athletes for which these rehydrants were originally intended, replacing electrolytes is a fine idea. In the school cafeteria or in front of the TV, they are only adding unnecessary salts and sugars.
It isn't just grandaddy Gatorade. Others are salt and sugar heavy as well.

Fruit juice has become something a whipping boy lately.
They give lots of sugar with little to none of the fiber of the fruit.

Two points from here:
One, when you eat fruit the bulk is filling. When you drink fruit juice it is not filling.  Hence you can easily overconsume sugars.
And two, fruit juice is sold by the idea natural is good. Unless you squeezed it yourself, don't think the juice is natural. The juice industry is selling a highly processed product. 
Shall I ruin store bought OJ for you? Some might be suspicious from the start that Coke and Pepsi are big players in US OJ. Try this link.
Excellent quote from the comments of the above link:  "While orange juice sounds healthy, it's really just a concentrated dose of flavored sugar as far as your pancreas is concerned."

Soft drinks are hard core.
Obviously there's the sugar. And acidity.
Nutritional Facts of Popular 12-Ounce Soft Drinks456
Brand NameSugar (grams)CaloriespH Level
Cherry Cola44.421542.522
Coca-Cola Classic40.741502.525
Diet Coke14.7003.289
Dr. Pepper40.341552.899
Mountain Dew46.68803.229
Pepsi Cola42.111502.530
Diet Pepsi9.5203.031

OK. Obesity, diabetes, tooth destruction.
But how about behaviour problems? Soda consumption tied to kid's behaviour problems here.
And as to bone health? Caffeine and phosphorous in soda can cause release and displacement of calcium. Soda and osteoporosis here.

Sugar and flavoring added, pasteurized, canned. Not really fresh anymore, is it?

Iced tea.
The store bought bottled ('round here can buy it in gallon milk jugs) stuff is typically sugar laden.
So, the sugar thing again.

Flavored milk.
Dyes-- do you really want your kid eating dyes?-- may cause hyperactivity or allergic reaction, may not. Good bit of contention there. Certainly not going to improve their health.
And, of course, more sugar.

Now that you've read a page largely beating up on sugar you may want to read this quick series of quotes on "Why is too much sugar bad for you?"
Sadly only small mention is made of inflammation. That can be found here, and here.

Bonus link: Wonderful piece on America's other drinking problem.

Thursday, August 8, 2013

Before Your Heart Attack
8 Potential Predictors of Future Cardiovascular Disaster

In the months, and perhaps years, leading to a heart attack there are signs your heart health may be headed down the wrong road.

1. Erectile dysfunction (ED)

Erectile dysfunctional men aged 40-49 are twice as likely to develop heart disease.
The retrospective Cologne study found two out of three men treated for cardiovascular disease had suffered from erectile dysfunction, usually for years, before being diagnosed with heart disease.
Narrowing and hardening of arteries leads to decreased flow to the penis. As these are smaller arteries than those at the heart, they may show signs of disease early.
What do these  have in common:  Obesity, Smoking, High Blood Pressure, Diabetes, High Cholesterol, Lack of Exercise?
They are all risk factors for both ED and heart disease.

Side note: Depression is linked to high cortisol levels. This raises blood pressure and heart rate and could lead to heart disease. Heart disease correlates to ED. Depression correlates to ED and heart disease.

2. Snoring and Sleep Apnea

Plus he gets a video of the entire night!

Snoring is caused by airway obstruction. In sleep apnea breathing actually stops briefly.
Either way, less oxygen to the blood means less oxygen to the heart.
Have severe sleep apnea? You are three times as likely to die of a heart attack within 5 years.

3. Swollen legs/feet

When you remove your socks does your calf look like it's been strangled by argyle?
Swelling from fluid retention (Edema, or oedema to our Brit cousins. Ain't American English grand?) in regard to heart disease occurs because a) the heart is not pumping strongly, b) the feet are furthest from the heart, and c) the fluids that should be carried away pool.
There are many causes of edematous extremities from clots to medications.
What's causing yours?

Bonus: A simple test shows whether your leg circulation is adequate. This is of particular interest in diabetes.

4. Gum disease

Looks like novelty store hillbilly teeth.
Is poor circulation a cause of gum disease, or does gum disease allow infection leading to heart disease?
Either way it's a curious sign of potential heart trouble to come.

5. Arrhythmia-- Irregular heart beat

Your heart is racing or plodding, pounding, or skipping beats.
Coronary artery disease  is the main cause of arrhythmia, and the leading cause of death in the US. (Sleep apnea is also a cause of arrhythmia.)
As blood vessels narrow the heart receives less blood flow, weakens, and an electrical system failure occurs resulting in irregular contractions.

6. Angina-- Weight on your chest

Frank Henry Netter: The superlative medical illustrator.

Angina is a temporary decrease of blood to the heart. It is triggered by exertion and relieved by rest.
It is usually a symptom of coronary artery disease.
Angina feels like a chest constriction or pressure. It can also feel like indigestion or pain in the jaw, neck, upper back, or  arm.

7. Dyspnea--Shortness of Breath


Shortness of breath in heart disease occurs because the heart can't properly fill and empty. This causes increased pressure on blood vessels of the lung.
A doctor once told me he uses spirometry because it is an excellent baseline indicator of health.
That sentiment is borne out here with the sentence, "shortness of breath was a significant predictor of death from cardiac causes, as well as death from any cause." And here, "Vital capacity is a predictor of death from respiratory and cardiac disease and abnormal spirometry is associated with an increase in 'all-cause' mortality."

8. Insomnia

Watch the clock. That always helps.

During the weeks before a heart attack patients report unexplained bouts of insomnia.
Is it the stress of chronically poor sleep that leads to high blood pressure and increased heart rate?
A recent study of 54,000 makes the connection here, though no one is going out on the cause and effect limb yet.

ED gets smirks and snickers. But it is serious business. With that in mind...

A man goes to his family doctor to get a Viagara prescription. Doctor says, "You're fifty pounds over weight,  have high blood pressure, diabetes, and angioplasty last year.
I'm not going to give you Viagara!
That would be like putting a new flagpole on a condemned building!"

Argentina best look out for their condemned buildings.

Thursday, July 25, 2013

Sleep On It

5 Sleep postures affect your health

Most patients in my clinic receive advice on sleep posture. I want them to put the six to eight hours they sleep to use healing, not exacerbating the condition for which they came to me in the first place.
1. On back. Arms to sides.
This is anatomic position, though applied to supine (face up) sleeping for our purposes.
Stand naturally/relaxed. Your arms are at your sides. No  head tilt. Feet are approximately at shoulder width. Exactly the position most recommended for spinal health.
Yep. That guy's naked. Let's try to be adult about this.
In this position there is muscular balance: no tension here, relaxation there. The spine isn't contorted. Joints aren't tensioned. Pillows are available to maintain the cervical curve. If those are not used, pillows should be thin enough so as not to bring chin toward chest to maintain the above position.
For those with low back complaints and also to aid in maintaining this posture, a pillow or bolster placed beneath the knees to slightly elevate is also a common recommendation.
This is most often my recommendation for a sleep posture. But one posture doesn't fit all.
If you snore, or-- worse-- if you have sleep apnea, this posture should be avoided.
On his back? Check.
2. On back. Arm(s) up.
Look at Snory up there. Right arm up. Put your arm up like his. Do you feel the tension that creates? Now hold that position for an hour. No, don't do that. Aside from muscle imbalance-- tension here, relaxation there-- the humerus is forced forward. For some, this will place unwanted traction on  nerves and vessels. The position above is actually an orthopedic test position for thoracic outlet syndrome.
Still a good position for the spine.
3. Side-lying
Over half of us sleep on our sides. This isn't bad-- but it can be.
I tell my side sleepers to try to keep as close to anatomic position as possible. That means pillows sufficient to keep the head/neck in a neutral position and arms as near as possible to the body's sides. It can be tough.
This is a good position for snorers. Spinal curves are maintained. Sleeping on the left may help relieve heartburn (If you have heartburn we need to do more than change your posture at night.)
But then there's troubles. Most will do one of several things. Roll shoulder in with arm out or down, or elevate shoulder with arm up or out. For arms up, see above.
The rolled shoulder bit is something I encounter continuously. It is often apparent on visual exam. The sleeper has trained their shoulder to be dysfunctional. The sleeping position becomes the default waking position. The scapula rides high and loses motion. The humeral head is rolled forward and inward, making the biceps groove face inward. This can lead to or worsen any of the following which motivates our sleeper to see me: decreased shoulder motion, shoulder pain, painful arc syndrome, bursitis, tendonitis, tender points and/or trigger points, thoracic outlet syndrome.
And what to do about legs? For those with hip or pelvic problems this can be a poor choice position.  For them I recommend a pillow between the knees to approximate anatomic position. A body pillow can help as well, for both arm and leg placement.
4. Prone
No, no, no.
Stomach sleepers do all sorts of contortionist tricks. The most obvious and universal is their head has to turn to one side. If they want to breathe.
Today's tip for happiness: Do NOT image search "fetus".
On your side with knees slightly bent is good. Drawing your knees up to your chest is not. Unless you're still a fetus and then congratulations on your strides in literacy.
In the womb you had no need for spinal curves. Now life without them is pain. Also, ma was giving you your oxygen. Sleep like this now and you restrict deep breathing.
Over the years I have been asked repeatedly to recommend beds/pillows. Can't do it.
Those with low back problems often find the harder the better. Many will sleep on the floor when pain is acute. Some stiffen their bed by placing a board under the mattress. Some travel with their own pillow-- often found after much trial and error.
There is no simple answer. No golden rule.
Having said that, I will now shill for the mattress/pillow makers.
They say replace every five to ten years. Broad range. Not helpful.
If your mattress is no longer supporting you, no matter whether soft or firm, it is time to part ways.
Take your prospective new sleeping partner for a spin. Try them out right there in the store.
Buying a mattress is akin to buying shoes. You have to try them on and see how they fit.
For all the hokey my-life-was-changed-by-my-new-mattress commercials, there really and truly is something to it.
Doubt it? Sleep on this for a month and get back to me.

Thursday, July 11, 2013

9 Meds To Kill Your Memory

They come in on a string of medications. The older ones carry a list of their medications in purse or wallet. And they are forgetful. They have "senior moments". 

Memory loss isn't an inevitable consequence of aging. If ma or pa are getting forgetful, consider their medicine burden.  After all, 7 of 10 Americans are on a medication of some sort. Meds such as...

Zocor, Crestor, Lipitor, et al.
Statins lower cholesterol. They are among the most prescribed drugs in the world.
Cholesterol is absolutely necessary for your existence. Monkeying with your cholesterol has undesirable consequences including memory loss.
A study here found that 75% of statin users "experienced cognitive ADRs (Adverse Drug Reactions)determined to be probably or definitely related to statin therapy". And, notably, the FDA has required labeling to include memory loss warnings since 2012.

Wonder why folks choose the sunny summer and tropical locales for vacay?

Amitriptyline/Elavil, Nortriptyline/Pamelor, Desipramine/Norpramin, and other tricyclic antidepressants.
These are currently among the most prescribed meds in the US.
These drugs block serotonin and norepinephrine which are necessary to modulate memory formation.
This migraine brought to you by your painkiller.

Hypertension drugs
Metoprolol/ Lopressor/Toprol, Propranolol/Inderal, and other beta blockers.
Used to treat high blood pressure and arrythmias, but also to treat  migraines, chest pain, and glaucoma.

Gambling. The perfect partner to inappropriate sexual behaviour.

Parkinson's disease drugs-- dopamine agonists
Ropinirole/Requip, Apomorphine, Apokyn/Pramipexole, Pramipexole/Mirapex
Used for Parkinson's disease, but also restless leg syndrome. The wide range of side effects includes, curiously enough, inappropriate sexual behavior. I doubt being unable to remember the behaviour will be a benefit.

Antianxiety drugs-- benzodiazepines
Alprazolam/Xanax, Diazepam/Valium, Triazolam/Halcion, Lorazepam/Ativan,  Midazolam/Versed, Chlordiazepoxide/Librium and others
Used to treat anxiety, but also muscle spasm and insomnia.

Old line antihistamines
Diphenhydramine/Benadryl and others.
While used to treat allergies,  they may also be used for nausea, vomiting, or insomnia.


Sleep disorder drugs-- nonbenzodiazepine
Eszopiclone/Lunesta, Zolpidem/Ambien, Zaleplon/Sonata
Another class linked to curious and undesirable side effects beyond memory loss. You may recall these as an additional Kennedy curse.

Antiseizure/Nerve pain drugs
Gabapentin/Neurontin, Carbamazepine/Tegretol, Levetiracetam/Keppra, Topiramate/Topamax, Pregabalin/Lyrica, Valproic acid/Depakote and others
They were a hit as antiseizure meds, and now they've gained new life as nerve pain meds and to treat bipolar disorder.

Poppy seed bagel anyone?

Opioid painkillers
Fentanyl/Duragesic, Hydrocodone/Vicodin, Hydromorphone/Dilaudid, and Oxycodone/OxyContin/Percocet.
If you missed it, the feds have been cracking down on opioids for some time. Opioid overdose deaths have increased nearly 500% in one decade among US women.
Like others on this list they interfere with messaging within the brain.

Bonus edit: http://web.mit.edu/newsoffice/2013/neuroscientists-plant-false-memories-in-the-brain-0725.html



Friday, June 28, 2013

Five Benefits of Rocking a Beard


Used to wear one only in winter-- helped prevent wind chap while skiing. Now it's on full time and no more razor burn.
But there are other reasons. And so I give you...

Will this be the only ridiculous beard pic? No it will not.

This my take on an article by  K. Aleisha Fetters

Even their guitars are sunproof.

Basal cell carcinoma is the most common cancer. 1 in 5 Americans will develop skin cancer. Most lesions occur above the shoulders.  UV rays take the blame.
Beard pro-tip:  Grow a neck-beard for maximum coverage.

Nose ring optional.

2.  No-blemish skin
A top reason of mine.
When you ditch the razor you skip the rash and cut down on acne and folliculitis. Shaving is a great way to spread bacteria around and infect follicles.
See? No blemishes.

3. Beards are Butch
I only know one man named Butch. While he has a pretty tough history, he wears no beard.
Nonetheless, apparently both sexes perceive the bearded as more masculine than the shorn.
 "..an intermediate level of beardedness is most attractive..." (Sorry, no blemish dude. You're doing it wrong.) and "Masculinity ratings increased linearly as facial hair increased, and this effect was more pronounced in women in the fertile phase of the menstrual cycle..."

Seems to've worked for this guy.

4. Moisturized
This one plays to me again. I used to hate wind chap when skiing.
This is all about sebaceous glands. These glands are at the base of the hair follicle. They secrete fatty sebum which keeps the skin moist and so protects. A beard keeps sebum in place like kudzu keeps dirt on a bare slope.

Bare slope.

5. Pollen trap
You blow your nose after a manly day tossing hay bales and what comes out is enough to start a garden. Nose hairs (with an assist from mucous) works that well.
And so does your beard.
How do bees collect pollen? They wallow in the stuff and collect it on the tiny hairs of their tiny bee appendages. Your beard is like that, catching and keeping pollen and dust out of your face-holes.

Works for the ladies, too.

For the most erudite and exciting musings on pollen/allergies ever written on this blog, page down a couple posts.

And one man's solution to the high costs associated with shaving.