Today's Thoughts on Fruit and Fructose

A lot of press is being given to the impact of fructose. Dr. Lustig's viral video on sugar should be required watching for all humans. Fructose is fruit sugar, so with all the data supporting fructose and insulin resistance, many are taking that message to mean stop eating fruit. Here are some quick thoughts:

1. If we could just eat the skins of the fruit, it would be gold. Very little nutrients (outside of fiber) live in the pulp.
2. The message of 9 servings of fruits/veggies often looks like 7 fruits and 2 veggies for most people. Reversing this is likely optimal.
3. Berries are a good focus fruit-wise.
4. Unfortunately I think the highly eaten fruits have been modified to increase their sweetness and their nutrient density has dropped. Bananas and grapes are at the top of the list. There is fiber to help slow the absorption of fructose, but for those with insulin resistance and obesity they are probably better off minimizing.
5. The fructose in fruit is infinitely better than anything mainlined without fiber/nutrient density like soda/processed foods. There is a slow absorption due to the fiber in the fruit, so its insulin impact is drastically lower.
6. Unfortunately in our society, fruit juice and V8 are truly regarded as fruits. There is no fiber, only fructose.

Eat more veggies!

The Problem with Bioidentical Hormone Replacement

No, it's not cancer risk. We can monitor that risk pretty closely with salivary hormone levels so that the balance between estrogen/testosterone and progesterone (breast cell proliferation) and estradiol and progesterone (uterine) is optimal.

The risk is your doctor not realizing the therapeutic window that needs to be achieved and that blood monitoring is not all that helpful. Too little hormones is a problem, but so is too much. Often, excessive levels of hormones lead to the same symptoms as too little (save for hot flashes): water retention, weight gain, cognitive change, insomnia, irritability.

When we start hormones with the anticipation of it being the only measure that needs to be taken to achieve health, we get into trouble. You cannot ignore the impact that diet, stress and lack of exercise have on health and excpect the hormones to "cure-all". Doing this leads often to starting out with a hormone dose that's too high or continuing to push the dose because we don't feel better all the while ignoring the food sensitivity or heavy amounts of unmanaged stress.

Checking for excess levels in blood doesn't cut it. I once heard the director of a lab quote that hormone levels have to reach 10 times the overdose amount in order to show up in blood as too high. 10 times you ask? That's exactly what we see in saliva. Most women we see in the office on BHRT regimens that are not feeling well have an estradiol level >100 (nl 4-10) and progesterone >2000 (nl 100-300). The lab can't even quantify the number it's so high!

I recently saw a client that had these excessive levels, couldn't understand why she was gaining weight and fatigued and her thyroid was normal. We focused on her hormone replacement regimen and checked salivary levels. They were all undetectably high. After several months of gradually lowering, she came into the office to report that the most recent drop in progesterone dosage (which finally got her saliva level below 1000 for the first time in years) she immediately stopped craving carbs and has started losing weight.

I love BHRT. I have found it to be the missing piece in a lot of women's journey toward health. But it cannot be the only piece, and it cannot be blindly given with no monitoring for balance. Start low and go slow, but also focus on the trifecta of optimal health: stress management, whole foods nutrition and digestive balance. Then make dosage changes based on how you are feeling and the tissue levels of hormone (saliva, not blood).

Local hospital's fraud shows health care system's ills

Just read an article (http://bit.ly/iv0JZX) about a local hospital and its parent company (a collection of mega-hospitals) being investigated for fraud. They allegedly have been overbilling Medicare, Medicaid and private insurance for millions of dollars more than the work that they did. What a shame. They will take a major financial hit and potentially loads of irreparable media exposure. Two questions come to me:

1. Do people really care?

2. Do we blame the hospital (sure), but what about the system?

Who Cares?

People largely will could care less about this case of fraud because they were not victims directly. When you create a cost-blind system, where neither the customer, nor the business have any clue what things cost, no one really gets "hurt". Sure, we all lost on this deal because we ultimately bare the burden of escalating healthcare costs and taxes, but no one personally feels cheated by Lutheran Hospital. We need to bring a much greater awareness to the cost of healthcare. People, on both sides need to realize how much money these medicines, surgeries, interventions (too many of which are unnecessary and quite harmful) cost.

I left the insurance world when I started GladdMD. I did that because insurance reimburses the better physicians for seeing a high volume of patients per day (around 30 on average to make the average wage, but the number needed to see is rising) and doing procedures. I do not do either of these things. I sit with patients for an hour, sometimes longer if they need it, so when I was with a hospital in an insurance-based practice it was in the red every month. In order to practice the type of medicine I wanted, I needed to work more like a lawyer, being paid for my time. I charge what I believe is fair and what allows me to spend time with my family and make a decent wage like the average family physician (the wage part that is, I spend a lot more time with my family then they do). Because I practice this way, some view us as expensive care. The truth of the matter is, if you knew how much your care really cost dollar-wise, we're the best bargain in town. A one-hour visit with our integrative practitioner to truly promote your health and empower you to feeling and being well is cheaper than the average 10 minute fast-paced, prescription-receiving visit your getting now.

Who's to Blame?

Blame both. There is no excuse for intentionally billing an insurance company for work that was not done. I suspect the punishment will be severe. But don't forget about the system that has been created. This disease-care system we have is very expensive, partly because your rewarded for using expensive testing and doing expensive procedures, and partly because the malpractice landscape has raised a bunch of physicians to practice defensive medicine. We are taught from medical school on that instead of, "Do no harm", we also need to "Get no sued". The expense of this care is not sustainable. The answer? Cut reimbursement across the board. The reimbursement from Medicare is pennies on the dollar. It is extremely sad, but we are in a time where caring for our nation's elderly is essentially charity work and good business practice would suggest you should not do it.

I am not sure what the ultimate cure is, but I can assure it starts with investing, from both the payer's (Medicare, Medicaid, insurance) and customer's (patient) side in true healthcare. Helping people connect their conditions and concerns to their lifestyle and providing the tools and resources to do such. I can assure you that the majority of folks that come to see us and other integrative providers and make this investment, cost both their own and their insurers significantly less money over within a year. And to spend time with patients and survive we bill the patient directly. Just good, honest business. Isn't that what this country is supposed to be about?

Raising a future designer/creator

I am fascinated by technology and the people and companies that are creating amazing things on a daily basis.

While I love taking care of patients and helping figure out ways to improve health, I also love creating things and am itching to be a part of a technology startup. The kind with bean bag chairs, white boards and lots of creativity flowing daily. It's why I created GladdMD, to free myself some to work on other projects. We're working on a new site, going to be doing some video blogging with the goal of delivering medical school to the people. It's imperative that people learn to take care of themselves and knowledge is empowering. I am also getting ready to start working on Mytavin.com, a tool to help people figure out which supplements, if any, they should be taking.

I have been recently been exposed to guys like Aza Raskin, who was the creative behind Firefox and recently started Massive Health (hope to meet with you soon in SF), Gary Vaynerchuk of Wine Library TV and now the Daily Grape and recently heard Zach Klein speak in Fort Wayne (he's from here). Zach was cofounder of Collegehumor.com and vimeo.com.

Learning the stories of success from these pioneers and hearing Zach talk about how much creating is still left to do, the future is wide open for progressive, out-of-the-box thinkers that have ideas and ways of improving just about anything. In a way, that's all of us. Unfortunately, so many of us remain cozy in our day to day lives and never creep outside the box. We all have ideas, all the time. Technology and and the tools available to today allow anyone to bring that idea to the public and make a reality.

So I was thinking about my kids and the future that is being laid out for them. The worksheet my son brings home that is created by the state of Indiana to do nothing but help him pass standardized tests. How do you stimulate creativity? How do you start building a future Zach Klein? It started yesterday with this discussion:

My 7 year old asked when we were going to start his free range eggs business that we talked about last year. We talked for awhile about what it would entail: purchase chickens, buy the materials and spend the time to build a coop, buy feed, research the how-to's and how we would market it. Then I asked him, "What happens when we go to the lake, or out of town?" He smartly replied that he would have to hire someone. He made the connection that this would cost money and eat into revenues. I was trying to imprint the lesson of scalability and also creating a lifestyle to balance with your work. He can see that there are some real limitations to the egg business now (not that it isn't an amazing lesson and experience for a child). So then I presented another option. "Sam, what if instead you learned about computers and were able to create something really helpful and cool that people used. What if it made money because people paid to use it or simply because a lot of people liked it?" I asked what happens now if he goes out of town. He answered that the business still makes money, and he could take his computer with him and check on things from lake. Atta boy.

Enter Scratch. So, motivated by the idea that there are greater opportunities for my son in the future if he learns to channel his creativity in technology versus learning how to throw a curveball (not to say I won't still promote sports, just give up early and realistically on professional aspirations), I searched for ways that kids can start to learn coding and programming. MIT built Scratch to do just that. It's a basic tool that let's kids program different cartoons or games with simple language and tools. He loves it. Talked about it for two day and finally tonight we logged in and set up his profile. He spent 90 minutes creating sounds, pictures and animations with a huge smile. I am happy and proud to present Sam's first project: Funny Show. The future is bright!

Sam's Funny Show