. : Neuroblog : .

Monday, August 03, 2009

Vitamin D deficiencies in the Sunshine State

Over the past year or so, I have noticed a remarkable increase in laboratory-documented vitamin D deficiency, particularly in middle-aged women. As you all know, the human body cannot make Vitamin D -- a necessary pre-requisite of healthy bone and muscle functioning. Vitamin D can only be absorbed from certain foodstuffs and sunlight.

Cow's milk comes to possess Vitamin D only through the process of "fortification" whereby your friendly local dairy pours in the supplement. Otherwise, such unadulterated dairy products as cheese and yogurt -- although high in calcium -- maintain no significant levels of Vitamin D.

Thus, many women attempting to prevent osteoporosis may erroneously believe that a high-calcium diet comprised of Tums, cheese, and yogurt -- and devoid of fortified milk -- may be adequate. They are obviously wrong. Indeed, all the Boniva and Reclast in the world won't help build healthy bone on a D-deficient matrix -- kind of like attempting to put fresh plaster on a crumbling concrete surface.

Women aren't the only ones at risk for this disorder. Men on corticosteroids, proton pump inhibitors (anti-ulcer drugs), or anti-seizure compounds show similar pre-disposition. Moreover, the dermatogists have done a fantastic job of mandating sun avoidance and various cosmetics, thus impeding a solar source of Vitamin D. Hi-SPF Coppertone may be great for that creamy complexion, but is actually preventing sunlight manufacture of an important nutrient.

Back in the day we didn't see so much of this deficiency as Granny would typically walk to the bus stop; hang laundry in the back yard; and take her afternoon iced tea on the front porch. Nowadays, we leave our air-conditioned garages in sun-tinted vehicles on our way to the undercovered parking at our local climate controlled mall or office building. Thus, modern American humans have less and less exposure to sunlight.

Typical, clinical symptoms of Vitamin D deficiency include muscle aches, bone fractures, headache, and difficulty concentrating. It doesn't take a full blown case of Rickets to make the diagnosis. Only a doctor's suspicion and the appropriate blood test.

Although, not a proponent of mega-vitamin supplements, I do recommend a simple test for all middle aged people -- particularly those city folk who may be at risk.

posted by Neuroblog at 10:44 AM | 8 Comment and Respond by clicking here

Tuesday, June 30, 2009

Food as Medicine

Obviously, those of you acquainted with our practice understand our apathy, enmity, and overall antipathy toward vitamin supplements. Indeed, this multi-billion dollar industry preys upon the physical sensitivities of the American public in hopes of achieving youth, beauty, and prowess.

All the health claims are truly without merit! Look in all the great medical textbooks and you'll see that there exist only a handful of documented vitamin deficiencies, quickly remedied with ascorbate, niacin, milk, or folate.

Humankind -- over our million year evolutionary path -- has developed a keen capacity to integrate all manner of food sources into the necessary building blocks of life. Stuck on a desert island, one would likely obtain all items required for healthy living. Stuck on Manhattan island, one would not only find those items, but additional products leading to the hyper -nutrition state known as obesity. The healthiest societies tend to be thin, e.g., vegetarian Swami's and yogurt-drinking Uzbeki's.

Aside from scurvy, beri-beri, or rickets, are there any true diseases which could be treated with a specific food? Recent data suggest that some Alzheimer patients may benefit from ingesting a ketone-laden beverage each morning. There is a newly developed food product known as caprylic triglyceride, which has been shown to increase cognitive functions in certain types of Alzheimer patients. The theory goes that Alzheimer's disease represents a disorder of a brain cell's ability to take up and transport glucose. Kind of like a broken turnstile in the subway station which prevents passengers from getting in. Providing this alternative food source allows one essentially "to jump the turnstile" In fact certain types of PET scans have corroborated this concept of deficient CNS glucose metabolism in Alzheimer's.

The greedy human brain requires lots of nourishment -- consuming up to 20% of all blood sugar and oxygen. That's why you feel light headed often before hunger pangs set in. Neurobiologists have known for quite some time that the brain can utilyze ketones as an alternative to glucose. During starvation, ketone bodies provide the principle source of brain energy -- hence the sour ammonia breath when you've skipped a meal or two. Seems like "Mother Nature" was the original inventor of a hybrid vehicle. Scientific development of ketone-based products may overcome some of the Alzheimer-related problems of deficient glucose transport, hence alleviating some broken brain functions.

Thus, a new era of medical intervention is upon us whereby foods not medication may offer exciting options in the management of certain disease states. Maybe Grandma Gelblum's homemade chicken matzoh ball soup has some commercial application after all...

posted by Neuroblog at 3:06 PM | 0 Comment and Respond by clicking here

Wednesday, November 05, 2008

A Less Bloated Presidency

Over the past few weeks, many pundits have discussed the differences between the two presidential candidacies. Skin color, age, military experience, left-wing, right-wing, mannerism, religion, philosophy were all non-stop fodder for media babble and voter contemplation.

As a neurologist spending the average work-a-day warding off stroke and obesity, I was struck by one major difference. The McCain campaign appeared much fatter than the Obama-ites.

Starting with Joe Sixpack -- whose very name implies the daily consumption of 3600 calories of brew; to Joe the Plumber who seemed too portly to wiggle through any sewage line I've ever seen, to the numerous behind-the-podium supporters bulging out of too-tight jeans, the McCain candidacy struck me as resoundingly rotund!

Indeed, the Republican VP candidate hails from a state the size of a continent, whereas Biden's Delaware is so tiny that most folks probably couldn't find it on the map.

Obamans, by contrast, seem downright scrawny, starting first and foremost with the new President-elect. Could this be the dawn of a down-sized America? Perhaps, the electoral vision now encompasses a new aesthetic vision whereby "less is the new more".
We have had our taste of gas-guzzling SUV's which are now virtually unsellable and will likley cause the demise of Detroit. "Going green" no longer refers to a St. Paddy's day outfit, but a whole new philosophy of utilizing fewer carbon emitting products.

Indeed, when returning from overseas visits, the first thing that always strikes my American eye is the largeness of the American life. Large cars, houses, TV's, streets, cities, and people. With a population exceeding 300 million, and natural resources stretched to the limit, perhaps our new Democrat administration will signal a new approach to a nation wide diminution. This does not necessarily mean an economic contraction or decreased quality of life. Because, as any Tiffany's shopper knows, "great things come in small packages"!

posted by Neuroblog at 12:04 PM | 0 Comment and Respond by clicking here

Sunday, October 05, 2008

Neurology, Melanoma, and the Presidency

As a rule, I avoid political discussion with my colleagues and patients. Sex and religion are always fair topical game in any medical practice.

A thorough history of sexually transmitted diseases is a component of a comprehensive physical exam; and, of course, an understanidng of a sick patient's religious faith enables the practioner to develop end-of-life treatment guidance.

At this juncture in our nation's history -- where we are fighting two seperate military wars in Iraq and Afghanistan to stave off terrorist insurgency, and a $700 billion war on "Wall Street" to prevent total financial meltdown of our economy, I must spend a moment offering a neurological perspective on the upcoming presidential campaign.

Republican aspirant, John McCain, has a history of melanoma -- the super aggressive skin cancer that doesn't stop at the epidermis but manages to send off rogue attack cells which eventually nest in the lungs, spinal cord, and eventually the brain. Once melanoma hits the brain, incoherence and death usually take hold in just a few months despite aggressive medical care.

Many business people, military folks, Cubans, Jews, fundamental Christians, and other citizens believe that he posesses, by virtue of historical and present experience, the abilities to stare down and quash the many foes menacing our country.

However, his judgement in choosing his running mate, the previously unknown Sarah Palin of Alaska -- who in the few media interviews she has permitted shows unknowing grasp of our financial, diplomatic, and military challenges -- demonstrates an extraordinary cognitive deficit.

Now, I am certainly not saying that McCain's skin cancer history is now a brain cancer event. I am merely supposing that, as one of the oldest presidential candidates in American history, his judgement is markedly imparied and likely to worsen with age.

If elected, the 72-year-old candidate, will be a 73-year-old president. That's pretty old to be in the battle arena with so many dragons at the gate. Sarah Palin, as "heir apparent" to the old knight, should cause us all significant concern. In this country of ours, whereby anyone can grow up to be President, not everyone should be President!

Sarah Palin's glib and tiring tirade that she's just like any other "hockey mom", or "Joe Sixpack" suggests that she may indeed possess some attributes of certain "average Americans". (Please bear in mind that the consumption of a six pack of beer by any single "Joe" usually spells a disorder of alcoholism and may predispose to fetal defects -- a topic of certain relevance to this VP nominee.)

However, to be a heartbeat or melanoma away from the most powerful office on earth requires an individual of outstanding -- not average -- capability. A six-pack swilling hockey mom from Alaska may be someone you'd want to say hello to at your local Chili's, but it certainly isn't someone you could trust to negotiate the complexities of Iraq, health care, or the econcmy.

For all his failures, "George W" at least managed to get an MBA from a good school. With Palin potentially at the helm, the Bush presidency, by comparison, will look like an encyclopedia editorial board.

A new administration under McCain and Palin does indeed represent change -- for the worse!

posted by Neuroblog at 8:46 AM | 1 Comment and Respond by clicking here

Wednesday, September 17, 2008

National Health Care ---- Fuhgettaboutit!

Up until a just last week, the big buzz amongst us doctors was the impact of a McCain or Obama victory on National Health Care. We doctors have understood for quite some time that millions of Americans do not have access to basic health care. Thus, when they do get sick, it's usually more catastrophic -- and hence, costly -- than if a modicum of prevention had been available.

These folks may often tie up our ER's and other Urgent Care facilities for mundane fever and flu affairs. This off-kilter practice not only burdens the health care system, but proves costly for municipalities, tax payers, and even the poor patients themselves who have to miss ordinary day work or child care time in their quest for basic service.

McCain, in predictable Republican fashion, seemed to advocate the present employer-based insurance model, with government and other charitable entities picking up the fringes. Obama appeared on the verge of a nationalized system, herding every citizen into some type of program as would cover basic health care costs -- essentially Medicare for everyone!

This week's $80 billion governmental purchase of the AIG insurance company; and last week's $100 billion purchase of Freddie Mac and Fannie Mae; as well as our $90 billion annual expenditure in Iraq seems to guarantee no money left for any new health care initiatives, except for possibly offering free Band-Aides at your local city hall.

Is this anyone's particular fault? Well, this corresponding neurologist -- who certainly possesses no qualifications when it comes to economics -- does not think so -- despite McCain's demands for a Congressional "inquiry". You see, our society made a collective decision over the past decade or so, that a big house, flat screen TV, fancy car, or Disney vacation had to be had today without real ability to pay or significant down payment.

In Grandpa's day, we had something called "lay-away". Indeed, my grandfather Harold Buckman's clothing store in South Baltimore had a signficant lay away program. To the significant chagrin of my grandmother, Selma, he offered customers -- interest free, of course -- the ability to choose their clothes at the start of the fall season when selections were best , and lay them away in time for Christmas (Back then, we weren't terribly political correct, so it was your job to know someone's religion and wish them a "Merry Christmas" or "Happy Hanukkah" accordingly; Kwanza did not exist).

I have fond youthful memories of lots of folks coming in on payday and plunking down $20 toward their "lay-away" purchase.

There were no fancy derivatives, "interest free payments until June of 2015", outsourcing, call centers, rebates, etc. However..."Pop Pop" got his money and the customer got their clothes. Now, the investment banks have lost their money, and the U.S. taxpayer is nakedly exposed.

I am not typically nostalgic and certainly don't wish to go back in time -- although it would be swell to once again visit my Mama and Pop Pop! However, the current economic turmoil will certainly put a comprehensive national health care plan on the back burner for the foreseeable future as the government -- with diminishing credit reserves -- will surely have to put any new initiatives on long-term "lay away".

posted by Neuroblog at 5:52 PM | 0 Comment and Respond by clicking here

Monday, August 18, 2008

Dop-ing is a chinese province near Beijing

Any contender for Olympic gold must be well aware that all manner of athletic body fluids are closely scrutinized for the presence of manufactured compounds which could artificially enhance prowess and performance.

Doping compounds have been around ever since the Aztecs chewed Coca leaves to amplify high-altitude rock dredging; or the Indians smoked tobacco for enhanced mental acuity

Nowadays, various pharmaceutical compounds such as Epotin -- typically employed by hematologists to boost bone marrow production of red cells in cancer victims -- has been found in the urine of now-defrocked cyclists who hoped to gain an aerobic edge over their non-hyperemic colleagues. Fortunately, the International Olympic Committee has firmly put their foot down in a resolute forbid of artificial physical boosters.

With the recent revelations that Chinese officials utilized computer-enhanced graphics for the opening ceremony's televised fireworks display; and the admission of voice-dubbing of the adorable 9-year-old songstress -- seems the real vocalist had teeth deemed too askew for a perfect "Chinese face", I believe that the Chinese are guilty of television doping -- or even duping!

Clearly, the intent of Olympic competition has always been to foster un-adulterated physical competition between contestants. Although with Aquaman-inspired synthetic body suits now available to present day swimmers, I wonder how such champion predecessors as Mark Spitz would have fared had they been availed of these high-tech textiles.

Nevertheless, the Chinese visual presentations of that which is not, certainly violate the Olympic spirit of objectivity. You'd think that with 5000 years of recorded history to draw upon, they would not have to resort to latter-day trickery.

I'll certainly be looking forward to London 2012. Perhaps our television screens will display less computer generated Mandarin razzle-dazzle and a bit more British restraint. I'll definitely be anticipating a creaky nod from Queen Elizabeth as she reposes in the royal box -- wrinkled skin, crappy teeth, arthritic joints, and all. And at least you'll know her jewelry will be the real thing!

posted by Neuroblog at 1:46 PM | 0 Comment and Respond by clicking here

Wednesday, June 18, 2008

Paula Deen: The Savannah Satan!

Having just celebrated Father's Day with my two teenage kids, I, like millions of American men took to our patios and Weber grills to prepare a Sunday meal. In my home, food has always played a central role of family bonding, social interaction, and fun.

Once in awhile, when not attending to my kids or my clinic, I'll flip on the Food Channel, and try to find a new spin on my trusty crock pot regimen. Most of these shows are entertaining, and informative. However, the recipes of Paula Dean are truly toxic to human physiology. Now, don't get me wrong! I like "Mac & Cheese" as well as any other red-blooded American. But by the time she's done greasing the pan, oiling the macaroni, inserting the two sticks of butter, and dolloping the whipping cream, most coronary care units south of the Mason-Dixon line would be on "fly-by".

I was most dismayed, when a recent episode dedicated to cooking on a budget for "po' folk" suggested a meal of fried catfish, pork and beans, double-buttered corn on the cob, and egg-yolk custard for dessert. All, according to Paula, costing mere pennies. Of course, she neglected to mention that the cholesterol and diabetic drugs which would attend such a repast would easily offset any monetary savings. Moreover, in my opinion, poor folk , with much greater prevalence of obesity, diabetes, heart attack and, stroke, can ill afford this menu!

A really novel approach would be to take the culinary highlights of southern cooking and apply them to more contemporary philosophies of health. Truly, I am not a party pooper! I just believe that if you are going to the bank making millions off of your culinary heritage, then you should offer something up better than a greasy spoon.

posted by Neuroblog at 10:49 PM | 1 Comment and Respond by clicking here