Dr. H on Food, Medicine and Life

2008 Archives

It's been a rough year financially, and we're exhausted after a seemingly interminable political election, so let's recreate ourselves during this brief holiday respite with rest, relaxation, maybe some exercise or outdoor activities, perhaps a couple of trips to the stores to scoop up post-Christmas bargains, some great movies, books, shows and plays, some good eating, and above all, time spent with cherished friends and family.

Thanks go out to you, my faithful blog-readers, radio listeners, podcast down-loaders, patients, and friends who have so buoyed me with your enthusiasm for my message of health in 2008. I promise to emerge reinvigorated at the end of a short holiday hiatus with more great health stories and news of vital breakthroughs, bringing you the same critical perspective on "Intelligent Medicine" that has been my trademark for all these years.

Meanwhile, I'm about to go down to the radio station to record some great new music bumpers which I ripped from my music collection to share with you when Health Talk begins its 21st season in 2009. I hope that you'll enjoy them. I also have about a dozen new movies to see over the next week or so. Frost/Nixon was great, by the way, I recommend it highly.

May the coming year bring you health, happiness, success, love and sustenance!

"Vitamin Supplements No Magic Bullets Against Prostate Cancer"

"Vitamins Not Helpful In Preventing Prostate Cancer"

"Study Finds Some Prostate Cancer Supplements Possibly Harmful"

And even this one from the usually more temperate Tara Parker Pope at the New York Times:

"News Keeps Getting Worse for Vitamins"

MY entire professional career--and that of hundreds of sincere and conscientious doctors and scientists--is about alerting people to the benefits of supplements . . . so how can that entire body of work be dismissed so casually with a snarky statement like "News Keeps Getting Worse for Vitamins"?

The major networks gleefully pounced. I was dismayed to watch Tuesday's evening news. Predictably, ABC, NBC, CBS dumped on the whole concept of vitamin supplementation, when the JAMA study in question was confined to a pair of nutrients in the context of one medical condition. No attempt was made to balance the presentation by mentioning that thousands of studies continue to underscore the benefits of supplements.

"This is just the latest in a string of disappointing news about vitamin pills, a nearly $8 billion industry," smirked Dr. Jonathan Lapook, the CBS Evening News medical correspondent. He neglected to mention that pharmaceutical drugs, by comparison, are more like an $8 HUNDRED billion industry, and that a mere $8 billion would barely cover the tab for direct-to-consumer drug ads designed to convince the public that they need to take medications for newly made-up conditions.

Big pharma pushing for healthy people to take drugs? No problem. A dismal history of drug safety, with major recalls and black box warnings being issued practically every month? No problem.

So given that the press is biased and blandly conformist, how about a little "Fairness Doctrine" when it comes to supplements? Equal opportunity. Consider writing headlines like: "Drugs Fail Again to Prevent Cancer"? "Medicine Stymied in Efforts to Cheat Death with Magic Bullets"?

Maybe that's why people are turning away in droves from traditional media, and using more niched news sources like radio talk shows, cable news stations, and the internet.

And amidst all the bad press, are Americans fleeing the "irrationality" of taking supplements? Hardly. Hot on the heels of Tuesday's downer headlines, it was announced this week that a new survey documents the popularity of alternative treatments. More than one-third of U.S. adults and nearly 12 per cent of children use alternatives to traditional medicine, according to a large federal survey that reveals how entrenched acupuncture, herbal remedies and other natural therapies have become. The survey was compiled and released by the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM).

The finding was immediately greeted with derision by such conventional medicine stalwarts as pediatrician Seth Asser, who harrumphed: "In addition to the fact that these things are unproven and potentially dangerous, they also feed the mentality that you can forego proven treatments in favor of these magic potions."

Translation: "You people are just scientifically-illiterate boobs! Toss those worthless supplements and just take your medication!"

So what're the implications of the current SELECT Study that demonstrated no benefit for selenium and vitamin E in prevention of prostate cancer? Well, for one thing, it does not, as the headlines claim, portend the death knell for chemoprevention via supplements. Testable hypotheses abound, and more research needs to be done, for example with vitamin D in the prevention of cancer. Or, consider the plethora of plausible protective nutrients like EGCG from green tea, or SGS, DIM and I3C from cruciferous vegetables, lycopene, and many more, that deserve full consideration in double-blind, placebo-controlled trials.

Trouble is, SELECT cost taxpayers $112 million dollars, and bucks like that are not going to be easily forthcoming in the current fiscal climate. But think of the savings to our health care system if inexpensive, safe nutrients could supplant exorbitant drugs for disease prevention. Trouble is, the financial incentives lie heavily in favor of the BigPharma giants.

One other facet of SELECT has not been aired in any of the press accounts. The Journal of the American Medical Association, in attempting to explain why previous studies showed dramatic benefits of vitamin E and selenium, and the new studies show none, suggests--get this!--the future IMPOSSIBILITY of doing good prostate cancer prevention trials!

Why? The JAMA editorial states that, because prostate cancer is now so avidly screened-for and so aggressively treated, it has become impossible for us to ever determine the effect of protective nutrients or drugs. We have transformed the natural disease of prostate cancer into a mere blip on a PSA, or a microscopic nest of cells on a biopsy. How many of these early-detected prostate cancers would have their progression averted via nutrition or designer drugs will become impossible to determine, because we now indiscriminately treat at the drop of a hat!

Since the medical establishment decries vitamins as worthless, are standard treatments for prostate cancer very effective? Au contraire. The very same week the JAMA study came out, the New England Journal of Medicine argues for a wait and see approach for most men with early prostate cancer as young as 65. Why? Because the adverse effects of the current therapies for prostate cancer (radiation, surgery, and hormones) may outweigh their often equivocal survival benefits.

So let's keep some perspective here. What a topsy-turvy world we live in when our health care system is faced with the imminent threat of catastrophic financial collapse, and our press is urging us to turn away from the very nutritional supplementation that may be our last best hope for prevention!

The term "Twinkie Defense" refers to the defense strategy adopted by White's attorneys when he was tried in 1979. It has come to mean any obfuscatory legal machinations used by unscrupulous attorneys to distract a jury from the salient criminal facts.

It was never contested that Dan White killed Milk and Moscone; but his defense attorneys argued that he was, to employ a legal term, of "diminished capacity" at the time of the crime. Evidence was marshaled during the trial to show that he was depressed, as evidenced by his departure from his usual clean-cut appearance into slovenly, bearded, unkempt habits; careless eating, involving sugar and fast food; and estrangement from his wife and family. Psychiatrists testified that he might have "snapped" and that he was incapable of premeditation.

The jury bought it. Instead of the death sentence for 1st degree murder sought by prosecutors, he was convicted of manslaughter and sentenced to a relatively light 8 year prison term.

The outrage over his lenient sentence was so great among the gay community of San Francisco and its supporters that the city exploded into civil unrest, called the White Night Riots. Later, critics of White's light sentence coined the derisive term "Twinkie Defense."

Turns out, Twinkies never figured in the trial testimony. Rather than attempting to suggest, as alleged, that "The Twinkies made me do it", defense attorneys briefly alluded to White's poor diet to underscore that he was not his usual buttoned-down, fastidious self.

Compounding the dismay of Milk's admirers, White was released from prison after a mere five years. But he did not "walk" scot-free. Two years later, he was dead, a suicide.

As a side note, Hostess Twinkies occupy a special place in my own personal bio, because, for about five consecutive years, when I was in elementary school, my mom would prepare a special bedtime treat for me: a Hostess Twinkie and a glass of milk. Mmmmm . . . I can still taste it. It was Heaven. Sometimes, I would get a pink or white Hostess Snowball--remember those? Or one of those chocolate Hostess Cupcakes with a white squiggle on top--oh YEAH!

Now, while my behavior was somewhat obstreperous as a kid, I did not descend into a life of criminality. But all that sugar, hydrogenated fat and preservatives--who knew in those days?

Turns out that the Milk case wasn't the last time that fast food was fingered as an incitement to murder. Years later, once again in California, a McDonald's employee, using an Uzi submachine gun, a shotgun, and an automatic pistol, murdered 21 people in what came to be known as "The San Ysidro McDonald's Massacre". He was killed by police, but his widow attempted to sue McDonald's, because, she alleged, he was under the influence of junk food at the time. Specifically, MSG added to Happy Meals was said to be the culprit. Additionally, it was charged, the killer had high levels of lead and cadmium in his body on autopsy--allegedly the result of inhaling fumes in the McDonald's kitchen.

But when it turned out the San Ysidro shooter had worked as a professional welder prior to frying burgers at McDonald's, the case was dismissed on insufficient grounds.

Notwithstanding the dubious provenance of the Twinkie Defense, there exist mounds of evidence linking poor diet to criminality and mental problems. Lack of essential fatty acids figures prominently in impulsivity, attention deficit disorder, and bipolar disorder. Additionally, studies confirm that kids exposed to high levels of lead while being fed a nutrient-depleted diet are more prone to delinquency.

One of the great books on this subject is "Crazy Makers" by Carol Simontacchi. There's also an excellent scene in the movie "Supersize Me" in which film-maker Morgan Spurlock visits a school where cafeteria reform dramatically impacts discipline issues and academic performance.

In a study of around 3,000 men and women over the age of 75 (average age 83), ginkgo failed to slow the progression to cognitive impairment. At the start of the study, which lasted 6 years, most of the subjects had normal memories, with just over 400 suffering from "mild cognitive impairment." The papers screamed: "Ginkgo of no value in Alzheimer's." The implication: "Just stick to your 'effective' drugs."

Problem is, that's not what the study showed.

First off, NO drug has been shown equal to the task of preventing memory deterioration in NORMAL subjects, so no drug is superior to ginkgo in this regard. Drugs approved for treatment of Alzheimer's like Aricept and Namenda work only transiently, for a few months at best, in staving off symptoms of moderate to severe Alzheimer's Disease.

This has been a source of controversy in Britain, where the National Health Service has (rightly) denied coverage of Aricept for mild memory loss--imagine the hit to the socialized medicine health care budget if every Brit with a "senior moment" would clamor for the drug! Outraged patient advocacy groups haven demanded the government rescind the ban.

Incidentally, the authors of this JAMA study were brain researchers with known financial ties to pharmaceutical companies that make Alzheimer's drugs.

Selective amnesia? Numerous studies substantiate the benefits of ginkgo, a powerful circulatory enhancer and antioxidant in ESTABLISHED dementia. Proving it does not halt the progression toward Alzheimer's is not the same thing.

Personally, I prefer Huperzine for cognitive support. The ancient Chinese remedy, a derivative of club moss, works like medications by enhancing brain levels of acetylcholine.

Other supplements proven to forestall cognitive decline include:

o Vitamins B12 and B6, and Folic Acid

o Omega 3 fish oil (especially DHA)

o Pycnogenol

o Blueberry

o Curcumin

o CoEnzyme Q 10

o Acetyl-l-carnitine

o Vitamins C and E

o Phosphatidylserine (PS), glycerophosphatidylcholine (GPC), and phosphatidylcholine (PC)

o Epigallocatechin Gallate (EGCG)

o Resveratrol

WebMD: Statin Benefits Patients With Low Cholesterol

USA Today: Study: Statins Help People with Normal Cholesterol, Too

Business Week: Crestor Study Will Boost Statin Demand

"It's a breakthrough study, it's a blockbuster. It's absolutely paradigm-shifting." Steven Nissen, MD, Cleveland Clinic

With raves like these, what are the chances that you'll eventually have to relent, and join the headlong stampede to statins?

Let's look at the facts.

First, the idea of using highly sensitive C-reactive protein (Hs-CRP) to predict heart disease risk is not new. In fact, you probably heard it here first, on Health Talk, at www.drhoffman.com, and in my books starting with Intelligent Medicine in the early 90's. In 2006, in How to Talk to Your Doctor (About Complementary and Alternative Medicine), I called for the inclusion of Hs-CRP in the routine assessment of cardiovascular disease risk. I have routinely employed the test for over a decade with patients at the Hoffman Center. All the while, the medical establishment saw fit to dismiss the test as "experimental".

That is, until last week. When Hs-CRP's wagon became hitched to marketing statins to millions of additional Americans, it suddenly became "legit."

What is the Jupiter Study? As reported in the media, it showed that, even in people with LDL cholesterol less than 130, those heretofore considered "safe" by current standards, the cholesterol-lowering drug Crestor produced an astonishing 44 per cent reduction in cardiovascular events (heart attacks, unstable angina, stents, and bypass surgery) in just 1.9 years of use. The results of the trial were so good that the study was halted after less than two years even though it was scheduled to run for five. The response to Crestor was so good, it was deemed unethical to deprive study participants of its benefits.

What gets lost in the hoopla is that Crestor worked well only in those with an Hs-CRP of 2.0 or greater. Hs-CRP is a marker of inflammation of the coronary artery walls. I have long contended that the way statin drugs work is not so much by lowering cholesterol, but via a super-aspirin effect. And that's what the Jupiter study has established. The anti-inflammatory benefits of statins are there for those with high Hs-CRPs, even if cholesterol is normal.

What about absolute numbers in the Jupiter study? Surely, a study of over 18,000 people world-wide, costing millions of dollars (incidentally, underwritten by Astra-Zeneca, the makers of Crestor!) has to be the final word, right?

Forty-four per cent reduction in cardiovascular events! Sounds pretty good, until you eyeball the statistics. The actual number of events went from 136 in those not on Crestor, vs. 77 in those taking the drug. That's an absolute risk reduction from 1.8% to 0.9% -- LESS THAN ONE PER CENT! Translated, that means that only 1 out of 120 people in the study achieved benefit from the medication. Would not the same benefits be accrued from just taking low-dose aspirin? And at $3.45 per day for Crestor, would not aspirin be more cost-effective? And since Hs-CRP is easily modified by natural approaches that I've been employing for years with my patients, are statins always called for?

So what happens now? Will millions of Americans with normal cholesterol now go on Crestor or other statin drugs, "just in case?" Why not?

Since this trial was halted shy of two years out, we just don't know the long-term effects of Crestor administration. One thing that struck me about the study after reading it carefully is that, even in its short duration, trial doctors reported a whopping 270 cases of diabetes in patients taking Crestor, vs. 216 in those on placebo. Arguably, the study could have been halted early for ethical reasons to protect participants from developing diabetes! But the emphasis was on the benefits of Crestor, not its potential downsides.

Now imagine tens of millions of Americans taking powerful drugs like Crestor for decades in hopes of averting cardiovascular disease. (Forget, for a moment, the monumental cost). Recall instead that a couple of years ago, an intense debate raged over whether Crestor should be BANNED. The worldıs leading medical journal, the Lancet, editorialized that Crestor was too powerful, had too many side effects, and was just another me-too drug in a crowded field of safer statins, concluding it should be banished from the formulary of Britain's National Health Service.

By dramatically lowering cholesterol in people whose cholesterol is already normal, or even low, might we not risk a whole slew of unanticipated consequences? Muscle aches, liver problems, fatigue, memory loss, dementia, insomnia, and impotence are already counted among statins' side effects.

Could preventive cardiology take such a massive wrong turn? Easily. In the short-sighed, head-long pursuit of profits, haven't we sent our financial institutions into a tail-spin? The same can be said of our medical system. In years hence, when the health of Americans collapses, and our overburdened health care system bankrupts itself, the analogy will be made manifestly clear.

(In my next blog, I'll talk about all the natural ways we can lower Hs-CRP without resorting to statin drugs)

So, as promised, here are some proven natural ways to lower HS CRP:

LOSE WEIGHT. Excess body weight, particularly around the mid-section, is associated with elevated HS-CRP. In the Jupiter Study, around 75% of the participants were overweight. Could it be that HS-CRP is simply a marker for being out of shape? And that a concerted program of weight loss could have averted a statin prescription in the vast majority of at-risk participants?

EAT AN ANTI-INFLAMMATORY DIET. High-glycemic index carbs like sugar and refined starches have been shown to increase HS-CRP. So ditch them in favor of good quality protein and healthy fats. Dietary polyphenols and bioflavonoids found in Technicolor fresh fruits and vegetables, olive oil, spices, dark chocolate, tea and red wine tamp down inflammation. Avoid hydrogenated fats, refined vegetable oils, and stock up on nuts like walnuts, and fish like salmon, which are rich in Omega 3ıs. Come to think of it, sounds a lot like the Salad and Salmon Diet!

EXERCISE. Regular exercise lowers HS-CRP. Try for at least a half hour of aerobic exercise five days a week.

DE-STRESS. Stress and anxiety literally have a ıblood-curdlingı effect: they raise levels of inflammatory cytokines.

SLEEP. Sleep deprivation has been shown to raise HS-CRP. Since 1900, we sleep, on average, two hours less than our pre-electric age ancestors. Jet-lag, shift-work, and even changing to daylight savings time in the spring all increase the risk of heart attacks.

TAKE MAGNESIUM. Magnesium deficiency has been shown to raise HS-CRP.

TAKE A MULTI-VITAMIN. Itıs not clear what nutrients or combination of nutrients do it, but multi-vitamins have been shown to lower HS-CRP.

GET YOUR D CHECKED. Deficiency of vitamin D is associated with higher levels of inflammation. These days, most of my patients are safely taking at least 2000 IU of Vitamin D3.

TAKE A FISH OIL SUPPLEMENT. In addition to eating Omega 3-rich fish, take an EPA/DHA supplement daily.

TAKE PHYTOSTEROLS. Plant phytosterols have been demonstrated to lower cholesterol, as do statins. But do they also lower HS-CRP like statins? Turns out yes! Take supplements containing plant phystosterols like Advanced Cholesterol Support from the Vitamin Shoppe. Nuts, beans and avocadoes are great natural sources, too.

So, as promised, here are some proven natural ways to lower HS CRP:

LOSE WEIGHT. Excess body weight, particularly around the mid-section, is associated with elevated HS-CRP. In the Jupiter Study, around 75% of the participants were overweight. Could it be that HS-CRP is simply a marker for being out of shape? And that a concerted program of weight loss could have averted a statin prescription in the vast majority of at-risk participants?

EAT AN ANTI-INFLAMMATORY DIET. High-glycemic index carbs like sugar and refined starches have been shown to increase HS-CRP. So ditch them in favor of good quality protein and healthy fats. Dietary polyphenols and bioflavonoids found in Technicolor fresh fruits and vegetables, olive oil, spices, dark chocolate, tea and red wine tamp down inflammation. Avoid hydrogenated fats, refined vegetable oils, and stock up on nuts like walnuts, and fish like salmon, which are rich in Omega 3's. Come to think of it, sounds a lot like the Salad and Salmon Diet!

EXERCISE. Regular exercise lowers HS-CRP. Try for at least a half hour of aerobic exercise five days a week.

DE-STRESS. Stress and anxiety literally have a "blood-curdling" effect: they raise levels of inflammatory cytokines.

SLEEP. Sleep deprivation has been shown to raise HS-CRP. Since 1900, we sleep, on average, two hours less than our pre-electric age ancestors. Jet-lag, shift-work, and even changing to daylight savings time in the spring all increase the risk of heart attacks.

TAKE MAGNESIUM. Magnesium deficiency has been shown to raise HS-CRP.

TAKE A MULTI-VITAMIN. It's not clear what nutrients or combination of nutrients do it, but multi-vitamins have been shown to lower HS-CRP.

GET YOUR D CHECKED. Deficiency of vitamin D is associated with higher levels of inflammation. These days, most of my patients are safely taking at least 2000 IU of Vitamin D3.

TAKE A FISH OIL SUPPLEMENT. In addition to eating Omega 3-rich fish, take an EPA/DHA supplement daily.

TAKE PHYTOSTEROLS. Plant phytosterols have been demonstrated to lower cholesterol, as do statins. But do they also lower HS-CRP like statins? Turns out yes! Take supplements containing plant phystosterols like Advanced Cholesterol Support from the Vitamin Shoppe. Nuts, beans and avocadoes are great natural sources, too.

"I walk." That's a phrase that I've also come to greet skeptically. I hear that countless times in response to my query "Do you exercise?" whether on the air or in my office.

Consider the following:

Some of you may consider me an accomplished "jock" because I'm always exhorting you to swim, bike, run, and, yes, I'm an "older" athlete at 56. As many of you know, I just completed my comeback from a devastating hip fracture by completing the Mighty Hamptons Triathlon.

I just checked my time for that event, a respectable three hours eighteen minutes, and was stunned and a little humbled by my performance relative to my "elder" peers. I was actually in the lower quartile of my age group (55-59), with top competitors besting me by nearly three quarters of an hour!

As I scanned successive age groups, I was further demoralized when I noted that for each subsequent age group, 60-64, 65-69, and even 70-74, there were contestants who beat my time, albeit fewer and fewer. (I drew some minor consolation from the times of some 20- and 30-somethings who turned in worse performances than me)

On this last weekend's edition of Health Talk, I featured the story of 81 year-old New York City Marathon contestant Joy Johnson. I ran the NYC Marathon in 1991, and it was an exhilarating experience, but the obsessive emphasis on running that marathon training dictates made it my last. If I'm gonna be out there for hours at a time, I'd rather vary it between swim/bike/run.

Joy began running at 58 (!) and has gone on to compete in 21 consecutive New York City Marathons. She told the Wall Street Journal before the race: "I've told my friends if I die here on this track, do not call 911 because I do not want to be revived. I say, wait a half hour, maybe 45 minutes, then call the mortician. That's the way I want to go."

Luckily, the mortician didn't get that call. Joy Johnson completed the race in 6 hours and 15 minutes and was fine. As of this writing, two other marathon contestants, one aged 58, succumbed to their exertions.

So why pursue lifelong exercise? Studies show that moderate exercise, like walking and doing light housework and gardening is superior to sedentary lifestyle--it confers modest cardiovascular benefits.

But losing weight--not just averting the inexorable weight gain that occurs with aging--requires intense exercise, especially for middle-aged women. This includes heavy housework (like scrubbing floors and cleaning windows, which is mostly out-sourced these days); intense yardwork (chopping wood, digging holes, sawing trees); running or fast-jogging; biking on hills; swimming laps; competitive tennis; aerobics; or fast dancing.

The same distinction between casual exercise and intense conditioning shows up in a recent study of the effects of activity on cancer risk: only women performing high levels of exercise enjoyed protection from breast cancer (30% risk reduction!).

So whatever you're doing, set more ambitious goals, and ramp it up. The marathon's not for everyone, so find your outlet for peak performance that matches your capabilities and doesn't invite injury. Get supervision from your doctor if you have a health problem or are unclear about your cardiac risk.

What a strange juxtaposition! Several hundred doctors gathering to learn about the latest techniques in detoxification, held in a town where everyone is hell-bent on getting maximally polluted!

To get to the lecture halls and exhibits, you had to traverse a windowless casino full of typical revelers, smoking, gambling, drinking, and eating a variety of unwholesome foods. Many appeared vitamin D deficient from hours of playing blackjack or the slots--outside, the sun shone brightly, but inside the gaming halls the lights were perpetually dimmed: 24/7, gamblers relentlessly stoked their dopamine receptors. Wonder what PET scans of these people's brains would've revealed!

While we ACAM docs talked about cancer and heart disease prevention, fellow occupants of my hotel were busily acquiring these diseases. Particularly alarming was the number of overweight folks--not just those carrying a few extra pounds, but truly morbidly obese. At times, a dozen or so behemoths would be in view, lumbering painfully across the casino or perched precariously on stools in front of video poker or blackjack screens, looking like patients in the waiting room of a gastric bypass surgeon.

Then I noticed something peculiar. Uniformed security guards carried the usual radios, handcuffs, but also--I couldn't believe my eyes!--stethoscopes. And for good reason: heart attacks and sudden deaths are probably as common as jackpots in the casino. I saw this painfully confirmed when I watched one of these guards escort a disasterously inebriated, reed-thin woman of 60 (or it may have been 45?) off the gambling floor. She looked as sallow as if she had not consumed a fresh fruit or vegetable in the last 20 years.

All was not lectures and hard work. We celebrated ACAM's 35th anniversary with a great party whose featured guest was Suzanne Somers. Suzanne is a serious champion of alternative medicine, and she gave a great speech praising us holistic docs for having the courage to buck the system and offer natural alternatives to patients like her.

I was privileged to be the emcee of the event, and gave a short talk. My theme was the impending crash of our "over-leveraged", wasteful, inefficient, and toxic medical system.

I made the point that, just like our financial system, our medical system is headed for imminent collapse. But, just like Wall Street, conventional medicine is lurching drunkenly along, and will not be fundamentally reformed until it founders. "People," I said, "Don't expect either of the current presidential candidates to deliver a brand new health care system by December, 2009 like a shiny new Christmas toy!"

Rather, the solution lies with innovative preventive and treatment strategies offered by doctors, now far in the minority, who practice complementary and alternative medicine. That's why ACAM has survived for 35 years, and despite attacks from conventional medicine, why doctors like us will be ready with a "bailout" when our once-vaunted medical system becomes unsustainable, and is powerless to halt the progressive deterioration of Americans' health--a crisis that will make today's financial meltdown look like a mere blip.

(More on some of the highlights of the Fall ACAM meeting in later blogs, plus fabulous pictures of the banquet with Suzanne Somers!)

Monday, Oct. 6, AP: Pope Benedict XVI says the global financial crisis shows the futility of money and ambition.

"He who builds only on visible and tangible things like success, career and money builds the house of his life on sand," the pontiff says.

"We are now seeing, in the collapse of major banks, that money vanishes, it is nothing," the pope adds.

Benedict says "the only solid reality is the word of God."

Hmmmm. The ULTIMATE de-leveraging.

The whole thing hit me like a tsunami this week as I watched Fox Business and tallied my paper losses. As if on cue, my sinuses had a liquidity crisis. My immune system got a margin call.

"Could the Pope be right?" I thought, as I sat congested in temple during High Holy Day services last week. Diversification is said to be the key to a balanced portfolio. Accordingly, I was weighting the spiritual sector of my personal "holdings."

The money part was headed for what the financial analysts like to call "an inflexion point." How far down no one knew. The physical part was reeling from a hard-charging rhinovirus.

So I was praying. Not for success in investment (too late for that), but for insight into how to better help my patients. Unlike finance, that's something at which I have a chance at a modicum of success.

On Saturday morning, I was cheered by a great article in the New York Times Magazine by Michael Pollan, who, in a letter directed to the next President of the United States ("Farmer in Chief" ), details a plan for reforming America's agricultural and food policies.

Why is this important when so much else is threatening the future of our country, and indeed, the world?

Pollan makes the point that our approach to food is integral to our survival. We need to change our food system because modern high-tech agribusiness fosters our dependency on oil, contributes to global warming, and even makes us more susceptible to terrorism. Not to mention that food subsidies underwrite the production of the cheap, plentiful junk food that undermines the health of Americans and threatens to tank our health care system.

Just like we've blundered into an over-leveraged financial system, we've opted for an expensive, wasteful, and ultimately precarious food production system. The solution is to return to basics: local production, natural fertilizers and feeds, and sustainable agriculture.

The public also needs to be better educated about good food choices. Pollan even urges that five acres of prime White House lawn be consecrated to a "Victory Garden" like the one started during WW II by Eleanor Roosevelt.

I agree that the next President needs to prioritize our food supply, or else, if and when the market recovers, we will be headed for a environmental/health/energy/entitlement perfect storm that will make the current credit crunch look like a temporary blip. Our very survival depends on this.

So let's de-leverage. Maybe the present crisis offers us a unique opportunity to pause and regain our sobriety, and prevent our headlong rush into a toxic future.

Forty-eight hours later, my cold was just a memory.

Despite the bailout now being hammered out by Congress and the Administration, we're in for some rough sailing. We'll need to scale back our over-inflated expectations as the mess gets sorted out.

When it comes to health care, don't expect a shiny new Christmas toy come Inauguration Day in the form of a streamlined, revamped, equitable, accessible health care system. No matter who wins, the grandiose plans touted by the presidential candidates will be pared back by the reality of a sputtering economy. Military expenditures, financial bailouts, and ever-escalating medical costs will conspire to gut proposals for meaningful health care reform.

Amid the financial melt-down that our country is experiencing, let me offer some silver-lining observations:

With declining prospects for windfall profits on Wall Street, maybe, just maybe, some of our most talented young people will stop opting for quick-buck careers in banking and finance. Instead of coming up with ever-more arcane and insubstantial financial instruments, perhaps our talented youth will use their brains to train for jobs as engineers to fix our crumbling infrastructure or solve our energy and environmental problems; become teachers, a once revered career path that is increasingly eschewed for better-paying options; get involved in public service or government to help turn the country around with idealism instead of greed; or, become health professionals in less well-reimbursed areas like holistic primary care.

Just like our financial system, our health care system needs fixing. Will it require a Wall Street-like collapse to make that crystal clear? It's clunky, expensive, inefficient, inequitable, ineffective, and dangerous. To rev profits, it emphasizes high-tech and BigPharma fixes to address health problems better addressed with diet, nutrition, and gentle, natural techniques. Maybe the ever more likely prospect of imminent financial shortfalls will get America focused on a "Bail-Out Plan" for medicine that emphasizes prevention and natural approaches.

What can you do in the meantime? While your financial portfolio may be suffering, there's nothing to prevent you from strengthening your health portfolio. After all, as bad as the current monetary crisis is for many Americans, it's nothing compared to a personal health crisis (I'd take a hit to my Lehman Brothers stocks any day over my devastating hip fracture a couple of years ago!)

This is a great time to solidify your diet and exercise program, and take advantage of the relative bargain of consulting a complementary health care practitioner to highlight potential health liabilities and beef up your supplement program. Since there are NO safe havens for your surplus cash these days, what better place to invest it than in something over which you have some measure of control: your own health!

Although it was my fond wish to eventually participate in another triathlon, I had no idea at that time whether my leg would heal completely. There were some good signs: prior to my rod removal, my affected leg was progressively less stiff and painful, and I had begun cycling and running, albeit a little conservatively, so as not to risk inflammation and muscle strain. Therefore, I was all the more shocked and disappointed when the second surgery last fall dealt me a big setback.

One year later, this Sunday, at age 55, I completed the Mighty Hamptons Triathlon 2008, in a stunning vindication of the powers that God and Nature grant us for recuperation. The story below:

First of all, what is a triathlon? This emerging sport was featured for only the second time in this year's Beijing Olympics. It involves a 0.9 mile swim, followed by a 24 mile bike ride, and culminates in a 6 mile run. Champion athletes complete this in less than two hours.

Variations from the Olympic format include sprint and youth triathlons, which are shorter, and increasing distances up to and including the full Ironman Triathlon (2.5 mile swim, 115 mile bike ride, and 26 mile run).

Since my first Olympic distance triathlon in 1990, I've done several, including the 2005 Mighty Hamptons Triathlon in which, at 52, I equaled my personal best time established when I was 39.

Crazy as it may have seemed at the time, this spring, after recovering from my second hip surgery, I began to entertain the idea of doing a comeback triathlon. So, without great fanfare or hoopla, I signed up for the September 14 event, knowing full well that if I wasn't ready, I could quietly bail without loss of face.

I trained hard over the summer, complementing progressively longer run, bike or swim workouts with strength and flexibility workouts at the "Y" with my personal trainer. I kept mileage on the injured leg within reason, staying attuned to soreness or weakness. Month to month, my stamina and endurance improved.

Race week approached, and I was psyched. I obsessed over the extended weather reports, which kept changing from sunshine to rain, and then to "chance of rain." The weekend of the Sunday event, three thirty-something racers converged on my Hamptons home which turned into a triathlon base camp. Saturday involved tuning up our equipment, doing some warm-ups, and carbo-loading.

We turned in early to prepare for the 6:40 AM race start, and I set my alarm for 3:30 AM! When I woke up, I was dismayed to look out into the pitch darkness and see rain pelting down onto my deck. I was 100% sure that the race was going to be a washout, attended only by some obsessed hammer-heads. I wasn't going to be one of them.

As my fellow racers woke up, we peered at each other apprehensively, and shook our heads. But then the rain let up a little, and we decided to head over to Sag Harbor, at least to do the swim, even if the land parts of the event were to prove a washout. As we arrived at the race site, the sky opened up and we sat in our cars doubtfully watching the deluge pound our windshields.

But then there was a let-up in the rain intensity. Other athletes appeared to be foolhardy enough to attempt to race, and so we unloaded our bikes and headed tentatively over to the transition zone. Before I knew it, I was in my wetsuit, and clambering out into the water with scores of other swimmers. "Was this a good idea?" we were asking each other, with gallows humor. Someone pointed out a VERY dark squall line looming on the horizon

A loud horn sounded, and we were off, in the familiar confused melee of churning swimmers that characterizes the mass-start of a triathlon. I kept my cool, though, and deliberately charted a path through the thrashing competitors.

About half-way through the swim, I realized that the onrushing dark clouds had opened up a torrent of rain. I thought to myself: "OK, sky, get it over with, because the only place to be in these weather conditions is UNDER the water." Sure enough, by the time I emerged from the swim and headed for the bike transition, the clouds had wrung themselves out, and we confronted wet roads, but only a light rain.

By the time I was on the bike, I was relatively enjoying myself, surrendering myself to the mass hysteria of hundreds of oblivious bike riders challenging the elements. The course was a little slow as we braked cautiously to avoid spin-outs on the slippery hairpin turns. Amid the warm temperatures, the cool rain actually felt refreshing.

Finally, the bike split was over, and I parked my bike in the water-logged transition area and launched into the run. This was the supreme test of my recently repaired leg, and as I loped off I was attuned to signs of impending trouble. To my relief, as in my longer training runs, my hip performed perfectly, and I focused on enjoying the long slog and taking encouragement from spectators who gathered along the race course.

After a seeming eternity, the finish line loomed, and I kicked toward the tape with all that my legs and my lungs had left in them. The thirty-somethings had long completed their race, and they and the non-racers of my entourage congratulated me.

Winded, soaked, and little sore, but not destroyed, and charged with endorphins, I headed back home for a hot shower and lots of nutrient repletion, a restorative nap, and some veg time on the sofa channel-surfing the Sunday roster of football games and news.

Afterward, my co-racer houseguests acknowledged that, had it not been for the group dynamic, individually we would each have turned over in bed and bagged the race on that rain-sodden morning. But, in the end, we were all glad that we had done the event.

Thanks are in order to the race organizers and Southampton Town police who did an excellent job of averting mayhem under inclement weather conditions; to my friends and family who offered encouragement; to my orthopedic surgeon, Dr. Dean Lorich at the Hospital for Special Surgery; to Victor, my personal trainer at the Vanderbilt "Y"; to my many listeners, patients and other well-wishers who buoyed my recovery; and to God and Nature for the healing reprieve granted to me after my accident in May of 2006.

(Check back for pictures of the event that we will post as soon as they become available)

Unfortunately, the WSJ didn't see fit to publish my letter, so I'm reproducing it in its entirety below

Letter to the Editor WSJ Re: Bookshelf by Scott Gottlieb "Herbal Legends" Trick or Treatment, by Simon Singh and Edzard Ernst, M.D.

August 19, 2008

I was disappointed to read Dr. Scott Gottlieb's uncritical review of Trick or Treatment. This book appears to be the latest in the genre that debunks alternative medicine written, not by actual practitioners of natural therapies, but by "authorities" with a Quackbuster agenda.

It is disingenuous to allude to the infrequent harms associated with alternative medicine when it is well-documented that hundreds of thousands of Americans die in hospitals each year from adverse reactions to FDA-approved drugs properly administered by licensed medical professionals, and untold millions of Americans have adverse reactions to FDA-approved drugs.

Evidence-based studies tell us that antibiotics make little difference in treating bronchitis, sinusitis, and childhood ear infections. Aggressive strategies to control diabetes with drugs control blood sugar but yield little benefit in mortality. Today's hallowed drugs and heroic interventions are too often quickly relegated to medicine's junk heap.

No wonder that Americans turn to alternatives, which are not, as Singh and Ernst dismissively allege, just well-administered placebos. Moreover, studies show that most consumers of complementary medicine do not dangerously eschew conventional treatments--they simply want to access the best of both worlds.

Natural therapies are notoriously difficult to validate in traditional study settings. While Dr. Gottlieb states "the evidence of clinical trials is largely ignored when it comes to alternative medicine," are multi-modal interventions involving diet, supplements, physical manipulation, and lifestyle amenable to the randomized double-blind placebo controlled model engendered by drug trials? Medicine's slavish adherence to inappropriate evidence criteria could impede acceptance of much that is valuable in the altmed armamentarium.

It is unfortunate that, at the very historical moment when our costly, ineffective, and side-effect laden medical system threatens to founder, ideologues like Singh and Ernst are foreclosing what well might be conventional medicine's best option for avoiding meltdown: incorporating safer, low-tech, relatively cheap therapies, and empowering patients toward enlightened self-care.

Ronald L. Hoffman, MD New York, NY

Merck has been aggressively marketing this new vaccine for Human Papilloma Virus, even lobbying state legislatures to mandate the vaccine for all girls age 9 and above (I guess that's when they think girls start to become sexually active these days!).

The theory is that we can eradicate the scourge of cervical cancer by innoculating ALL girls against HPV, the main cause of pre-cancerous transformation in cervical cells. The argument is even being made that, while we're vaccinating our young girls, we might as well give shots to the boys, because, after all, they can be carry the virus and sexually transmit the disease.

But this effort to add yet another required vaccination to the long list to which our kids are subjected is fraught with drawbacks--and perils.

Not the least of which is the unwillingness of some parents to acknowledge that their adolescent girls will imminently engage in sexual activity. When proposed government mandates take effect, ALL girls will get the vaccine, regardless of whether theyıre having sex. In the government's cynical view, there's no telling when your little girl will become active, hence the attempt to vaccinate young grade school girls. Imagine the pre-teen discussions this will prompt at Brownie troop meetings or in cafeteria lines!

The vaccines are expensive, costing around $360 for the 3-shot series (no wonder Merck is pushing this!). Side effects range from sore arms, and low-grade fever and malaise to paralysis and death in a few tragic cases.

The New England Journal's editorial is entitled "Human Papillomavirus Vaccination--Reasons for Caution." Their main point is that the vaccine program is a big experiment with our kids as guinea pigs. While the vaccine does prevent SOME forms of HPV, incredibly there are NO long-term studies that show it actually reduces the incidence of cervical cancer--the prime rationale for the expensive and potentially hazardous universal vaccination campaign. This is terrible science!

Why should a vaccine that's been shown in experiments to prevent HPV infection NOT help to prevent cervical cancer? The Journal article points to several reasons:

1) Just like the flu vaccine, the HPV vaccine is only effective against certain strains, but not all, of the disease-causing virus. Sure, we could modify the vaccine every year to head-off new or resistant strains of HPV, but that's exactly what we try to do with the flu shot, sometimes with poor results.

2) One of the consequences of the vaccine campaign might be to make women (and men) less careful about unprotected intercourse, thus actually increasing the risk of cervical cancer due to resistant HPV or chlamydia, another suspected trigger of cervical cancer risk. Increased unwanted pregnancy, other sexually-transmitted diseases, and even HIV might be the unintended consequences.

3) Similarly, falsely reassured that they are "bullet-proof", some vaccinated women might skip annual PAP smears, which clearly ARE helpful in catching cervical cancer before it spreads.

4) Since the vaccine is new, it's unclear how long it confers protection. Ten years? Twenty? Are there variations in women's immune systems that make the vaccine "take" longer in some women, and wear out in others? We simply don't know!

5) Are there other, as yet unrevealed consequences of the Gardisil vaccine? Might it have suppressive effects on immunity--since we know that normal exposure to infections entrains healthy immune systems to respond better to infections and cancer? Again, unknown territory.

6) Is the cost of the vaccination program justified? Surely, some would argue, if we could save even just a few lives, aggressive measures are justified--no? But what if a national program to "eradicate" HPV were to cost--let's just say--$18 billion (do the math--that's the cost of vaccinating just one generation of 50 million young girls and boys!)? Wouldn't it be more prudent and cost-effective to embark on a national campaign to provide PAP smears (average cost $100) to all eligible women?

Folks, this is nuts! Even the usually complicit New England Journal of Medicine is saying hold on:

"With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs. Instead, we should concentrate on finding answers through research rather than base consequential and costly decisions on yet unproven assumptions."

Right on, New England Journal!

As we waited by the checkout register, I watched the cashier scan the dozens of grocery items we were buying. It was all done by computer, effortlessly, efficiently.

Then a thought occurred to me: All the nutritional information for each product has been compiled somewhere: its caloric value, carb, sugar, fat, protein and fiber content, even the vitamin/mineral breakdown, and probably even its ORAC value, preservative and artificial ingredient content, even levels of hazardous mercury. Perhaps there's even a way to compute nutrient density, a reasonable proxy for foods' nutritional value.

So . . . theoretically at least, it would be possible for the grocery store to provide each departing shopper with, not just the price total for their day's purchase, but also with its caloric value, and the nutritional composition of the food they're buying.

Suppose then, that the purchases could be linked to voluntary demographic data about the characteristics of the purchasers and their family: family size and composition, activity levels, height and weight of individual family members. Maybe, even, an anthropometric measurement portal through which each shopper could pass and record height, weight and body composition and metabolic rate!

There might even be a special "Aoooogah" klaxon that would sound when the shopper exceeded the reasonable caloric allocation for, say a family of four with few metabolic demands because of a sedentary lifestyle!

Exhortative messages might be given to shoppers like: "We notice that you have purchased 21,347 calories of food today. At this rate, the average family of four should subsist for at least four days. If your family consumes all this food in three days or less, we suggest that you either (a) increase your household's metabolic rate with a concerted program of exercise for all family members, or (b) delete some or all of the following items from today's shopping list: soda, cookies, candy bars, M & M's, pretzels, chips, and/or frozen pizza.

Now taking this one step further, a totalitarian government of the future might decide to harness this technology to impose healthy guidelines on its recalcitrant citizens. Wait, this isn't so far-fetched, even social democratic Japan has enacted new regulations to assure a fit, non-obese population--employees now are required to queue up at work to be weighed and to have their waist-lines measured. The reason: health care entitlements are going through the roof, and the government has a stake in curtailing medical expenditures associated with diseases of excess. Can't happen here? Teachers tell me that they are now required to calculate the BMI's of their students and make a report to parents when they exceed a certain threshold!

Such a government regime might install software at the checkout counter that actually prevents citizens from exceeding nutritional guidelines. Over-consumers would literally be flagged down at the cash register, and prevented from committing dietary malfeasance. How might the ingenious shoppers of the future circumvent the new nanny states' tyranny?

Overweight shoppers desirous of obtaining their sugary snacks would be reduced to the stratagem used by generations of high school kids trying to pay winos a few bucks to obtain booze for them.

Someone who has expended their caloric quotient for the week, languishing unhappily in front of the PriceChopper display window, would go up to someone of healthy weight and body composition--say, a competitive cyclist stopping off at the market to buy some broccolini and a bottle of Evian--and enlist them to sneak out a box of contraband Oreos.

Just like environmentally-compliant utilities selling carbon credits, healthy consumers could sell "junk" credits to gastronomes trying to circumvent the calorie controls imposed by the food police. A lively junk-trading market might emerge on the internet of the future--with abstainers saving up fat and sugar credits and engaging in spirited arbitrage.

Anyway, interesting speculation to idle away a few leisure minutes while on vacation. Don't worry, it'll NEVER happen. Markets would never accede to alerting customers to the nutritional perils of the food they're buying. Look how long it took to get them to list hydrogenated fat. They fought tooth and nail, and to this day, the disclosures remain misleading.

Now, the Iron Man comprises a marathon run, but only as the dessert, after a main course of a 2 1/2 mile swim, followed by an incredible 112 mile bike ride.

By contrast, the Olympic distance triathlon that will be featured in the Beijing Olympics comprises a one mile swim, a 25 mile bike ride, and a six mile run. That's the event that I've done several times.

On race day, we were woken up at the crack of dawn by inspiring rock music emanating from the bandstand at the race start on the other side of Mirror Lake. Family members and friends had gathered to support the race of David Cowan, age 31.

The starting cannon roared, and the swimmers churned the water like a school of piranhas jockeying for position on the fresh water lake. In the days before the race, I had plied the swim course, and found it one of the smoothest most delightful swim experiences of my life, after remorselessly orbiting in chlorinated pools and in choppy ocean waters.

After two circuits, contestants transitioned to their bikes, but the sky opened up with a punishing downpour that lasted the entire race. Incredibly, David maintained his pace, and as he passed our cottage a couple of times we tried to buoy his soggy spirits, but he appeared undaunted and flashed us the V sign.

Incredibly, the oldest contestant was a 71 year old who has done 31 Iron Man competitions so far. Many competitors are in their 50's. Professionals complete the three segments in just over eight hours, and David did it in eleven and change, a very respectable time, and a personal best.

The course remains open from the 7:00 AM start time until midnight, allowing a few stragglers to cross the finish line to applause after an amazing 17 hours of non-stop exertion. We saw a female contestant stumble toward the finish line on rubbery legs, fall to the ground twice, and amidst roaring cheers from the crowd, get up again and propel herself forward across the line.

The sport went from a freak aberration for hammerheads to such incredible popularity that race entries sell out on the internet within minutes of opening up. There are dozens of events world-wide, and athletes frequently travel thousands of miles to compete.

For my part, I found the athletes inspiring. While I'll never do a full Iron man, I think of their incredible determination whenever I feel "gassed" while running, biking or swimming. I tasted the hills of Lake Placid on an abbreviated bike ride on part of the race course, ran around Mirror Lake for a fraction of the marathon distance, and swam the lake. And the next time I get caught in a summer rain shower without an umbrella, I'll remember those intrepid contestants going a whole day in a downpour wearing nothing but sleeveless spandex jerseys, and I'll just shrug it off.

So whatever your personal Iron Man is, whether it's committing to a 20 minute mall walk three times a week, or trying a fifteen mile bike ride, or running on the treadmill for a couple of miles while listening to a podcast of Health Talk, be inspired and BRING IT!

First, I found out that the word "Adirondack" is a name given to the local Indians by other, neighboring tribes of ancient Native Americans. Translated, it means "bark eater," and the moniker was coined in recognition of local tribes' tendency to subsist on tree bark during the annual winter-spring famine. In commemoration of this, there is a Bark Eaters Inn northeast of Lake Placid.

And you thought you were being virtuous having that whole wheat bagel for breakfast! It took a lot of chewing to release the meager carbohydrate content of the tree bark--talk about low glycemic index foods! That's some real fiber!

There's more from a nutritional perspective: Jacques Cartier was the first intrepid explorer to visit the region in 1535. When he and his men were threatened with scurvy, local Indian guides told them to make tea from the arbor vitae plant, a common decorative that adorns many suburban driveways and perimeters. It turns out that arbor vitae is rich in vitamin C and polyphenols, like the French maritime pine, the source of modern pycnogenol. Hence the name arbor vitae, which means "tree of life."

WARNING: Don't try this at home. I read this in a history book, and haven't field-tested brewing tea out of my landscaping, and the neighbors would freak if I started gnawing my prized paper birches.

Additionally, one of the major impetuses to settlement of the Adirondacks during the "Gilded Age" (1875 to 1910) was health. The AIDS of the nineteenth century was tuberculosis, with even less prospect for cure. A doctor named E. L. Trudeau (hopefully no relation to modern scam-artist Kevin Trudeau) discovered that a couple of patients with terminal TB seemed to get better when transferred from the grimy cities to the open air of the Adirondack Mountains.

This set off a wave of health tourism to the pristine country. Health resorts and sanitariums sprang up around Saranec Lake, which enjoyed a brief economic boom around the turn of the century. Special rail lines were built to bring urban refugees up to the mountains.

Patients would typically recline for hours in Adirondack chairs on the verandas of stately hotels. They would talk, read newspapers and books, play cards, and dine on nutritious food in giant communal dining halls. Their main occupation was to inhale as much fresh, pine-scented air as possible, sometimes for weeks and months at a time. No one knew precisely how this was supposed to help them.

Now we know that one of the key benefits of getting out of the dark, polluted cities and into the sunlight was boosting levels of vitamin D, since ultraviolet light exposure triggers D synthesis by the skin. And new studies suggest that D enhances immunity overall, in particular resistance to the tuberculosis bacillus.

In fact, ancient archaeological digs in Turkey provide a clue to this phenomenon. Researchers report that Turkey was one of early man's first migration destinations after our origins on the sunny African savannah. Turkey is colder, more mountainous, and further from the equator than the African cradle of mankind.

Human remains discovered in Africa are free of evidence of TB infection. By contrast, bones from the Anatolian plateau show evidence of ancient tuberculosis. The suggestion: early man migrated from Africa to Asia Minor, put on furs, huddled in shelters against the cold, had fewer high UV index days, made less vitamin D, and developed a nasty propensity to one of the earliest diseases of "civilization," since humans originally evolved to walk naked in the tropical sun.

At any rate, a handful of TB sufferers got a reprieve in the fresh air of the Adirondacks, but many fared no better--maybe it was the modest Victorian clothes they always concealed their skin with.

It took an additional century for the therapeutic benefits of vitamin D to be appreciated. Now we can test levels of D and administer concentrated vitamin D supplements, and no less importantly, we can administer powerful combinations of drugs to reliably vanquish the ancient scourge of TB. Today, we just have to worry about cancer, heart disease, diabetes, autoimmune diseases, and osteoporosis, modern plagues which vitamin D could help to eradicate.

New guidelines posted yesterday by the American Academy of Pediatrics promise a bonanza for the failing pharmaceutical industry (Today, Merck, faced with unexpected resistance to its much vaunted Gardasil vaccine to prevent pre-pubescent girls from getting HPV infections, was down-graded by stock analysts).

Pediatric statins are the worst idea since those chocolate cigarettes they used to give us as kids!

Tara Parker Pope reports in the July 8, 2008 NY Times: "While some doctors applauded the idea, others were incredulous . . . 'To be frank, I'm embarrassed for the AAP today,' said Dr. Lawrence Rosen of Hackensack University Medical Center in New Jersey, vice chairman of an academy panel on traditional and alternative medicine. He added: 'Treatment with medications in the absence of any clear data? I hope they're ready for the public backlash'."

The new guidelines call for kids to be screened, as early as two where family history warrants, but no later than ten years of age. Low-fat diets are to be implemented "with two per cent milk" for kids with high cholesterol. But most controversial are the recommendations that call for powerful cholesterol reducing drugs to be used in the following cases:

Kids with LDL cholesterol greater than 190. But that's not all.

Kids with LDL cholesterol greater than 160 if any other risk factors are present like overweight, high blood pressure, family history of heart disease, or cigarette smoking [Junior's hooked on Camels, so make sure you put Zocor in his lunchbox!]

ALL children with diabetes whose LDL is greater than 130!

These ham-handed guidelines will insure that millions of kids are enrolled as lab rats in an experiment of unprecedented proportions!

While statins can help a limited number of older people with demonstrable cardiovascular disease, their use to prevent disease in otherwise healthy individuals is a total EXTRAPOLATION (Translation: a wild leap of faith). They seem to work best in people with high calcium scores or angina, after a heart attack, bypass or stent, and in middle aged men.

NO research shows they work in children, and it would take fifty years of careful study in thousands or even millions of kids to prove they provide one iota of benefit.

Cholesterol is actually essential for the developing brain. The brain is largely composed of cholesterol. Even in adults, a connection has been demonstrated between higher cholesterol--especially HDL--and better brain function. Whatıs bad for the ticker is good for the brain. Children's brains are rapidly growing and forming new nerve connections, and limiting cholesterol, either via an ultra-restrictive low-fat diet or through artificial cholesterol blockade might have unforeseeable effects on brain development.

Additionally, cholesterol is the building block for all the body's sex hormones: testosterone, estrogen, progesterone, DHEA, and even the adrenal hormone stress hormone, cortisol. Imagine the potential effects of limiting the availability of these on a child's normal maturation!

Not to mention the wide variety of statin side effects already recognized in adults that might take new, troubling forms in immature bodies: liver problems, muscle pains, mood and sleep problems, and memory deficits, to mention just a few of the more common ones.

And, since statins deplete CoEnzyme Q 10, which has a wide gamut of functions in cells, why aren't AAP pediatricians calling for universal prophylactic administration of supplemental CoQ 10 to those hapless children who will be exposed to statins' onslaught on their immature bodies? One of the theories behind susceptibility to autism is that it's a mitochondrial disease, and that's what Co Q 10 specifically governs.

Don't get me wrong--we should care about our kids risk of future disease--they're the future of our country, and unfortunately, of our stressed-to-the-breaking point health care system. High cholesterols should be just one of many warning signs that kids need corrective action, but not with drugs of unproven efficacy and safety. Meanwhile, kids with obesity, sedentary lifestyles and early tendency toward high blood pressure and diabetes should be targeted with boot-camp programs for risk reduction. I'd rather see public monies be expended on decisive lifestyle turnaround targeting kids (and their enabling parents), rather than creating a huge, unaffordable new drug entitlement so eight year olds can get statins.

The AAP pediatricians who promulgated these guidelines are either fat-heads ( a compliment, really, since the brain needs fat and cholesterol!), or else they themselves are suffering from statin-induced encephalopathy. At this early juncture, efforts to disclose that they are on the take from drug companies have yielded no obvious signs of unsavory ties, but just wait. Following the money trail recently revealed huge conflicts of interest on the part of researchers promoting powerful drugs for children with the newly-minted diagnosis of "childhood bipolar disease".

The new cholesterol guidelines and statin recommendations for kids are just typical of the paint-by numbers, mechanistic approach we take to medicine today.

The surgeon, the caller stated, had told him to "stop all his vitamins" preparatory to surgery. "Whatever you're taking, just get off it," the surgeon had told his patient.

Additionally, the caller wanted to check with me if what the surgeon recommended he take was correct. For post-surgical pain, the surgeon prescribed the medication Celebrex, a non-steroidal anti-inflammatory drug (NSAID), also known as a COX-2 inhibitor.

I told the caller that I disagreed with the surgeon on both counts, on the issue of the vitamins, as well as on the medication.

I wrote an entire chapter in my recent book "How to Talk With Your Doctor" on the role supplements play in enhancing surgical recovery. I point out a few instances of supplements that might be inadvisable in some surgical settings, and I provide a detailed list of helpful supplements, with scientific references.

I also have a section on this website entitled Supplements for Surgery in which I list supplements that are appropriate for surgery. Additionally, I formulated Advanced Systemic Enzymes specifically to treat trauma and inflammation--it's ideal for pre- and post-surgery. My experiences detailed on my Hip Blog are a testament to the healing power of nutrients for me personally when I made a comeback from two orthopedic surgeries.

The surgeon's ignorant ban on pre-surgery nutritional supplementation flies in the face of his surgical training, where nutrition is emphasized for proper healing. Like many doctors, he's poisoning the well for patients desirous of helping to facilitate their healing process.

But what ticked me off even more was the surgeon's misplaced recommendation that the patient take the anti-inflammatory Celebrex at the time of shoulder surgery. He should know his own surgical literature better.

In research presented at the June 25, 2004 meeting of the American Orthopedic Society for Sports Medicine in Quebec City, it was demonstrated that NSAIDs interfered with healing when given to rats who underwent rotator cuff surgery. The research was performed at the Hospital for Special Surgery in New York City.

Rats were divided into three groups, and then given either indomethacin, Celebrex, or no treatment at the time of their operations. The investigators found that the tendon to bone healing in the rats treated with the two drugs was "distinctly less robust" than in the control group. I'm not a surgeon, and even I know that! http://www.scienceblog.com/community/older/2004/4/20043531.shtml

Folks, here's an example of how obsolete medical beliefs prevent patients from receiving state-of-the-art medical treatment. "Intelligent Medicine" means deploying the best of high-tech medicine together with the best of natural therapies in pursuit of clinical excellence. Nixing supplements and prescribing counter-productive medication, as this surgeon did, is just bad medicine. Some of you may not believe this, but I hate it when I'm right about doctors giving the wrong advice, because it means that a lot of people out there are suffering because of medical bum steers.

(Not to mention that a high percentage of rotator cuff surgeries are unsuccessful, and leave the patient with residual pain and immobility. Many shoulder problems can be alleviated with a proper program of physical therapy or acupuncture, teamed with the right program of supportive nutrients.)

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Russert was one of over 300,000 Americans who die each year of "sudden cardiac arrest" out of hospital. Of these, only a handful can be resuscitated, and even fewer survive. CPR was administered when Russert collapsed during a taping at the NBC Washington Bureau studios, followed by unsuccessful attempts at defibrillation when the EMTs arrived.

Monday morning quarterbacking is hard in these cases, and to suggest that Russert or his doctors were somehow remiss is disingenuous. But inevitably, we search for meaning in this seemingly senseless tragedy. Many folks Russert's age are inevitably asking themselves "Could this happen to me? What steps can I take to avoid this fate?"

The facts are these: Fully one half of people who suffer sudden cardiac death have no warning signs. One quarter of heart attack patients don't even make it to the hospital; a third eventually die, despite the best medical ministrations. So the best way to survive a heart attack is to avoid getting one in the first place.

I think in wake of the Russert death there will be a surge of interest in the EBT heart scan, now a proven way to demonstrate calcium in the coronary arteries which is strongly correlated with heart attack risk. New studies demonstrate its efficacy in picking up heart disease long before it's detected in standard exams like stress tests.

But the biggest risk factor for cardiovascular disease is the metabolic syndrome. This creates the "perfect storm" for a heart attack. Too often ignored until it's too late, if you possess three of five indicators of metabolic syndrome, your chance of heart disease increases a whopping 274%. The risk factors, some of which were clearly in play for Russert, are: 1) Fasting blood glucose greater than 100; 2) waist circumference equal to or greater than 35" for women and equal to or greater than 40" for men; 3) HDL cholesterol less than 50 for a female, or under 40 for a male; 4) triglycerides greater than 150; 5) blood pressure greater than 130/85.

Drugs help with some of the manifestations of metabolic syndrome, but it's not how low you go with blood pressure or cholesterol . . . it's how you get there. And getting there with good diet, exercise, and supplements like fish oil is clearly preferably to artificially manipulating endpoints with drugs.

Russert was returning from a whirlwind vacation in Italy, taking advantage of the short hiatus between the primaries and the long Presidential campaign ahead. He was said to have just gotten off a plane with around two hours of sleep. Studies show that hours of sitting on transoceanic flights can literally thicken the blood, resulting in "economy class syndrome", or dangerous blood clots. Bad air, bad food, and high levels of stress hormones, or caffeine could have further enhanced his risk.

And here's one other point to ponder: Russert was inflamed. Like many overweight people on high-glycemic index diets, he suffered from joint problems, and was recently seen on crutches during his testimony at the Scooter Libby trial. The inflammatory cascade is a hallmark of the metabolic syndrome, and it contributes to inflammation of the coronary arteries and unstable, ulcerated plaque. Inflammation can be measured with the highly sensitive C-reactive protein test, and is a major risk factor for heart disease and coronary events.

Additionally, Russert may have inadvertently compounded his risk by treating his pain with a non-steroidal anti-inflammatory drug (NSAID) like Motrin or Alleve. Prescription NSAIDs like Celebrex and Vioxx have been implicated in increased risk for thrombotic events like strokes and heart attacks, and their less potent over-the-counter cousins have the same pro-clotting effects.

Whatever the facts, I'll be missing an old friend who used to keep me company while I rode my stationary bicycle or jogged on the treadmill watching "Meet the Press" on Sunday mornings.

The caller asked me what natural things he could take to alleviate his chest discomfort. My response was geared less to supplements he might use, but rather on the need for immediate medical attention. While "no insurance" often means foregoing optimal preventive medical care, clinics at city hospitals and at university medical centers are good places to go to enroll in low cost clinics if health problems become critical. But the system still needs a lot of fixing.

On the other hand, would access to unlimited medical care and prescription drugs improve the lot of Americans? It's simplistic to think so. Underscoring this is a recent Dartmouth University study that examines the care rendered to 4.7 million Medicare patients in their last two years of life. It turns that less is more when it comes to care of chronic illness.

Hospitals that treated patients more intensively and spent more Medicare dollars did not get better results. Aggressive care was not better care. More tests, more medications, and more doctors actually worsened the prognosis of many patients and accentuated their suffering at astronomical costs to the system. At this rate, Medicare will become unsustainable in a few years, much less universal care.

A similar study just out showed, counter-intuitively, that more intensive drug therapy to normalize blood sugar did NOT extend the lives of diabetics.

What an impressive rationale for examining low-tech, low-cost, gentle, natural health care interventions to save our medical system. What presidential candidate will have the guts to buck the medical-pharmaceutical complex and entitlement junkies to propose that we change the way we do medicine in this country? Or, as in the energy sector, will we have to wait for the medical equivalent of $10 per gallon gas before we challenge the current paradigm?

"What you see in meat eaters - -especially beef eaters -- is a lot of internal anger, fear and violence. Just look around. Pick ten people that you know who eat a lot of meat and rate their level of emotional stability, anger, fear, and violence."

"Then take ten people who are vegetarians or vegans and do that same exercise. Then compare those two groups of ten. You will find an amazing correlation. All the people who eat plant-based diets -- vegetarians or vegans -- are non-violent. They are not angry. They do not live in fear. They do not support war and violence. They do not treat others inhumanely."

"Now, compare that to meat eaters, which is what I used to be. Meat eaters are violent, and fearful. They support war. They might own many guns and like to use them. They might go hunting just so they can kill an animal and put its trophy on their wall. That is a classic behavior of meat-eating people. They support all kinds of violent acts by society."

"For example, they typically support the death sentence. They also think that animals can be treated cruelly without any real consequences. They do not believe in animal rights. They do not believe that animals really have to be taken care of. They just rather believe that humans can destroy, kill, torture and maim whatever they want -- even other humans."

"You see, their lack of compassion does not stop with animals. It also extends to other people. That is why people who eat a lot of beef and red meat also support war. They have no problem with the U.S. invading other countries, bombing civilians and killing tens of thousands of people. They have no problem with it at all as long as they can eat their steak and say, 'Oh, we are fighting for freedom.' That is very characteristic of meat eaters."

Whew! You get the idea. To support these dogmatic assertions, this health authority invokes an old theory: that of the "emotional contamination" of meat. According to this hypothesis, the terror of slaughter is somehow imprinted into the tissues of animals which are used in the domesticated food supply, and these "negative emotions" of fear and anger are somehow imparted to the human consumers of the meat.

But there is no scientific explanation for how that might happen, only the assumption of a "vibrational" transfer that defies the rules of biochemistry. When an animal dies, the stress hormones engendered by pain or injury dissipate rapidly. Also, cooking breaks down hormones and polypeptide neurotransmitters.

What about "humane" killing of animals that is practiced in kosher or Halal traditions? Does that mean that orthodox Jews and devout Muslims are more pacific than their infidel carnivores?

What about Eskimos, deemed to be among the most peaceful cultures on the face of the earth? They subsisted almost entirely on a diet of animal protein. And when their native diet was invaded by Western, non-animal foods like flour products and sugar, their rate of violence and suicide skyrocketed.

Having been a past vegetarian, in fact a practicing macrobiotic vegan, I can tell you that one can derive a certain sense of exclusivity and moral superiority from eschewing most of the foods that mainstream society indulges in. We used to call that "vegetarian hubris".

Some of my best friends and favorite patients are hunters, former military people, cops, political conservatives and foreign policy "hawks" and I wouldn't characterize them as violent or angry individuals. They are great family people, fun to be around, and can be very generous and charitable.

While one is playing rhetorical games around the theory that meat begets violence, how about these instances?

Portland, Oregon has had a rash of deer killings in a certain area over the last 2 years and police say they finally found the killer. Recently, state police arrested a 60 year old vegetarian who has admitted to the crime.

Ronald Livermore would take his 22 caliber rifle which he outfitted with a homemade silencer and shine a light in the deers' eyes before shooting them. He then left the carcasses along roadsides to rot. Police say a majority of the deer killed were pregnant or had just given birth. Livermore faces 8 charges which include tampering with evidence, waste of deer, hunting while suspended and aggravated animal abuse. I guess he didn't like meat!

One of the world's most celebrated vegetarians was Adolph Hitler. In "Hitler's Table Talk," a compendium of his conversations, he is recorded as having said:

"One may regret living at a period when it's impossible to form an idea of the shape the world of the future will assume. But there's one thing I can predict to eaters of meat: the world of the future will be vegetarian."

According to the website www.vegetariansareevil.com, the following mass murderers were vegetarian: Pol Pot, the notorious dictator of Cambodia; Charles Manson; and Ghenghis Khan. Additionally, William MacDonald, Australia's most famous serial killer, was said to be vegetarian.

Dutch vegan Volkert van der Graf was a notorious militant animal rights activist convicted in the assassination of Dutch journalist Pym Fortuyn.

From personal experience, while most of my vegetarian acquaintances are mellow and laid back, some are extremely rigid, intolerant and self-righteous.

Off all the hundreds of interviews I've done on Health Talk, the low point was an interview I conducted in the early 90's with a well-known vegan advocate, author of a popular book on how to save the planet. During the course of our conversation, which I felt was very sympathetic to vegetarianism, my guest seemed to become infuriated. While we paused for a commercial break, I asked him if anything was wrong, and he replied that I was constantly "interrupting" him. I had the distinct impression that if the phone were a gun pointed at my head, he would not have hesitated to pull the trigger.

Folks, there is no right or wrong here. All I ask is that both sides in the diet debate maintain scientific objectivity, and open their minds to the possibility that humans can subsist on a wide variety of foods, and that the ideal diet may be a matter of an individual's genetic predisposition and/or their specific health condition. Let's not confuse facts with ideology.

Now comes stunning validation of the potentially insidious effects of EMFs, especially in the young. On Sunday, May 18, 2008, Geoffrey Lean, Environment Editor of The Independent, one of Britain's leading papers, reported that women who use mobile phones when pregnant are more likely to give birth to children with behavioral problems.

This is based on a giant study of more than 13,000 children in Denmark published in the July issue of Epidemiology, a respected medical journal. It found that using cell phones just two to three times per day was associated with an increased risk of hyperactivity and "difficulties with conduct, emotions and relationships" by the time the offspring reached school age. And, more disturbing in this era where younger and younger children are being equipped with cell phones, the study found that behavioral problems were even more likely if the children themselves used the phones before the age of seven.

The scientists who undertook the study confess that they are surprised by the results, which they say were "unexpected." But Professor Sam Milham of the Mt. Sinai School of Medicine Department of Community and Preventive Medicine--chaired by Dr. Philip Landrigan, who recently pointed out the hazards to small children of pesticides residues on fruits and vegetables--says he has no doubt the results are real.

The Russians already take cell phone hazards seriously. The Russian National Committee on Non-Ionizing Radiation Protection says that use of cell phones by pregnant women and children should be "limited." The Russians equate the risk of cell phone exposure with that of exposure to cigarettes or alcohol. They conclude that children who talk on mobile phones are likely to suffer from declines in attention, diminished learning skills, and even "depressive syndromes" and "degeneration of the nervous structures of the brain."

With tragic childhood brain cancer on the rise, and unprecedented levels of Attention Deficit Disorder, Autism, Childhood Depression and Bipolar Disorder, shouldn't we be devoting more time to cell phone research?

On the Wednesday, May 21 edition of Health Talk, I chose to take a tack different than most of the media in discussing Senator Kennedy's new medical predicament. I stated that Kennedy's high public profile is likely to preclude his use of innovative cancer treatments that might offer him a real, albeit slim, chance of beating his disease.

Precisely because he is a public figure, he can't eschew the treatments proffered at Boston's prestigious cancer hospitals. Such treatment alternatives exist for brain cancer, but Kennedy's position in the limelight won't allow him to deviate from standard practice.

One such therapy is the Burzynski cancer protocol involving antineoplastons. This is not some off-shore therapy offered at an illicit medical clinic in Tijuana. It doesn't involve cobra venom, or peach pits. In fact, despite the fact that Burzynski has had to fend off government inquisitors to save his medical career, there is a phase II FDA trial underway to evaluate his treatment for cancer.

The NCI (National Cancer Institute) website even reports favorably on it: "The medical records of seven brain tumor patients who were thought to have benefited from treatment with antineoplastons were reviewed by NCI . . . The reviewers of this series found evidence of antitumor activity, and NCI proposed that formal clinical trials be conducted to further evaluate the response rate and toxicity of antineoplastons in adults with advanced brain tumors."

Accordingly, a trial is underway to assess whether the Burzynski therapy can be used to help brain cancer patients.

If you check out the Burzynski website, you can read actual testimonials of patients whose cancers responded to his protocols. This is not to say that he cures all, or even the majority, of challenging cancer cases that seek his treatment. But for many desperate patients, Burzynski has provided hope of real cure with minimal toxicity.

Read, for example, the account of Jamie Brown who was diagnosed with Glioblastoma Multiforme brain tumor. After surgery to remove the tumor in November of 2001, the tumor had recurred by January of 2002. Jamie's family explored options and decided to take Jamie to Houston to see Dr. Burzynski.

Jamie began antineoplaston treatment on January 16, 2002, and incredibly, by February 12, 2002, after less than one month on the Burzynski treatment, her tumor had disappeared completely. After follow up treatment lasting two years, MRIs and PET scans continued to show NO cancer cells.

At last report, Jamie is back at work, considered in complete remission, and has suffered no lasting side effects whatsoever from the treatment.

Or consider the case of Susan Hale. In 1997, at age 45, Susan was found to have "a brain tumor between the size of a golf ball and a tennis ball." The biopsy showed it to be a glioblastoma multiforme, grade 4. Her family was told she had "3 to 4 months to live, but this could be extended with radiation."

Gamma knife radiation temporarily halted tumor growth, but it came back with a vengeance, and Susan's family brought her to Burzynski.

Prior to initiation of antineoplaston therapy, Susan could'nt walk or stand upright, she couldn't talk, and her short-term memory was gone. After intensive therapy at the Burzynski clinic, her cancer disappeared.

Extensive physical and occupational therapy helped Susan regain function gradually. On May 13, 2000, Susan completed the 5 kilometer Revlon Run/Walk for Women. She continues to improve.

With results like these, you would think Dr. Burzynski would be a worthwhile resource to consider to offer Senator Kennedy--who many consider an irreplaceable national treasure--a chance at survival and continued productivity. But that's not how things work in America, especially when therapies lie outside "The Medical Mainstream."

An editorial in this week's (May 14, 2008) New England Journal of Medicine decries the marketing of stents directly to the American public. New "drug-eluting" stents are the latest solution to a problem frequently encountering by interventional cardiologists: the little metal coils they insert into people's coronary arteries shut down due to scarring. The medicine that the new stents are coated with medcine that suppresses the local immune response, and the stents fail less frequently.

But drug eluting stents don't come cheap: The most popular brand by Johnson and Johnson,Cypher, has a list price of $3,195 per stent (any size or length); several times the cost of the bare metal stents, which have decreased in price due to competition. In the US, an average of 1.7 stents are used per procedure, amounting to $5,400 for just the Cypher stent for every PTCA procedure. An estimated 850,00 stents are done each year on Americans, so do the math!

The New England Journal article is entitled: "DTCA for PTCA: Crossing the Line in Consumer Health Education?" DTCA stands for "direct-to-consumer advertising," and PTCA, or "percutaneous transluminal coronary angioplasty," is medicalese for stenting.

The Journal notes with some alarm that Thanksgiving 2007 heralded the crossing of a new threshold in DTCA. Until then, only drugs were being hawked on TV, on radio and in print media. But last November 22, 2007, while the turkey gravy was still literally congealing in their blood vessels, fans watching the traditional Turkey Day NFL bout between the Cowboys and the Jets were regaled by an unprecedented new ad.

Entitled "Life Wide Open" it depicts a hapless victim of coronary artery disease sitting on the sidelines while his better-vascularized friends are engaging in vigorous activities like fishing, swimming and jogging. The announcer intones: "when your arteries narrow, so does your life" and "it's time to open it." One is left with the impression that that the stent is an unqualified boon to quality of life and survival.

But the real facts, noted in the Journal editorial, are that stents have not been proven superior to good drug and lifestyle therapy in reducing the risk of death from a heart attack. And many countries that lavish fewer resources on expensive cardiac interventions have comparable or better heart survival statistics than we do in the US.

Then there are the side effects, too numerous to catalogue here, but they include sudden death, heart attack, and stroke, and the requirement that stent patients take sometime dangerous blood thinners long after their procedures.

The New England Journal did well to raise the question: do we really need to incite heart disease patients to press their doctors to unnecessarily line their arteries with titanium? What consumers really need is education about how heart disease is not just a matter of rotor-rootering with stents, or fixing with drugs, but rather that it can be addressed with lifestyle, supplements and conservative medical care.

Avosoy Complete Glucosamine/Chondrioitin: 2 twice daily

Foundation Formula Multi-Vitamin: 2 twice daily

Longevinex Resveratrol: 1 twice daily

NT Factor: 2 twice daily

Ashwaganda 500 mg: 1 twice daily

Maca 1000 mg: 1 twice daily

Ester C 500 mg: 1 twice daily

Pyridoxal-5-Phosphate (Vitamin B6) 50 mg: two twice daily

Advanced Longevity Formula (Vitamin Shoppe MD Select): 1 twice daily

MSM 1000 mg: 1 twice daily

Maxi-Gamma Vitamin E 500 mg: 1 twice daily

Vitamin D3 1000 IU: 1 twice daily

EGCG Ultra 70%: 1 twice daily

Transfer Factor: 2 twice daily

CoEnzyme Q10 120 mg: 2 twice daily

Orthomega EPA/DHA 1200 mg: 2 twice daily

DHEA 25 mg: 1 twice daily

Dr. Ohhira's Probiotics 12 Plus: 1 twice daily

Most of these supplements can be found in the Hoffman Center dispensary [http://www.drhoffman.com/page.cfm/64]

I'm not a foodie. I cook simply, mostly eat at home, rarely at restaurants, and seldom take-out food. The diet is fairly high-protein, but I treat myself to fruit and dark chocolate, and don't forego moderate amounts of whole grains, potatoes, and occasional natural chips.

Saturday:

Breakfast: Hummus on rice cake, roasted almonds, decaf coffee, dark chocolate

Lunch: Beef tacos, 1/2 avocado

Dinner: Grilled shrimp and chicken sausage, asparagus, brown rice, fresh strawberries

Sunday:

Breakfast: 3 organic eggs sunny-side up, 2 corn tortillas with butter

Lunch: Grilled Mahi, broccoli, baked potato

Dinner: Lettuce and arugula salad with tomatoes and avocado, cold turkey slices

Monday: Breakfast: Mushroom omelette, 2 corn tortillas with butter

Lunch: Lettuce and arugula salad with tomatoes and artichokes, one hamburger (no bun)

Dinner: Filet of Skate, sauteed in butter and olive oil, roast fingerling potatoes, cooked spinach, dessert of fresh strawberries and hot cocoa (dairy-free)

Tuesday:

Breakfast: Rice crackers with hommos and peanut butter, 1/2 avocado, handful of roast almonds

Lunch: Chicken Caesar Salad (skip the cheese and croutons)

Dinner: 3 Hamburgers, broccoli, fresh pineapple and blueberries, dark chocolate squares

I usually run 4 miles once or twice a week, sometimes along the East River, sometimes on the East End of Long Island where I have a house by the beach. I like running, but I keep running mileage down because, at the age of 55, I feel running is a little punishing on the knees and lower back.

I usually take a spinning class or two at the Y near my apartment, and, when out of the City, I take my custom Serotta bike down Dune Road near Westhampton, logging around 30 miles.

I enjoy swimming, so I hit the pool twice weekly for a swim of about a mile and change. That usually takes me around 45 minutes, and is a great eye-opener in the morning. When the weather warms up, I swim off the beach in front of my house (don't worry--no sharks!)

Once a week, I meet a personal trainer at the Y. I've dubbed him "The Lunge Nazi." He puts me through the paces with floor exercises, the weight machine, exercise balls, and the Bosu. Lately, I've been introduced to the 8 pound iron kettle ball, which is a great training tool. My trainer also administers a sometimes excruciating "stretch" which has helped me regain flexibility after my hip fracture.

I typically work out four to six days per week. On days when I don't work out (and sometimes after a work out), I take a brisk two or three mile walk. Conveniently, I live on East 47th St. in Manhattan, and my office is located on 6th Ave. and 27th St.--just shy of 3 miles, so sometimes I skip the subway. Additionally, I walk all over town shopping when I'm in the city--I never take deliveries. Schlepping groceries counts!

I enjoy the feeling of physical vitality that exercise imparts, plus I feel it keeps me mentally alert and banishes stress. Despite being 55 and just 2 years after a devastating hip fracture, I feel as fit as I've ever been, and I am free of chronic musculoskeletal complaints. I hope to enjoy my favorite activities for many years to come.

For one thing, substituting an herb for a standard drug isn't really holistic; in many cases, it's just surrendering to cholesterol-phobia. Drugs that lower cholesterol like Vitorin and Zetia don't actually reduce arterial plaque, according to recent studies. So why make the same mistake with an herb?

Admittedly, certain conditions call for statin drugs, like when people need protection after heart attacks. Fine. I'd rather use a standardized drug than an iffy herb if we really need to get the job done.

Red Rice Yeast contains a substance identical to the cholesterol-lowering drug lovastatin. How much is in each batch is anybody's guess--it's not carefully regulated. So if you're trying to avoid statin side effects by taking something "natural", forget about it: I've seen Red Rice Yeast cause elevations in liver function tests just like statins.

Additionally, the stuff comes from China. The Chinese have now totally blown their credibility by poisoning our pets with melamine, and most recently, our people with contaminated heparin. There are many instances where Chinese herbs have been surreptitiously laced with conventional drugs like steroids or hormones. Then there are contaminants, like arsenic, lead, mercury. I'm fed up with the Chinese.

Now comes news that certain brands of Red Rice Yeast have been deliberately spiked with lovastatin--I guess that's to make sure it assays as "potent" and it keeps customers happy with significant cholesterol drops. The FDA, even as understaffed as it is, has pulled the ticket on four Red Rice Yeast manufacturers for just this infraction. At least when Merck poisons you, you know what you've taken.

Worse news is that some batches of Red Rice Yeast have been found to be contaminated with citrinins--toxic byproducts of the finicky fermentation process by which the herb is prepared. Citrinins are potent neurotoxins--they damage the brain and the nervous system, and they can cause DNA damage.

After FDA shut down the original, reputable manufacturer of Red Rice Yeast, Pharmanex, they left the market wide open for poorly-regulated and unscrupulous manufacturers to fill the void and cash in. At least Pharmanex did their due diligence and tested and marketed a clean product, but the FDA squashed them, and hasn't been consistent in shutting down the market.

For the reasons stated, don't expect Red Rice Yeast to be around for very much longer.

Instead use niacin (under a doctor's supervision), fish oil, pantetheine, flax seed, garlic, EGCG, and a host of other agents for cholesterol-lowering and heart protection. And remember that there's NO substitute for diet and exercise.

But what is this much-ballyhooed story about? Well, for one thing, it's not new information. The study cited in the Cochrane Review of Medicine is a rehash of a 2007 study in the Journal of the American Medical Association (JAMA) that we thoroughly debunked last year.

Additionally, unlike the implication of the headlines, not all vitamins but only "antioxidants" were called into question. I put that in quotes because the tests were done on a type of synthetic vitamin E I haven't used since the 90's, a type of synthetic beta carotene I've also given up on, vitamin C, and vitamin A.

Now if I were a high school science teacher and one of my students had listed vitamin A as an antioxidant, I would have docked him or her significant points. If I were teaching a post-graduate nutrition course, I would've flunked the student.

I now use mixed tocopherol vitamin E, rich in gamma tocopherol, and in lieu of artificial beta carotene, I use natural mixed carotenoids.

By the way, the old/new supposedly "damning" study said that vitamin C had no ill effects. And selenium, zinc, lipoic acid, n-acetylcysteine, and the whole slew of antioxidants that we use in complementary medicine were not tested. Forget about the B vitamins, calcium, magnesium. And vitamin D, which is coming up HUGE in all recent studies.

Additionally, while there are hundreds of studies documenting the efficacy of antioxidants, the authors of this purportedly "unbiased" analysis cherry-picked just 67 to arrive at the conclusion that antioxidants killed people.

Were these healthy people to begin with who were done in by their vitamins? Actually, the study authors selected studies involving very sick individuals to demonstrate a slight statistical trend toward greater risk of death in vitamin takers. So this study says NOTHING about the ability of antioxidants to protect the healthy from disease or death.

Finally, the authors step over the line and reveal their hidden agenda by calling for MORE STRICT REGULATION of supplements in what is supposed to be an objective, dispassionate scientific article. This is a serious no-no in academic writing. It is tantamount to calling for a drug company to withdraw a medication if a study casts doubt on its safety--never happens!

A story like this is a great smokescreen on the very day when it is revealed that Merck deliberately covered up evidence of harm in its 2001 Vioxx trials, years before the drug was withdrawn, possibly accounting for tens of thousands of unnecessary deaths. Merck has set aside five billion dollars for settlements.

Once again, the press, conventional medicine, and pharmaceutical companies are colluding to poison the well for well-meaning supplement consumers. They would like us to refrain from taking vitamins, and just shut up and take our drugs.

I chaired a workshop on Clinical Nutrition, and gave lectures on natural approaches to Gastrointestinal Disease and Intravenous Nutritional therapy. Among the many great speakers there were Dr. David Perlmutter, Dr. Stephen Sinatra, Dr. Ken Bock, and Dr. Michael Schachter--all known to listeners of Health Talk.

Didn't get much time poolside, but I did manage a quick side trip to Sea World Orlando, where I arranged a "shark encounter" in which I was lowered in a special cage into the shark aquarium, where I got up close and personal with some toothy specimens ranging up to eight feet in length. I'll see if some of the pictures come out so we can post them on the website.

Also, I will provide exciting updates throughout the week on Health Talk on fresh new scientific breakthroughs that I gleaned from the many excellent lecturers at the ACAM meeting. Okay, excuse me now while I start unpacking and get ready for work . . .

Well, the first time I did one of those, the results were pretty scary. You got a rough approximation of a painting, but an art work it was not.

Unfortunately, the same thing is happening in the field of medicine today. We doctors are given "Paint by Numbers" guidelines, which supposedly make medical practice fool-proof. But a too-literal adherence to sometimes arbitrary guidelines results in botched results. And the disturbing part is the canvases doctors work on: People.

This came to mind the other day when I was fielding questions on my Weekend Edition of Health Talk program. A woman called for a second opinion after her doctor reviewed her cholesterol blood test and unceremoniously sent her a prescription for Tricor, a potent triglyceride-lowering medication.

The facts were these: She was 44, with no history of heart disease, diabetes or high blood pressure. She exercises heavily--four to seven times per week--and follows a good diet. There was a family history of heart disease, but hey, many parents of healthy Baby Boomers have heart problems as they get older. She wasn't overweight, but she said she could lose, maybe, ten pounds.

Now here's the clincher: Her cholesterol was 230, her HDL was 110, and her triglycerides were 116! Entirely normal numbers (although I generally like to see triglycerides 80 or less). While cholesterol was a tad high, her extraordinarily high HDL conferred major protection.

The prescription for Tricor was sent to the patient by mail, with no explanation other than highlighted "abnormal" results on her blood test. No doctor-patient dialogue had occurred. Strange that this patient, like many of my callers on Health Talk, found it easier to access ME for discussion than her own doctor!

I was astounded. What could possess a doctor, rigorously schooled for years in the nuances of physiology and therapeutics, to prescribe a potent drug to a young, healthy woman with NO risk for cardiovascular disease? The answer is: Paint by Numbers Medicine.

Don't get me wrong. The vast majority of doctors are technically adept, conscientious, and dedicated. I am in awe of what doctors do every day. I was the beneficiary of extraordinary technical expertise in the successful repair of my shattered hip a couple of years ago. Before modern orthopedics, this injury would've left me permanently hobbled.

But doctors have succumbed to misleading brainwashing when it comes to cardiovascular prevention. Scribbling the name of a drug on a prescription pad has become a short-hand for comprehensive action to prevent disease.

Lowering cholesterol has become an obsession among many of my medical colleagues. And while drugs are sometimes necessary, no data exists that confirms their benefits in healthy people--especially young women--with minimally elevated cholesterol. Tricor may occasionally be a useful option for patients who can't or won't exercise or stick to a low-carb diet like "Salad and Salmon", or won't avail themselves of natural triglyceride quenchers like fish oil and niacin. It's a drug that I have literally NEVER used, because all of my high-triglyceride patients respond beautiful to our natural approach.

And the data for Tricor is mixed: while it appears to lower cardiovascular events, most studies don't prove it helps patients live longer--which is the point, isn't it? To avoid one health problem only to succumb to another is not my idea of a successful medical intervention.

Why aren't doctors learning from the debacle of Zetia and Vitorin, two cholesterol-lowering drugs recently found to be ineffective at slowing arterial blockage?

They dramatically lower cholesterol, but that's not the point: As an editorial in the New England Journal of Medicine recently put it, "It's not how low you go, it's how you get there."

Don't settle for Paint by Numbers Medicine!

Favorite pages include this blog, our vitamin pages, and the Salad and Salmon Diet.

Also: There was a record number of downloads of our archived Health Talk radio broadcasts from www.worradionet.com

Continued thanks to our faithful internet audience who are making Health Talk and DrHoffman.com their source for vital health information. We will continue to endeavor to provide you with cutting edge health information . . . keep visiting as we roll-out new "killer apps" to enhance your experience as you browse.

"Medicine is stuck . . . the billions we spend on meds and additives are a waste . . . real farmers, men and women, work, using their arms. The women lift children, cook, and work in the kitchen garden. They develop upper body strength and cardiac health with physical work. For years, European farmers worked all day, usually standing up, and ate meat and butter and eggs and cheese and pie. A good diet is protein and fat and carbs. Real work is superior to exercise. Being waited on in assisted living is deadly. Use it or lose it."

"Learning and working change our brains and make us happy and smart. Our happiness is contagious. Stress, anger, blaming, complaining and sitting all day, harms our blood vessels and immune systems. Our unhappiness is also contagious."

"We can change ourselves and the world by a reverse domino effect, getting all to be responsible, loving, trusting, and happy people. Friendship is contagious, catches on, and spreads ever widely. The more fun we have the longer we will live. Make it a great ride, and eat and enjoy everything with no guilt. Our neurons, branching and growing daily into old age, offer excitement until the end. Be relaxed, be smart, be happy."

(Dr. Chamberlain, graduated from medical school 64 years ago. In her words, "I will be around the sun 89 times on August 15, 2008")

The theme was: What vitamins and supplements do you take to accompany various diet programs? With lots of people dieting this time of year, since many weight loss programs restrict certain key nutrients, it's helpful to have a look at some of the popular diets to note what supplements help fend off deficiency.

The full segment is archived at http://abclocal.go.com/wabc/media?id=6037078.

So click on this link or copy and paste it into your browser to have a look. Happy Easter!

Many Americans might have reservations about voting for a 71 year old candidate who will be pushing 80 if he were to serve a full 8 years.

Do McCain's age or health liabilities pose insurmountable obstacles to his candidacy?

"I am older than dirt and have more scars than Frankenstein," John McCain likes to say.

Senator McCain's mother is 94, looks stately and speaks lucidly, suggesting that her son has some genetic potential for longevity.

THE AVERAGE age of US presidents when they take office is 54. Ronald Reagan was in his 70's during most of his 8 year tenure, but entered office younger than McCain is now. Youth is no guarantee of a President's health; John F. Kennedy, elected America's youngest president at 42, was plagued with severe health problems that might have done him in if an assassin's bullet had not.

McCain evinced some degree of psychological and physical resilience by surviving 5 years of imprisonment by the North Vietnamese. Both his arms and one leg were broken when he ejected from his jet fighter-bomber over Hanoi in 1967. He was then beaten and bayoneted by angry civilians, until he was remanded to the Hanoi Hilton for months of solitary confinement, physical abuse and malnutrition.

Has he been left with physical or emotional scars from that experience? During the 1999 presidential primary against George Bush he released extensive medical records showing no significant health problems.

He is reported to have recently hiked the Grand Canyon rim-to-rim with his sons, no mean feat.

Of course, most people are aware of his brush with deadly melanoma in 2000. On a scale of 1 (best, localized and superficial) to 4 (worst, confirmed spread to other organs), his melanoma was staged at 2: it was about a half inch across, and had just penetrated the surface layer of the skin, which could have meant trouble.

At the time of surgery, dye was injected into the tumor where it circulated to a "sentinel node", the nearest lymph node which was the likely site of cancer spread. During the operation, that lymph node was carefully examined by a pathologist and pronounced cancer-free, but the surgeons took the precaution of doing a wider excision, and took out additional lymph nodes from the left side of McCain's face.

The lymph nodes were found to be cancer-free, but the extensive surgery left McCain with the scar and asymmetrical facial features that are now his hallmark.

Does this mean that McCain has no chance of recurrence? Eight out of 10 people (80%) diagnosed with stage 2 melanoma will be alive 5 years later. But it is now 8 years later, and with each passing year, the likelihood of melanoma coming back diminishes.

Still, there is always the remote possibility that a few errant cancer cells escaped the 2000 surgery and continue to lurk in McCain's body. Rarely, cancers like McCain's recur decades after initial surgery, and when melanoma metastasizes, the prognosis is usually grim.

What about McCain's age? The average life expectancy for an American male is 71 years, precisely McCain's age. Does this mean that McCain's warranty is about to expire?

But longevity statistics are deceptive. Seventy-one is the average age a new-born male infant can look forward to if born in 2008. If he surmounts the dangers of childhood and adolescence and survives to 25, his life expectancy would become 73; at my age of 55, the average life expectancy for a male is 77.

What about for 71 year-old John McCain? It appears that by having "dodged the bullet" of diseases like heart disease and cancer that fell many men in middle age, there's a big jump in life expectancy: the tables say that McCain should live to 83! That's well past the two terms that McCain needs to survive if elected.

For women, the news is even better. A 71 year-old woman has a life expectancy of 86!

Does this mean that an 86 year-old woman is poised on the brink of annihilation? Well, the proverbial goal posts keep getting pushed back, and she can expect to survive, on average, to 94!

One fly in the ointment is that McCain has been uncharacteristically cagey about releasing his most recent health records. He did so, with great candor, during his last presidential run. But he promises to do so again, fully and completely, some time next month.

We'll see then if he has any as yet unacknowledged health liabilities.

Vitamin E Supplements Could Cause Up to 27 Per Cent Increase in Lung Cancer

Vitamin E Linked to Lung Cancer

Vitamin E Warning

Taking Vitamin E Can Lead to Cancer

MY REACTION: These headlines are dumbed down versions of the actual study.

Typically, newspapers that generate press accounts from wire service reports have no analytical capability to contextualize the information. When you fail to process raw sewage, the results are predictable. Although I'm a respected nutrition expert, and available for quotes if journalists would take the time to do their due diligence, I almost never get called for my opinion before the papers frighten vitamin consumers out of their wits with stories like this.

After getting back to the States, I began doing some damage control on this study. First, let me state that I'm reluctant to go on the defensive about vitamins and supplements. Usually, if the negative stories are unsubstantiated, I don't even air them. Defending vitamin E after a story like this is a little like me saying "I don't beat my wife". What people remember is: "Did you hear that Dr. Hoffman was arrested on domestic violence charges?" But, with all the misinformation that's being promulgated, I feel I owe some accurate reporting to my listeners and patients.

So what did this study actually show? As reported in the American Journal of Respiratory and Critical Care, 364,418 Seattle area residents were mailed questionnaires asking them about various lifestyle factors, including the use of multivitamins, vitamin E, folic acid, or vitamin C.

Significantly, only 22% of questionnaire recipients returned their questionnaires (more about that later).

As might be predicted, a past or present history of smoking was the biggest predictor of lung cancer risk. So far so good.

The questionnaire recipients were asked if they had taken vitamins over the last ten years (more about that later, too).

When the researchers looked at vitamin C, folic acid, and multivitamins, there was NO relationship, either protective or detrimental, on the risk of lung cancer.

With regard to vitamin E, the researchers reported a relationship, but it was barely statistically significant (more on that later, too). They noted a paltry 5 per cent increase in the risk of lung cancer for each 100 mg (100 mg is approximately 100 IU) of vitamin E consumed. For example, for smokers who were daily consumers of a standard dose of 400 IU vitamin E, the risk of cancer was said to be increased by 20 per cent.

But there was NO increase in lung cancer for consumers of vitamin E who never smoked or were former smokers. The detrimental effect was only seen in current smokers.

What's the problem with this study and the alarmist reports it generated?

First, the press totally misrepresented the study, suggesting that vitamin E somehow "causes" lung cancer. Only in smokers was an adverse effect noted, and that was barely statistically significant.

What is "statistical significance"? Basically, it's a mathematical construct that's derived from the number of subjects studied in an experiment. For example, if you flip a coin 3 times, and it comes up heads all three times, you could not conclude that this coin delivers heads 100 per cent of the time. The sample is too small, and statistical analysis would show the results of your experiment are not statistically significant. Flip the coin 10,000 times, and when it comes up heads 5,017 times and tails 4,983 times, you can conclude with a high degree of statistical confidence that the likelihood of heads vs. tails is 50:50.

What about this study? Well, despite the large number of questionnaires sent out, only 77,000 responses were received. Sounds like a lot, but since lung cancer isn't all that common, only 521 lung cancers were reported by the respondents. That's a pretty small number for basing conclusions on vitamin E and cancer risk--barely statistically significant.

Now here's where it gets interesting. This study is what researchers call a "retrospective cohort" study. Retrospective studies look backwards in time, and rely on people's (sometimes faulty) memories. These studies are notoriously inaccurate, but unsophisticated newspaper journalists, and the general public, never took statistics classes, and don't know this.

The gold standard for drawing scientific conclusions is the "double blind placebo-controlled" study. But these take years to complete and are very expensive. Imagine recruiting 77,000 people and then feeding them vitamins or placebo pills and then waiting ten or twenty years to see who gets cancer?

What information gets lost when 79 per cent of questionnaire recipients don't get back to you? Do people actually remember if and when they took vitamins? Do they fudge what vitamins they took? Were they high quality or cheap discount vitamins? Does the fact that they got cancer change their recall? These are questions that the study--and the subsequent news reports--simply ignore.

Well known to statisticians is a phenomenon called "recall bias". Basically, the idea behind a form of recall bias is that when something bad happens to people, they tend to concentrate more on the minutiae of the antecedents leading up to their misfortune.

A good example is research performed a few years back for a popular book called "Dressed to Kill". The premise behind the book was that wearing bras causes breast cancer (the theory was that restrictive bras block lymphatic flow and allow "toxins" to build up in breast tissue).

A "study" was conducted by the author of the book that involved telephone polling. Women were asked about breast cancer history and bra-wearing (how 'bout that for a cold call!). The author claimed that there was a three-fold increase in breast cancer for women who regularly wore bras!

But recall bias offers an alternative explanation: women who got breast cancer said "Come to think of it, I WAS wearing a bra all those years leading to my breast cancer, maybe THAT's the reason I got it!" Recall bias highlights the intensely human need to perceive causality.

A safe conclusion from the present study on vitamin E is that neither vitamin E nor any of the other vitamins studied offers any protection from lung cancer IF YOU SMOKE.

I'm OK with that conclusion, because I continually reiterate that supplements can't combat the ravages of smoking. This would be like expecting a combo of vitamins to protect you completely from sunburn if you have light skin and broil in Acapulco for six hours continually without sunscreen; or, alternatively, to provide a total bulwark against radiation poisoning if you were to walk into the reactor at Chernobyl wearing a mosquito net.

A question not addressed by the study is what would have happened if the smokers had continually taken the RIGHT kind of vitamin E? Most vitamin E studies, especially the ones drawing negative conclusions, use the cheapest possible vitamin E, the dry or succinate form, or at best natural alpha tocopherol. These studies ignore the fact that vitamin E is present in nature in MIXED tocopherol form, rich in gamma tocopherol which appears to be decisive for vitamin E action.

In fact, studies now show that when you give alpha tocopherol in the absence of gamma tocopherol, tissue levels of vitamin E actually DECLINE. Gamma tocopherol appears to be essential for vitamin E bio-availability. Maybe that's why the addition of the wrong kind of vitamin E to the regimens of these smokers actually set them back, rather that conferring at least partial protection.

Finally, NO study has yet examined the effects of a truly state-of-the art, high quality supplement program on people facing oxidative stress, like smokers, or 9-11 Ground Zero rescue workers. Such a supplement program would have to include not just premium mixed tocopherol vitamin E rich in gamma tocopherol, but also natural mixed carotenoids, C, zinc, selenium, N-acetylcysteine, alpha lipoic acid, EGCG, sulforophane glucosinolate (SGS), intravenous glutathione, etc.

But after fiascos like the current vitamin E/cancer "study" and its attendant mis-reporting in the media, the likelihood of additional good antioxidant research being performed is zilch. And that is truly poisoning the well for conscientious Americans who take supplements to safeguard their health.

There, now I've said it, and it's off my chest. WHEW! And no, I don't beat my wife--I'm not even married!

Occasional joggers can be seen around the Parque del Retiro, Madrid's big open space. But at times I wondered if most of them weren't Americans. Jogging seems un-Spanish, with all the walking people do to get around. And the cobble stoned streets are hilly, giving you a good workout.

Because many of Spain's towns have medieval street plans, especially heritage places like Toledo and Segovia, you can easily walk 100 feet and find yourself completely lost, even with a street map in your hands. Unless you take guided tours, much of the time you will spend in Spain involves "orienteering".

Vitamins? I found health food stores with natural products, even herbal formulas, but in my entire week in Spain I did not see one bottle of supplements for sale. Maybe the vitamin revolution hasn't crested here. Give it some time.

A travel tip: Adjusting to a new time zone can be rough, and I found Advanced Sleep Support, a product I developed in conjunction with the Vitamin Shoppe as part of our new MD Select collaboration, to be excellent for knocking me out during my overnight trans-Atlantic plane flight, and for reinforcing sleep in a Madrid apartment where the sounds of late night revelers continually wafted up to my balcony.

My rudimentary Spanish got me through most situations, but I'm pleased to announce that future broadcasts of Health Talk will be in my native tongue, English.

Next: I'll tackle the recent headlines that erroneously claim "Vitamin E Causes Cancer". Hasta luego!

The typical Spanish market features standard cuts of meat, but all parts of the animal are displayed, including more daunting delicacies like hearts, kidneys, testicles, feet, and even whole heads with sightless eyes.

It would be tough to be a vegetarian here, although Madrid has some vegetarian restaurants. But meat portions, while delicious and wonderfully flavored with sauces, tend to be smaller than in the States. The concepts of the 22 ounce sirloin steak, or the double cheeseburger, are decidedly American.

Iberian ham is big here, and it's totally different than the American kind. Top of the line "jamon" fetches over 100 Euros per kilo (over $150 for 2.2 pounds), but it's so rich you only need to eat a couple of slices with beer or wine for a light snack. I tried some that was touted as having been raised exclusively on s diet of chestnuts and found it marvelously flavorful.

The food is uniformly tasty and of high quality. The fare in the dingiest little corner tapas bars is as good as the food in many expensive American restaurants. When you buy a bag of oranges or an apple in a Spanish supermarket, the fruit is fresh and flavorful, unlike some of the ersatz produce that is palmed off on U.S. consumers. There is almost no such thing as tasteless bread served with meals, and it's always fresh from a bakery a few doors down the street.

In case you're a fan of Mexican food, pretty much forget about it in Spain. If you make the mistake of ordering a tortilla in hopes of getting a burrito with spicy beans or meat in a flour wrapper, you'll be disappointed to receive what looks like a fluffy slice of omelette, which actually is light and delicious. It's somewhat reminiscent of potato kugel. And tacos are nowhere to be seen, so please don't risk seeming gauche by asking for them. They speak Spanish here, but hey, this is Spain, not Mexico, you norteamericanos!

Candy is popular in Spain, including excellent marzipan, which is a specialty of Toledo. It was said to have been invented by nuns in 1212 when famine swept the country. Toledan marzipan became the caloric non-perishable K-ration of its day that could easily be stored for months at a time, and shipped across mountainous roads by donkey to allay starvation.

Flan is a popular dessert--it's like rich cream caramel, and, while high calorie, it's probably a rich source of quality egg protein. I got the impression that Spaniards devour less processed cookies and candy bars than we do, but this could be changing.

And they like Coke, but probably don't yet consume liters per week like we do. While riding subways or while watching TV, I didn't see any ads for miracle diet programs.

Check back here soon for more on my trip to Spain!

I don't have very distinct impressions of my college trip (the Seventies were like that!), but I do remember a few things. First, it was still the Franco regime and there were mean-looking Guardia Civil troops wearing German style helmets or patent leather three-corner hats, brandishing menacing machine guns, standing in front of all the municipal buildings.

Additionally, there was a pervasive smell of bad plumbing everywhere you went in Spain. Some of the toilets were just dank holes in the floor with treaded cutouts for you to place your feet on. And finally, everything was dirt cheap. You could get a meal for a couple of dollars, a four course dinner for around ten dollars.

Things have certainly changed. Now the cops are discrete and amiable, many of them young women. They look like the ski patrol in fashionable day-glo uniforms.

Also the sanitation has improved, and no longer do foul aromas pervade the air of Spanish cities. If I had been smart, I'd have invested in Spanish plumbing supply stock back in '75.

And finally, the prices. Oh, the prices. The dollar is now at an all time low vs. the Euro, so even Spain is pricey. A typical meal is 20 to 50 Euros, that's $30 to $75. I saw a 48 inch flat screen TV being sold for 2900 Euros which translates to $4500. You can score one for less than half that at Best Buy!

There is an upbeat air of prosperity and growth without a hint of recession. Consumer goods are in big demand as the Spanish catch up to our standard of living.

The Spanish are a gregarious people. They gather in bars to socialize and watch sports rather than huddle in their living rooms to watch TV and call for take-out pizza like many Americans.

They keep crazy hours in Madrid. I was hard-pressed to keep up with the schedule. I was starving by noon, but restaurants didn't open until one, and were mobbed from two to four when everyone eats.

Then, don't try to find an Early Bird Special. The eateries shut until 8 or so, and it's not uncommon for Madrillenos to eat at ten, and then go for some entertainment. That compounded my jet-lag.

Few inhabitants of Madrid are fat, although it seems their favorite past-time is hanging out in tapas bars. I think the secret is portion control and lots of walking around. And while everyone drinks wine and beer, I did not see a single drunk person in my week in Spain. They are all talking so fast that it's hard to o.d. on food and liquor!

Check back here soon for more on my trip to Spain.

As I so often reiterate, it's not nice to fool with Mother Nature. A prospective block-buster HDL-raising drug called torcetrapib crashed and burned last year when a trial showed the expensive new synthetic, unlike niacin, increased cardiovascular deaths instead of preventing them.

Drug companies, while providing niacin in prescription form (e.g. Niaspan) have had trouble bankrolling the supplement because cheap forms can be obtained over-the counter in health food stores. The financial incentives are therefore skewed toward costly statin drugs.

Stung by negative findings about the cholesterol-lowering drugs Zetia and Vitorin and new skepticism about statins, the pharmaceutical giants are seeking to recapture market share with new, "innovative" lipid formulations. The latest will be Abbott Labs' Simcor, simply a combo of old-fashioned Zocor and Niacin.

When combined with statins, niacin produces even greater reductions of cholesterol, and the latest trial of Simcor showed an additional reduction of 27% in triglycerides. But why it's easier to reach for a prescription combo drug when niacin is available in health food stores is beyond me. And besides, Abbott's "new" drug is simply a copy-cat of Kos Pharmaceuticals' Advicor combining Lipitor and niacin, available since 2001.

Problem: Acceptance of high-dose niacin is limited by its tendency to produce flushing in about 75% of patients. Typically, within minutes or hours of consuming niacin, subjects report skin-reddening and a heat sensation, usually mild and transient, but sometimes quite unpleasant.

I take pains to explain to patients that, while this may be alarming, flushing is completely benign, and if tolerated, is not a sign of anything untoward. Niacin dilates capillaries, the tiny blood vessels in the surface of the skin. In fact, sometimes niacin is recommended for circulation in conditions like Raynaud's syndrome (In my opinion, it doesn't work that well for poor circulation to hands and feet, since bigger arteries are involved in such conditions).

In fact, just this week on Health Talk I discussed a case report in the Annals of Emergency Medicine in which a group of high school morons shop-lifted some niacin from a health food store and then ingested massive amounts to avoid detection in a drug screening test. That niacin somehow counteracts drug tests is purely the stuff of urban legend, but kids still persist in trying it. Four kids became ill with itching, burning sensations, and a rash.

But the most serious case was that of the ring-leader who chugged eleven tablets and experienced dizziness, vomiting, and heart palpitations. In the ER he was found to be suffering from acidosis, liver failure, and hypoglycemia, which resolved after a few days. Interestingly, despite the elaborate precautions, a drug test performed three days after he was admitted was still positive for marijuana!

Proposed solutions to the niacin flush have included "Time-Release" niacin which I've noticed only delays the flushing and usually doesn't eliminate it. Some studies have even shown that the time-release form of niacin is associated with greater risk of the other major niacin side effect: liver problems.

Then there is "Flush-Free" niacin, usually niacin hexainositol, which in my opinion simply doesn't work ("No pain, no gain"). Studies which support its efficacy use doses like three grams per day, but I rarely see cholesterol budge with niacin hexainosinositol.

Finally there's the advice to take a "Baby Aspirin" a half hour before each niacin administration, but I've found protection to be inconsistent, plus it's a pain to remember the timing, and some people can't or won't take aspirin because of stomach problems.

Meanwhile, drug companies are trying to capitalize on niacin's heart-protective potential by developing a patented process to minimize niacin's flushing effect. A new drug is being introduced by Merck called Cordaptive which teams niacin with a patent super-aspirin called laropiprant; it blocks the release of prostaglandins that cause flushing. Cordaptive may soon be available in 2008, and Merck is counting on it to offset losses caused by the Vioxx debacle, and to recapture some of the lipid market share now dominated by Pfizer's Lipitor.

But interestingly, a cheap natural alternative appears to trump Cordaptive's putative benefits. A new study appearing in the online edition January 29, 2009 of the British Journal of Pharmacology reveals that the supplement quercetin is a very efficient flush-blocker when teamed with niacin. Quercetin is a common bioflavonoid found in apples, buckwheat, tea and onions. It is associated with protection from cancer, and blocks the release of histamine from mast cells, making it an ideal allergy blocker.

In the recent study in BJP, rats and humans were given quercetin in doses equivalent to 1000 mg while ingesting niacin. After an average dose of 1750 mg of niacin, quercetin reduced flushing by a whopping 96%! By comparison, aspirin (even at 325 mg) only reduced the flushing by 30%.

In the experiment, quercetin was injected into experimental subjects, so it remains to be seen if oral dosing of quercetin will confer the same benefits, but it certainly is inexpensive and natural, and worth a try if you're taking niacin and are bothered by flushing. Because more quercetin is absorbed via injection than by the oral route, I would recommend two 500 mg capsules of quercetin two or three times daily an hour or so before niacin dosing.

IMPORTANT CAVEAT: Don't try niacin for cholesterol reduction on your own without supervision by a health practitioner. Doses greater than 250 mg per day can cause liver changes in about 5% of patients, and so you need to get your liver function tested along with cholesterol, HDL and triglycerides at one month, three months, and then around every six months to monitor your response to niacin. Just because you don't get flushes, doesn't mean you can't have liver problems, so heads-up!

Thank you for extending my life.

Recently, you referenced on your program the Lipitor commercial promoted by Robert Jarvik. You interestingly noted that although Dr. Jarvik appears a jock in the commercial, he may actually be more of a couch potato (these are not your exact words).

Well, I just saw the new Robert Jarvik - Lipitor commercial. In this updated version, there was no jogging or canoeing to be seen. The extent of Dr. Jarvik's activity was tossing a stick & holding a drinking cup. The dog running after the stick proved the more active of the two. I couldn't help but wonder if Dr. Jarvik even has a dog (I guess I'm now a bit cynical as to the truth in advertising).

I had a good laugh.

Jean (Brooklyn)

COMMENT: Thanks, Jean, for your timely and amusing update. Yes, I saw the most recent commercial, and apparently it was hastily cobbled together in reaction to a Congressional investigation which just disclosed that Robert Jarvik used a body double to depict his rowing exploits in the previous iteration of the Lipitor ad. He does, however, ably toss a stick to the dog, an exploit implicitly facilitated by the statin drug he claims to be taking.

Dr. Hoffman

Recognize that even with new doubts cast on the efficacy of these drugs for patients with mild to moderate elevations of cholesterol, especially for women and seniors, your doctor may be AFRAID not to prescribe a medication. Surely it is simpler to proffer you a prescription as a stop-gap against mortality than to engage in a lengthy and protracted discussion about diet and exercise and cardio-protective supplements.

Additionally your doctor is under the gun to adhere to "clinical practice guidelines" or "standards of care" that have been created to take the thought process out of treatment. This "paint by numbers" approach to medicine substitutes algorithms and numbers for individualized care. It's one of the reasons that veteran doctors are retiring in droves from medical practice.

Everyone eventually dies, and heart disease remains the leading cause of death--with or without drugs. Woe unto the doctor who fails to take a "CYA" approach and fails to prescribe a statin to every patient with a cholesterol of 200, or with parents who died in their 70's of heart attacks, or with borderline blood pressure, or who has inquired about the latest TV ad for Lipitor--the reasons FOR prescribing cholesterol-lowering drugs are endless. The trial bar is only too happy to capitalize on such a misstep--at the same time they sue doctors and drug companies over the side effects of cholesterol-lowering drugs!

I was discussing this sad state of affairs with one of my medical colleagues at poolside during a break at one of my medical conferences. He said: "No problem, we just have our patients who decide not to take drugs sign an informed consent stating that, aware of the potential risks and benefits of cholesterol-lowering drugs, they have opted to pursue a non-pharmacological approach to their cholesterol problem."

I have decided to reproduce this ingenious document below in its entirety so you can copy and paste it and take it to your doctor if you opt not to take medication for your cholesterol. Here it is:

I, __________________________, have been informed that with my current level of cholesterol, most physicians in the USA following the usual "Standard-of-Care" guidelines would prescribe a cholesterol-lowing medication, such as a statin drug.

I am choosing to manage my lipid levels by utilizing lifestyle measures, such as nutrition and exercise, along with natural nutritional supplements. I am aware that there are risks in not taking cholesterol-lowering medications, such as possibly an increased risk of heart attack or stroke. I am also aware that there are risks in taking statin drugs, such as muscle pain and liver damage. The advantages and disadvantages of these approaches have been discussed with me, and my questions have been answered to my satisfaction.

Being informed, if I choose not to receive cholesterol-lowering medications, I assume all responsibility for my choice. I do not hold Dr.___________ responsible for my decision and outcome.

_______________________/ ________ Signature of Patient /Date

_______________________/ ________ Witness /Date

I've been using natural bio-identical hormones to treat women (and men) for nearly twenty years, with excellent results and minimal side effects. Countless patients are enthralled with the results of this life-changing therapy.

Now the government (YOUR government!) wants to take this option away from you. Following up on a "Citizen's Petition"--not from a group of concerned citizens but from a greedy corporate entity--drug company Wyeth, the makers of synthetic estrogens like Premarin (PREgnant MARe's urIN!)--the FDA is trying to ban bioidentical hormones.

They don't even want us to use the word "bio-identical" because they say it's "misleading"! They would ban it, in direct contravention of the First Amendment.

Wyeth stands to regain a lot of the market share it lost when millions of women ditched their HRT after the 2002 Women's Health Initiative Study showed synthetic hormones were harmful. They would like nothing better than for the government to do their dirty work and eliminate the competition.

You can read about this incredible story at www.homecoalition.org.

This is the beginning of a big fight and we need an aroused citizenry to spread the word and stop Big Pharma and Big Government from colluding to deprive Americans of their health freedom.

I urge you to use the simple template at the Home Coalition website to write the President and your congressmen and tell them that this will be a huge political loser for them, and that they will have millions of enraged constituents to contend with if the FDA gets its way.

Top antioxidant foods are rated according to their ORAC values. ORAC or "Oxygen Radical Absorbance Capacity" is an internationally recognized way to measure antioxidant levels.

Blueberries, blackberries, pomegranates, prunes, and raisins all make the top ten.

Vitamin C was made the list, but it only rated #7.

But the top three in ascending order of ORAC values are (drum roll please!): #3 grapeseed extract; #2 green tea extract; and the undisputed #1 champion--olive leaf extract.

Potent, high ORAC value standardized extracts are now the basis for cutting-edge nutritional supplements, and they're a boon to nutritional formulators like me as I comb the scientific literature to translate the latest research into innovative new health products for you.

Other distinguished science reporters joined Taubes this week in finally reporting the truth about cholesterol-lowering drugs. Tara Parker Pope of the NY Times wrote a story on January 29 entitled "Great Drug, but Does it Prolong Life?" In it, she accurately took on statin drugs, which admittedly have limited benefits that sometimes justify their use in patients who've had heart attacks, angina, stents, or bypass surgery, or those with familial hyperlipidemia with cholesterol levels of three or four hundred. But for the majority of Americans with fair to middling cholesterol she writes: "The surprising answer appears to be no."

Whoa! What a stark admission in the pages of the august NY Times! Doctors routinely snow patients into believing that statin drugs like Lipitor, Pravachol, Zocor , and Crestor are veritable lifesavers. True story: Last week I talked to an 87 year old woman with NO evidence of heart disease with a cholesterol of 260 and an HDL over one hundred who was told by her doctor to take Lipitor OR SHE WOULD DIE!

Same week: I tried to talk sense into a man of 49 who had an LDL cholesterol of 159 whose cardiologist friends told him (erroneously) to take Pravachol because "Even if you're healthy, it'll make you live longer." Despite demonstrating to him that his risk was minimal by performing an EBT heart scan that showed his plaque score to be ZERO, this otherwise intelligent guy was afraid not to take the drug!

Here are the facts, as laid out in the Times article:

"A 2005 study in the Archives of Internal Medicine looked at seven trials of statin use in nearly 43,000 patients, mostly middle-aged men without heart disease. In that review, statins didn't lower mortality."

Pope continues: "Nor did they in a study called Prosper, published in the Lancet in 2002, which studied statin use in people 70 and older. Nor did they in a 2004 review in the Journal of the American Medical Association, which looked at 13 studies of nearly 20,000 women, both healthy and with established heart disease."

To top it off, this week the January 28 cover story of Business Week (a magazine not inhospitable to the pharmaceutical industry!) was entitled "Do Cholesterol Drugs Do Any Good?" In it they conclude that "Research suggests that, except among high-risk heart patients, the benefits of statins such as Lipitor are overstated."

The article goes on to explain that, in healthy patients, 100 to 300 patients would have to be treated for decades to prevent just one heart attack. Which might be wastefully expensive but fine, except for the high incidence of side effects such as muscle pain and weakness, insomnia, cognitive impairment, and impotence.

And who is this guy Jarvik who so sincerely intones the benefits of Lipitor in those ubiquitous TV ads? There is now a call for a Congressional investigation of Pfizer's use of Robert Jarvik as its spokesperson because, incredibly, Jarvik HAS NEVER PRACTICED MEDICINE WITH PATIENTS.

His original degree is in engineering, and he is the inventer of the Jarvik artificial heart which enabled him to show-boat in green surgical scrubs beside South African dentist Barney Clark in the 1980's (REMEMBER?). While the cumbersome device extended the lives of a few patients for months, it was soon relegated to the scrap heap of medical history when supplanted by heart transplants and more finessed approaches like the left ventricular assist device.

It turns out that Jarvik, unable to go medical school in the US, was a graduate of the University of Bologna in Italy, and never even performed an internship or residency. How he is then held up as an authority on prevention of heart disease is unclear--hence the uproar. Imagine the clamor if I were opinionated while similarly non-credentialed--critics would pounce because I was rendering medical recommendations with NO real-world background or experience in clinical practice! Yet I've been treating patients for twenty-five years now, and the facts about unnecessary and harmful drugs are inescapable.

Stay tuned for more developments on the heated cholesterol controversy, because, as with many elements of faith of the modern medical canon, lowering cholesterol with drugs can't withstand the scrutiny of evidence-based research.

The commercials are gone now, amid the backlash to the just-released "ENHANCE" study, which showed no advantages to Zetia given alone, or combined with the Merck statin drug Zocor in Vitorin. No reduction in heart attacks, strokes or death, and no reduction in plaque in the carotid arteries. In fact, mysteriously, Vitorin was slightly worse than Zocor alone in reducing cardiovascular risk.

The results have shaken the pillars of Wall Street and mainstream medicine. Stocks of Schering and Merck are reeling. Patients are calling their cardiologists in droves. Predictably, there's even talk of class-action lawsuits as lawyers roil the waters around the wounded drugs. Meanwhile, the makers of Zetia and Vitorin have placed full-page ads in papers telling consumers to just hang in there and keep taking their meds. Yeah, right!

What happened? Isn't lowering cholesterol the chief way we can reduce cardiovascular risk? Has medicine taken a wrong turn?

Personally, I never liked these drugs and NEVER have prescribed them. Other statin drugs are fine under certain circumstances, but probably not because they lower cholesterol. Rather, it's due to an inadvertent side effect: like expensive designer versions of aspirin, they combat inflammation, a more fundamental risk factor for arterial wall damage.

Gary Taubes, a frequent guest on Health Talk, nailed it in his January 27 Sunday Times op-ed piece entitled "What's Cholesterol Got to Do With It?" In it he notes that we have fallen hook, line and sinker for the "Cholesterol Hypothesis", a mere theory which does not meet the demands of scientific rigor.

(Remember Taubes as the author of the revolutionary Times article entitled "What if it Was All a Big Fat Lie?"-- the cover story for a 2003 edition of the New York Times Magazine that famously featured a picture of a greasy steak on the front.)

Taubes argues convincingly that we're playing cholesterol limbo ("How low can you go?") based on an entirely wrong set of assumptions. Cholesterol levels on their own are not good predictors of heart attacks, but the ratio of cholesterol to HDL is. Half of heart attacks occur in individuals with normal cholesterol. LDL cholesterol is a mixed bag, with new tests that we do at the Hoffman Center revealing that there is both good and bad LDL.

We're conflating the benefits of cholesterol reduction using drugs with the benefits of having low cholesterol and favorable HDL ratios the natural way--which may be the result of good genes and healthy diet and lifestyle. Lowering cholesterol a lot with a drug is the way to go, we speciously reason. That's like saying that the best vacuum cleaner is the one that makes the loudest noise (my analogy): in the case of Vitorin, extra cholesterol reduction leads to no additional therapeutic benefit. Mother Nature always has a way of biting back when you mess with her!

The same thing happened recently with a new Pfizer HDL-raising drug called Torcetrapib. It worked just fine to artificially raise HDL (good concept!), but inexplicably caused so many increased heart attacks and deaths during the test phase that Pfizer had to abandon the project. Apparently HDL in a pill is no substitute for good diet and exercise.

So the onus is now on the drug-makers to demonstrate an advantage to these medications. I'm not holding my breath. Meanwhile, I'll continue to eschew their use until I see compelling evidence for their benefits, which I doubt will be forthcoming.

Don't worry--I didn't chow down on buffalo wings with blue cheese dip, pizza, and nachos. Instead, I had arugula salad and nice, hot home made chicken soup--a good thing, because just LOOKING at the game, the coldest in Giant football history, made me feel cold.

I felt challenged just dashing out on the patio (wearing a flannel shirt) to turn off the light after the game with temperatures in New York City in the relatively balmy teens.

The Giants played their coldest game in team history, with temperatures at Lambeau Field in Green Bay ranging down to -3F, with wind chills down to -23F! And there's this crazy new shtick where the offensive linemen, and some of the other players, demonstrate their machismo by wearing just short sleeves!

It's said that the tradition began in 1982 at what has come to be known as the "Freezer Bowl"--the 1982 AFC championship game between the Cincinnati Bengals and the Chargers. The temperature then was ten below, with wind chill estimated to minus 40! The Bengal offensive line amazed Cincinnati fans and their opponents by running out on the field wearing short sleeves. It is said that an inebriated Bengals fan died that day of hypothermia after sitting out one quarter bare-chested--a bad idea since booze makes you oblivious to the cold, but causes your blood to rush to your skin surface, resulting in a rapid and sometimes fatal loss of body heat!

Now I understand that this is a show of toughness. I guess the idea is that, if you're cold, you're just not maximally hustling.

But the short sleeve thing is gonna make it a lot harder on the mothers of America. Just imagine all those kids emulating their favorite football stars! Bad role models!

I remember rushing out to play (in Southern California, where the temperature NEVER drops below 45!) with my mother calling after me: "Puleeeez! You must be crazy! It's chilly {a term reserved for any temperature below 66 degrees)! You need a sweater! You're gonna catch your death of pneumonia!"

The truth: Researchers have investigated the effects of cold on respiratory infections in experiments where they immerse volunteers in ice water. NO increase in colds or flus was seen.

What DOES account for the increased frequency of viral infections in the cold weather? New studies have just shown that rhinoviruses and influenza viruses thrive in cold, dry conditions that prevail in winter months.

But I have another theory: Lack of sunlight in winter creates a deficit of vitamin D, a powerful immune-enhancing vitamin. My solution is to take extra vitamin D in winter, go to the tanning parlor once or twice a week, and, if I feel like I'm coming down with a bug, I load up on extra vitamin D for a few days. The result: fewer, milder colds.

So here's a tip for the victorious Giants: Hasten from Green Bay to Arizona, the site of the Superbowl, and get some healthy rays!

PS: Congratulations to the New York Giants, now reigning Super Bowl Champions!