BACK TO BLOGGING/HAPPY NEW YEAR

I have a calendar that has a page making fun of blogs. It says, "Blogging: Never before have so many people with so little to say said so much to so few." It's pretty funny, and sadly true.
There have never been a ton of readers of this blog, but I'm sure there were more (i.e. 2 or 3) back when I was updating the blog daily. That became a drag, and as a result the blog suffered.
So for 2009, I'm going to get Dr. Tofuhead going again, and set some reasonable goals. If the blog completely sucks please let me know, and I'll revamp the whole thing or shut it down.

NEW FEATURES FOR 2009:
1. The blog will be updated once a week.
2. As usual, there will be a new topic and also reader questions will be addressed as they come in. 3. If I'm lucky, my brother Randy will put up some photos.
4. There will be more of a focus on preventive health, i.e. keeping yourself healthy...and happy. I'm going to be combing the Mental Health literature for useful new tidbits.

TODAY'S TOPIC: USEFUL RESOURCES FOR YOU!
I get a lot of useful health information from sources that are not written for doctors; they are written for "lay people" like YOU. There really are some exceptional sources of health information out there, mixed in with a whole lot of crap. The Internet in particular has a wealth of useless and erroneous health information, and I am dismayed every time I do a general search about a disease using Google. So here are a few sources that are in print, that are readily accessible, and that are LOADED with useful health topics:
1. Harvard Health Letter: this is a monthly newsletter that is relatively inexpensive and loaded with good information from the folks at Harvard Medical School. It covers everything from exercise and nutrition to detailed reviews of new tests doctors use. For example, a recent issue covered cholesterol blood tests, how much sleep you need, what kinds of fish to eat, a review of topical pain creams, cardiac stress tests, and everything you need to know about ear wax. It's available online as well, though you need a subscription to access the current month, which I highly recommend. Check it out at: http://www.health.harvard.edu/.
2. The University of California, Berkeley Wellness Letter: similar to the Harvard Health Letter, this was the health newsletter that started health newsletters. I can't overemphasize how awesome this newsletter is. I can't think of a single health or nutrition-related topic they haven't covered in depth over the last 3 years. The issue on my desk covers generic vs. name-brand drugs, berries, motorcycle riding, organic vs. commercial produce, preventing and treating mosquito bites, exercise, and all the skin cancers you need to know about, plus more. If you have to spend a bit of money on just one source of health information, this is the one I recommend. Check it out at: http://www.wellnessletter.com/. Better yet, try it for a year- it's only 20 bucks.
3. Live Longer, Live Healthier, free online book: the website associated with this newly-published health book sucks. But check it out: the authors, 2 highly respected academic professors in Internal Medicine, want you to have their book, FREE. They are not publishing it for sale; rather, they put the entire book online and they invite you to download the whole thing, with no strings attached. That's a lot of paper, but the book is just over 200 pages and has gotten great reviews from some very tough reviewers, notably the editors of the New England Journal of Medicine.
The web site is new and I suspect you'll be able to search for individual topics at some point. For now, you can open the book in Adobe Acrobat and print just what you want, or you can print the whole thing. Check it out at: www.healthierlongerlife.org.

EAT LESS, DRINK LESS, EXERCISE MORE, LOSE WEIGHT

I didn't come up with this topic idea. The "Leather District Gourmet," who has a blog much better than mine, came up with it. But I like it. I actually think the topic could fill an entire book with hundreds of pages of useful information. So why don't I write that book? Because, in short, nobody would buy it. In America, lots of people need to lose weight, but naturally they don't want to do it the "old fashioned" way. Who likes to be told that they need to eat less, drink less, and exercise more? Answer: nobody. At least not in America. Americans want instant results, without having to do much work. Here are some examples of some potential weight-loss books that would sell like hotcakes:
1. Eat More, Drink More, Do Nothing, and Lose Weight
2. Binge Your Way to a Smaller Waistline
3. Why You Don't Need to Exercise to Lose Weight
4. The High-Fat, Low Activity Lifestyle to Lose Weight
5. Losing Weight by Watching TV
6. How to Take off the Pounds in Less than 2 Minutes a Day
7. How to Change Your Waist Size Without Changing Your Diet
Unfortunately, I'm not going to write these books; I'm going to tell you the harsh truth about weight gain and weight loss.

THE HARSH TRUTH ABOUT WEIGHT
We all know Einstein's wonderful equation, whether or not we understand it: E=mc(squared).
The equation for body weight, in my opinion, is just as sublime:
Calories consumed - Calories burned = Calories converted to body fat.
It's that simple. In other words, if you consume more calories than you burn off, those extra calories will be stored, usually as fat, and that fat will increase your body weight. Fortunately, your body already burns 1500-2500 calories just to keep you breathing and thinking, depending on your age, size, and daily activities. So you ARE allowed to eat SOME calories!

WHAT ABOUT MY METABOLISM?
Nearly every day, at least one patient comes in with a similar story: "I'm not eating all that much, and I exercise, and I keep gaining weight. So I know it's not my calories, I must have a thyroid/adrenal/glandular/diabetic/metabolic problem." And while it is true that some metabolic or hormone-related problems can cause weight gain, it's hard to emphasize how rare that circumstance is. In nearly 10 years of medical practice I have seen exactly 3 patients who had abnormal weight gain for hormonal reasons- all 3 had critically underactive thyroid glands. Most people who think they are gaining weight for hormonal reasons are still consuming more calories than they burn off. Once I have proven this to patients when their lab tests come back normal, I typically ask them to start keeping a "food and exercise diary," so that we can take an honest look at how much they are eating, and how often they exercise. The result is predictable: I never see those patients again. Because the truth hurts.
As for metabolism, there is no question that it slows as we get older. At age 25, for example, you can probably consume 2500 calories per day, or more, without gaining weight. At age 50, that exact same number of calories might add a pound per week to your body weight. I do not dispute that. But this slowing of the metabolism is not pathological, and there is no scientific medical treatment for it. Treating your slowing metabolism as you age is a matter of paying attention to it and respecting metabolic change. Unfortunately, that means eating less, drinking less, and exercising more! You'll find plenty of quacks willing to sell you expensive hormone products to "speed up your metabolism," and prove me wrong. But hormones are powerful substances- I don't recommend messing with them unless you absolutely have to.

CAN MEDICATIONS CAUSE WEIGHT GAIN?
Many patients blame their excess weight gain on medications they take, some of them rightly so. Unfortunately, they tend to blame weight gain on a whole host of medications which usually do NOT cause weight gain. Let me simplify the issue by giving you a list of medications which clearly DO cause weight gain, because it's a short list:
1. Steroids, such as prednisone.
2. Anti-seizure medications, especially Depakote (also used for bipolar depression).
3. Insulin.
4. Some of the oral diabetes medications, such as sulfonylureas and "TZDs" such as Actos.
5. The anti-depressant Remeron, which is used primarily in the elderly.
6. Topamax, a medication used for migraine headaches and seizures.
That's about it. I'm sure I'll anger many people by saying this, but guess what: oral antidepressant medications, anti-anxiety medications, and birth control pills do NOT cause significant weight gain. I know you gained 20 pounds when you started Prozac. But that's because you started eating more. Sorry.

I WANT TO LOSE WEIGHT: WHAT CAN I DO?
The bottom line: you need to burn more calories than you eat and drink. It's that simple. When you start looking at the different calorie types, it does get more complicated, as not all calories are the same. Dr. Atkins, Barry Sears, and their followers are probably onto something when they target simple carbohydrate calories as the most "fat promoting." But recent studies suggest that the extra fat-promoting qualities of carbohydrates are probably a bit overstated. That's because you can still put on plenty of pounds if you're on a carb-free diet and you eat more calories than you burn off.
Here are my basic tips:
1. Cut back on alcohol. Most alcoholic drinks have hundreds of calories, with very little nutritional value. As far as your body is concerned, a margarita is as good a source of excess body fat as a Big Mac. Like beer? Try to find one with less than 100 calories per bottle. They are out there.
2. Eat at least 3 meals a day. Studies have shown that people who skip breakfast, like me, more than make up for it with increased calorie consumption with their subsequent meals.
3. Avoid eating late at night. Your fat cells love a nice dose of calories at bedtime, when they know you won't have a chance to burn those calories off. That means: more fat for your body!
4. Join a gym. Better yet, buy a very nice treadmill or exercise bike for your home, so there will be no excuses. You'll be surprised how many calories you can burn while watching an episode of "Iron Chef" (if you're on a treadmill, that is).
5. Try a diet. Studies have shown relatively equal, if modest, weight loss in patients pursuing the Atkins Diet, the Ornish Diet, Weight Watchers, and the South Beach Diet. Personally, I think the Atkins diet yields the best short-term results, and the South Beach Diet or Weight Watchers are easier to stick with for the long term. These diets work- it's the dieters who fail because too often they "fall off the wagon." I'm not saying it's easy.
6. Get a good scale. You might "feel fat" one day when it turns out that you lost 3 pounds the previous week! Give yourself a chance to feel good about the numbers, and to catch yourself when things are going in the wrong direction.
7. Make slow and steady process and realistic goals. Many people say, "I need to lose 100 pounds," when they should be saying "I need to lose 3 pounds a month regularly." Doesn't the latter goal sound more realistic?
QUESTIONS? Post a comment!

WANT A RECESSION-PROOF JOB?

Hello, dear readers, if any of you are left. I don't like long absences, but sometimes I have no choice. Sometimes, there is just no time for me to blog. Why? Because I've been busy as a beaver at work, every day. When the economy goes down, it seems, my work hours go up. That's because I have the modern-day equivalent of a "goose that lays golden eggs." That's right- I have a RECESSION-PROOF JOB!

There has been a lot of press about the so-called RECESSION-PROOF JOBS these days. The truth is that there is probably only one job that is entirely "recession-proof," and that's the job that Barack Obama just got. But still, there are jobs that are more recession-proof than others. Based on my experience, I think that many of those jobs are in HEALTH CARE. Let's examine some of those jobs, or professions, and examine why I think they are recession-proof.

1. DOCTORS: why on Earth would a high-paid person like a doctor have a job that could be considered recession-proof? Easy. Because the job of a doctor is to heal the sick and to keep the healthy, well...healthy. That job seems to get busier when there is a recession. I'm not entirely sure why; but I can speculate that more people are stressed out, working more hours, and abusing themselves more with their favorite "self-medications:" tobacco, alcohol, and recreational drugs. I certainly see more depression, alcoholism, insomnia, lung disease, and related illnesses during recession. My colleagues in surgery, pediatrics, and even dermatology have the same experience. It's only human; when we are worried about our finances and our job security, we tend to put our health on hold. And that's why society needs doctors even more during a recession.

2. NURSES: Any doctor in his right mind will tell you that a doctor without a nurse is like a pilot without an airplane, or something like that. I'm all but worthless without my nurses. Who do you think starts the I.V.s, schedules the appointments, gives the immunizations, refills the meds, takes out the stitches, and bandages all the wounds in a busy clinic or hospital? That's right, it's the nurses. We doctors have to do a lot of heavy-duty "thinking," "diagnosing," and sometimes "operating," but to be honest the nurses do most of the hands-on work with patients. And as the shortage of doctors grows, nurses are increasingly doing more of the work that doctors used to do. Some of the nurses at my clinic, for example, have their own entire practices full of patients they treat themselves. And the best part is that some of them make as much money as the doctors do. And what about this "doctor shortage?" Well, it's bad. But it's a minor problem compared to the shortage of nurses. If every person in the state of Kansas instantly became a nurse, we'd still need about 20,000 more of them. Imagine how many awesome, unfilled jobs in nursing there must be!

3. PHYSICIANS ASSISTANTS: Despite the misleading name, "P.A.s" do much more than assist doctors. Most of them evaluate and treat at least some patients themselves. They do assist in the operating room, but these days most of them can do some operations and medical procedures themselves. Like nurse practitioners, they may even have their own independent medical practices. They are in high demand, and they get paid well.

4. PHARMACISTS: When the economy is bad, people get sick more often, and abuse themselves more- so guess what? That means they take more drugs! And I'm not just talking about illegal drugs. Every year there are more people on more medications, and new medications coming onto the market constantly. Thus, the demand for pharmacists is tremendous. These are not just the people who count pills; increasingly, they do research, monitor patients on dangerous drugs, evaluate drugs for interactions and side effects, and counsel patients in numerous ways about the risks and benefits of medications. They also counsel doctors. They know more about medications than we do, and doctors beg them for guidance on a daily basis.

5. NURSE ASSISTANTS AND NUSE'S AIDES: The variety of degrees and jobs in nursing has gotten so complex that honestly I can't even give you an accurate list of all the various job titles. Suffice it to say that you can get a nursing or nurse assistant degree in 1, 2, 3, or 4 years, depending on how far you want to go. Bottom line: you can be trained to do a high-demand, kick-ass job in a short amount of time, and you'll have job offers coming at you faster than you can handle. Many of these jobs are at the lower levels, where there is minimal schooling involved. And even the lowest-level nurse's aide can get more training, and work up the nursing hierarchy. There is no limit to where nursing (or nurse assisting) can take you!

6. NUTRITIONISTS AND DIETITIANS: You might think a dietitian is someone who sits down with you and tells you to eat healthy foods. But that's only a small part of what these people do. Many serious health conditions require extremely complex nutritional planning and execution, and nutritionists and dietitians are relied on heavily, in all hospitals and in most clinics. Some people can't eat at all, and are fed for years through tubes and I.V. lines. Who makes sure those folks are getting enough of the hundreds of nutrients we need to survive? Who has the skill to design diets to protect your liver, your bones, your blood vessels, your brain, your newly transplanted organ, or your failing kidney? You guessed it: a dietitian. Or a nutritionist. It's as challenging and rewarding a job as any in health care.

IN SUMMARY:

If you are interested in health, worried about your current job, looking for your career path in life, or just need a midlife change of occupation, consider looking into heath care. Most people make the erroneous assumption that you need a ton of schooling, perfect grades, and an early start to get a good-paying job in this field. But that's no longer true. Even high-ranking medical schools that train tomorrow's heart surgeons are seeing a surge in older applicants and applicants who have worked in other careers for years, or even decades. Believe it or not, they LIKE those applicants. Real-world experience makes better health care workers, even if the experience is not health-related. And if you're in school or just starting school, so much the better. The world of health care is your oyster. And take it from me, a lowly primary care doctor: helping people to heal and stay healthy is a uniquely wonderful experience. My colleagues in nursing, pharmacy, nutrition, and related fields will tell you the same thing.

WHAT CAN YOU LEARN FROM FOOTBALL?

Today's blog was originally going to wrap up the seafood topic; but I'm at my in-laws' house and I don't have my notes, so we're going to take off on a tangent. After all, it's Sunday, and that means it's a day full of wonderful NFL games.

Before you immediately bail on this blog, let me just say:

1. You don't have to be a football fan to learn something useful today.

2. I really like watching football, and basketball for that matter, but I'm by no means a fanatic fan and I'm not going to bore you with a long tribute to sports.

3. Even if you hate NFL football, you can learn something relevant to your health by watching a football game. Or at least by reading today's blog.

FOOTBALL INJURIES: A WONDER OF NATURE

If you watch a football game, it's obvious that people get hurt quite a bit. But given the size of the players, the speed at which they travel, and the body-to-body impact that occurs, it's not how often players DO get injured that's surprising. I think, and my practice partners agree, that what's surprising is how often players DO NOT get injured in these high-impact, intense games. Let's look into 3 types of injuries that don't occur as often as they should, and why.

HEAD INJURIES

Actually, head injuries occur constantly in football. You hear about them sometimes, but the true number of head injuries is hard to estimate, because players are sent back into the game even with relatively major concussions. That's part of football. I'm not even sure a concussion is considered an injury in football. In any case, why aren't there more serious head injuries?

Answer: HELMETS. Helmet technology has improved drastically over the years, and will continue to do so. Any doctor who treats athletes will see people who have sustained severe concussions, even with helmets on. But the feared head injuries (skull fractures, intracranial bleeds, ruptured blood vessels in the brain) are much more common in athletes that are not wearing helmets. Most of you probably don't play full-contact football. But if you bike, ski, snowboard, skateboard, or rollerblade, please do yourself a favor: Wear a helmet. It's the easiest way to avoid the most dreaded type of sports-related injury.

BY THE WAY, THANK YOU: To motorcycle riders who don't wear helmets. They are are largest contributor of brain-dead bodies (namely, themselves); and brain-dead bodies are our largest source of organs for transplant. I fully support motorcycle riders not wearing helmets, as long as their organ-donation cards are filled out.

KNEE INJURIES

The serious knee injuries that are common in football are also common in recreational weekend sports that we all do from time to time. This injuries include tears of the ACL or PCL ligaments, meniscal tears, fractures, and tears of the ligaments on the sides of the knees, known as the collateral ligaments. When I watch NFL football, I'm amazed that ligament and meniscus tears don't occur in huge numbers. How is it that a lineman can dive helmet-first into your favorite quarterback's knee, and not cause a tear?

Answer: KNEE STABILITY. You can stabilize your knee with a brace (especially the expensive, hinged kind), your you can build your knee stability internally. Knee stability is largely a function of the pure strength of the muscles around the knee, especially the muscles of the thigh. Keeping your quadriceps and hamstring muscles strong means that the ligaments and cartilage in the knee joint have extra support, and can take more abuse. Want some specific exercises? Try the following next time you're at a gym:

1. Quad extensions (on a weight machine)

2. Hamstring curls (on the machine where you lie on your stomach and pull your feet up toward your butt)

3. Seated leg presses

4. Standing hamstring curls (on the cable machine)

If you need more exercises or info on how to build strong thighs, ask one of those incredibly fit, handsome trainers most gyms have walking around these days.

BACK INJURIES

Surprisingly, football players get back injuries less commonly than the average Joe who shovels snow, lifts boxes, helps a friend move, or does any of the other activities of life that stress the low back. If you've ever had a "slipped disk" or "low back strain," you know it can be fairly disabling, and you also know that it may come back to visit- frequently. Some studies suggest that back pain absorbs more time and money than any other condition in the American health care system. With all the impact to the spine, pile-ups, hyperextensions, falls, and collisions, why don't football players constantly injure their backs?

Answer: CORE STRENGTH.

You've probably heard about building or strengthening your "core" these days, even if you don't do Pilates, yoga, martial arts, or boxing. Strengthening your "core" simply means keeping your abdominal and low-back muscles strong. The reason to do this is essentially the same reason you want to stabilize your knees: your core muscles add layers of stability and strength to your otherwise vulnerable spine, spinal nerves, disks, and other ligaments in the back. It's never too late to build up core strength. In fact, it's the foundation of treating back pain and even the most severe back injuries. Core strength also protects the spine from injuries, by supporting the vulnerable structures and absorbing forces on the spine.

Football players spend a ton of time working on their abdominal and low-back muscles- a fact that is evident if you've ever seen a picture of a running back with his shirt off. Even those 350-pound offensive lineman have a dense wall of abdominal musculature underneath all that spare tire. That's a big part of why the backs of football players can take a ton of abuse without causing disabling pain.

So how do you strengthen your core? Most gyms have machines to help you do this, and the exercises in Pilates, yoga, and martial arts also have numerous moves designed to keep the core strong. Crunches and sit-ups are the most well-known abdominal exercises, and these work great. I recommend also doing low-back exercises, such as forward bends and back extensions (you need a piece of equipment called a "Roman chair" to do these right, but most gyms have these).

Obviously there are far more parts of the body to injure, and many more techniques to avoid injury, than we've covered here. But this is enough to help you get started, and maybe enough to help you appreciate the resilience of NFL players.

RESPONSIBLE SEAFOOD PART 2

ANNOUNCEMENT: I never quite knew where to put my responses to reader comments, my updates on past topics, and my corrections and explanations to various items I'd neglected, so time and again I've been in the habit of doing a whole blog entry to attend to those matters. From now on, to keep new topics coming, I'm creating a section at the end of the blog called "LEFTOVERS," where I'll address those items, unless a topic is large enough that I can do a substantial blog entry devoted to it.

Hopefully by now some of my readers are eating more seafood, and perhaps finding the sustainably caught or farmed finfish in stores near them. I know it's not always easy. I thought it would be easier to find responsible shellfish, until I read about them and checked out my local supermarket. It was "slim pickins," but then again I was at a major chain grocery store.

As with the other fish, you can get more information about good seafood choices on the web site www.seafoodwatch.org, from which I boosted most of the below information.

RESPONSIBLE SHELLFISH TO EAT:

1. CLAMS, farmed (apparently farmed anywhere is OK according to seafoodwatch.org)

2. CRAB, stone and Dungeness crabs (this seems too good to be true, as local Bay Area sources tell me that Dungeness crab is fast becoming overfished on the West Coast- hopefully seafoodwatch will have an update on this at some point)

3. LOBSTER, U.S. Spiny lobster(wild)

4. MUSSELS, farmed

5. OYSTERS, farmed

6. SCALLOPS, farmed (Bay scallops only)

7. OYSTERS, wild (unfortunately, there is a "mercury warning" on this one)

8. SHRIMP, U.S. ONLY (farmed or wild, but these are considered OK choices, not "Best Choices"). Alas, it seems that no shrimp are great choices.

YOU'RE MOST LIKELY to find U.S. shrimp, or farmed Bay scallops, at a typical grocery store. Fortunately, these are healthy food choices and at least the farmed Bay scallops are considered a "Best Choice" by seafoodwatch.org. If you're lucky enough to live near the coast, you may commonly find such delicacies as Spiny lobster, wild oysters, and stone crabs. In fact, stone crabs are easy to catch yourself if you live near a pier. And they are simply delicious!

NEXT BLOG: we're going to get more into some more exotic fish, mollusks such as squid, and more about fish you can catch yourself.

LEFTOVERS

1. Tilapia: apparently not all farmed U.S. Tilapia are without problems- check the reader comments on my last seafood blog, a reader has a great link to a site that "fleshes out" the facts about Tilapia.

2. Drug questions? Some of my own patients have brought up some amazing questions about pharmaceuticals lately; questions that have sent me off to hit the textbooks and to hit up my pharmacists for more info. If you're on any drugs, prescribed or otherwise, feel free to ask any questions here.

3. Finally, my favorite: What ILLNESS does Kenley from the show "Project Runway" have?

I spent all day thinking about this one. But I need to restrain myself, because of the following disclaimer, which you must read before reading any further:

-I don't know Kenley at all and have never met her.

-I'm not a psychiatrist.

-She may be acting. After all, she should have been fired at least 3 episodes ago. Why do they keep her on? Because a "crazy person" stirring up drama makes a show more exciting. She may be getting paid under the table to act nuts.

-If she does have a mental illness that she's struggling with, it would be harsh to rip on her about it. Unlike her, I'm actually nice to most people and feel guilty making fun of them, unless they are myself.

SO, I'm simply going to list the diagnoses that I've been WONDERING about, when I see her behavior on television. You'll have to find out more about them on your own.

1. (Most likely, in my limited opinion): Narcisisstic personality disorder, quite possibly with antisocial features.

2. Borderline personality disorder with psychotic features.

3. Bipolar depression (currently in bipolar mania part of the cycle).

How she behaves in future episodes may help narrow down this entirely speculative list.

THANKS, PROPS, AND ADMISSIONS BY DR. TOFUHEAD

Short but sweet: that will be today's blog. As Thanksgiving approaches, I'm reminded how much I have to be thankful for.

THANKS:

1. V., for pointing out that Adeline penguins get pink eye. The question of why disparate species can get the same diseases is complicated, and, I believe, has critical clues as to the nature of disease and immunity. Why, for example, do humans, monkeys, birds, mice, and lizards get malaria, while many other species don't? Why do penguins get pink eye, when other mammals closer to humans don't? These issues continue to perplex and amaze me.

2. Mrs. Church for kind comments about my seafood blog. Her blog, The Leather District Gourmet, is amazing, and several quantum leaps in quality above this one. Check it out.

3. Anonymous, for the comments about bird flu. He or she points out that bird flu can be cured by early administration of a medication called osteltamivir (Tamiflu) in specialized hospital. I do agree that early hospitalization of patients with bird flu, who need intensive supportive care, can save lives. But unfortunately there is no scientific evidence that osteltamevir, steroids, or any of the other medications impact the clinical course of this disease. I stand my my assertion that prevention and avoidance are the best approach to bird flu. But I welcome, thank, and listen to people who disagree with me because that's how I learn new things.

PROPS:

To my brother who puts all the images in this blog and helps me learn how to blog in general. I'm not good with most things technological and computer-related, and I could never have gotten this blog off the ground without him.

ADMISSIONS:

1. It's becoming more clear by the day that I'm pretty much the only person I know who thinks camo clothing is fashionable. I stand by that assertion, much like some folks stand by the assertion that the Earth is still flat.

2. I love Crocs and think they look great. But you should know that most people disagree. You should also know that the history and management of that company is so thoroughly dysfunctional that the story of Crocs reads like a bad soap opera. The Crocs company got greedy, and too big for their britches, and as a result there are literally millions of pairs of Crocs in warehouses across the globe gathering dust. That's a lot of plastic, and a lot of waste, and a lot of investors in Crocs lost their shirts. So a message to the Crocs company: GET YOUR SHIT TOGETHER. I won't support your company much longer.

3. Want some good clogs? Skip Crocs for now, and invest in some Danskos. I think they look great, for whatever that's worth.

4. I'm addicted to the show "Project Runway."

5. Despite my encyclopedic knowledge of food, nutrition, and health, I have calculated that I am approximately 23 pounds overweight and have started a new diet. I'll let you know how it works. When I tell you that you should eat something, you should probably eat less of that thing than I would in one sitting.

XXXOOO

Dr. Tofuhead

RESPONSIBLE SEAFOOD: PART 1

All day long I find myself looking at bad cholesterol numbers, and high blood pressures, and singing a similar song to my patients: Eat More Seafood. Eat More Vegetables. Exercise More.

It's pretty simple to live a healthy lifestyle, when you really think about it. But some of these things need elucidation, especially if you're thinking about more than just a healthy "you." What if you're thinking about a healthy planet? I know I am. I want to keep my own body, my family, my community, and my patients healthy. But JUST AS importantly: I want my planet to be healthy. Perhaps that's even more important. After all, if we don't have a healthy planet to support us, what use is our own health?

As you know from my recent blog, when a doctor tells you to "eat more seafood," you can include shellfish on your shopping list. But as you may also know, seafood, including shellfish, is a complicated issue. Which seafood items are fished or farmed in a manner that respects the environment? Which fish are overfished? Which fish are farmed in a manner that destroys ocean and watershed ecosystems? Which fish are loaded with mercury and other harmful contaminants?

RESPONSIBLE SEAFOOD THAT IS GOOD FOR YOU

If you read no further, read this: the web site that will tell you everything you need to know about seafood: www.seafoodwatch.org. This site was created by the Monterey Bay Aquarium in California, and it's updated frequently. Rather than just telling you what NOT to eat, this site gives you lists of seafood products that ARE safe to eat, that ARE readily available, and that ARE fished or farmed in a sustainable manner. Yes, the lists do get long and complicated, but that's just because there are many organisms that can be described as "seafood."

SEAFOOD TO EAT: FINFISH

Here are the best choices. Keep in mind the SAME fish can be a sustainable choice or a TERRIBLE choice, depending on how it was raised or caught. If you don't know, ask the person at the seafood counter of your store. If they don't know, leave the store and go somewhere else.

People have NO BUSINESS selling stuff they don't know about, especially if it's food.

EAT THESE:

1. FARMED U.S. Catfish (easy to find)

2. PACIFIC wild Halibut (moderately easy to find)

3. ALASKA WILD Salmon (sometimes hard to find)

4. ALASKA WILD Pollock (hard to find)

5. U.S. FARMED Tilapia (easy to find)

6. FARMED Rainbow trout (easy to find)

7. U.S. or BRITISH COLUMBIA, trolled or pole-caught Albacore Tuna (hard to find)

8. Trolled or pole-caught Skipjack (I've never heard of it)

9. LAKE, TRAP-NET caught Whitefish (moderately easy to find)

10. U.S. FARMED Barramundi (I don't know where to find it)

THE EASY BOTTOM LINE

If the above is too complex for you, let me recommend my favorite 3, easy-to-find, very healthy and large finfish. There are lots of little healthy fish, but today I'm talking about fish that are nice as fat fillets and steaks, when you want a big slab of yummy fish:

1. U.S. Farmed Tilapia: it's hard NOT to find this fish in food stores. Can be used in any recipe that calls for Halibut, trout, sole, flounder, catfish, or other "whitefish."

2. Wild Alaskan Salmon: you might need to go to a specialized meat or seafood store for this, or a Whole Paycheck Market. I rarely see this in the normal chain supermarkets, which are awash with Atlantic Salmon and farmed salmon, both of which are BAD CHOICES for the planet. If you don't know how to cook salmon, post a comment. I've got recipes.

3. Farmed Rainbow Trout: this is still my favorite fish to pan-fry with a bit of butter, lemon, and salt and pepper. I consider it the "flank steak" of fish: lean, tasty, and delicious without a lot of spices or sauces needed. I see it in most of the grocery stores I go to.

NEXT BLOG: SEAFOOD TO EAT- THE SHELLFISH

PINK EYE IS NOT THAT BAD

It's "Pink Eye" season, as well as flu season. Like most terms for diseases, "Pink Eye" is a term that gets batted around freely, and usually inaccurately. Let's clear up this concept a bit.

WHAT IS PINK EYE?
Pink eye is better known as "infectious conjunctivitis," a contagious infection of the eye which is fortunately very benign. There are strange varieties of this in the developing world, but here in the U.S. there are just 2 main types. Both cause the eye or eyes to be red, painful, itchy, sensitive to light, and sometimes full of mucus and pus. Pink eye lasts weeks. If your eyes are itchy, watery, or bothersome intermittently for months or years, you don't have pink eye, you have eye allergies.
THE 2 TYPES OF PINK EYE:
1. Viral conjunctivitis- this accounts for more than 90% of cases of pink eye. There is no cure, you just have to suffer for 2-4 weeks until it goes away. Most people, including doctors, incorrectly think that you need antibiotic eye drops to treat this. You don't. Antibiotic eye drops for viral pink eye will either do nothing, or make your eyes burn more.
2. Bacterial conjunctivitis- this causes about 5-10% of cases of pink eye. It usually affects just one eye, and is not quite as contagious to others. This type of pink eye gets gradually worse without treatment with antibiotic drops, and it DOES NOT go away on its own.
HOW DO YOU TELL VIRAL PINK EYE FROM BACTERIAL PINK EYE?
Fortunately, it's not that hard. Bacterial pink eye (the one that requires antibiotic drops) produces large amounts of white or yellow pus in the eye, so that in the morning the eye is crusty and initially hard to open. It's quite painful, and while it can be in both eyes, it's usually just in one eye. It also progresses; each day it gets more red, more painful, and there is more pus. So if you think you have bacterial pink eye, see your doctor!
By contrast, the common viral pink eye is very annoying, but does not get worse day by day. It can be painful and irritating, and it easily spreads to the other eye. It can also produce a lot of mucus in the eye, but this is usually clear mucus that is sticky in the morning and more "runny" the rest of the day. It's not white or yellow mucus. NO eye drops will shorten the duration of viral pink eye.
HOW DOES PINK EYE SPREAD?
1. Bacterial: infected body secretions have to actually get into your eye to give you bacterial pink eye. Babies can get it just from being born, via contact with vaginal bacteria (all babies are usually given a dose of eye ointment at birth to prevent this). But you can probably get it from the saliva, snot, or eye secretions of your child, spouse, or friend. So if someone you're in close contact with probably has bacterial pink eye, see your doctor if your eye starts bothering you.
2. Viral: viral pink eye is very contagious. It almost seems to spread via "ESP" or perhaps through the "fabric of the universe." It's possible that it can travel on water vapor in the air, and just "land on" your eye. It certainly can be spread by close contact with infected people, especially if you happen to rub your eye. If your child has viral pink eye, I suggest you simply get some sunglasses and assume you'll have it within the week.
HOW DO YOU TREAT PINK EYE?
1. Bacterial: get some antibiotic drops from your doctor; most eye doctors and optometrists can write a prescription for these as well. Put a cold, wet towel over your closed eye for 10 minutes periodically- it can be very soothing. Take ibuprofen or naproxen for the pain. You'll be better soon.
2. Viral: you can try anti-inflammatory drops such as Naphcon, Zaditor, Ophcon, or Visine; they usually don't help much. A lubricating drop such as "Artificial Tears" is probably more helpful. Use a cool compress on your eye or eyes when you have time. Wear sunglasses. Try some ibuprofen or naproxen. Rest. You won't be better that soon, but there are worse diseases to have.
WHAT NOT TO DO WHEN YOU HAVE PINK EYE, BACTERIAL OR VIRAL:
-Don't wear contact lenses
-Don't swim in chlorinated pools (not dangerous to do, just painful)
-Don't handle other people's small children
-Don't get eye surgery
-Don't ask your doctor for narcotics (we know it doesn't hurt that bad)

THE FLU SHOT: FREQUENTLY ASKED QUESTIONS

Yes, it's almost flu season again. That means it's the season when many people will start spreading various myths, inaccuracies, untrue stories, and other nonsense about the flu shot and why they don't get it. I don't care that much- people are free to skip out on getting flu shots if they want to. I just want you to know the facts about it, so that you can make an INTELLIGENT choice as to whether or not you want the flu shot. I'll give you the facts via a format I like, the common "Frequently Asked Questions" or FAQs.

THE FLU SHOT: FAQs

Q: Can the flu shot give you the flu?

A: NO. The flu shot is a dead, killed, completely inactive virus. You cannot get an actual flu from the flu shot, even if your immune system is weak or nonexistent. There ARE some live flu vaccines that are given as a nasal spray, but I don't trust these; they haven't been around long enough. They can't give you the flu either if your immune system is normal. Your doctor probably has the good 'ol flu shot for you anyway.

Q: I got the flu and it was just like a bad cold, and I got over it. Why bother getting a shot to prevent this?

A: You didn't have the flu. You had a bad cold. Did you have shaking chills, a fever over 102, severe diarrhea, and body aches that were so bad you couldn't get off the couch for almost 2 weeks? I didn't think so. You had a cold. Stop telling people you had the flu. If you had the flu you'd be begging for the flu shot this year.

Q: Does the flu shot make you feel sick afterwards?

A: Sometimes. It may give you a low-grade fever, MILD body aches, fatigue, and nausea for 1 (one) day. If it gave you these symptoms for longer than that, you either had a cold coming your way already, or you are a hypochondriac (see earlier post about hypochondriasis).

Q: Can't the flu shot give my child autism?

A: No. This question has been addressed in studies that are some of the largest clinical trials in medical history, and time and again, it's been shown that there is NO provable link between ANY vaccine given to children, and autism. But there are much bigger, fancier blogs and web sites than mine that will tell you the opposite. I go with the science, and I believe the scientific studies on this issue (which, by the way, are NOT funded by the drug companies) are conclusive.

The flu shot is safe for kids, and kids don't like having the flu.

Q: Who should get the flu shot?

A: Everyone. I'd say everyone "should" get the flu shot, but I don't push the issue in young, healthy people. Why? Because the flu sucks, but it won't kill those people. I do push the issue in some patients (see next question).

Q: Who REALLY SHOULD get the flu shot?

A: Senior citizens (people over 65), people with diabetes, people with lung diseases such as emphysema or pulmonary fibrosis, people with cancer, heavy smokers, people with heart failure and other chronic heart conditions, and young children (under 5 is "young" in my book but ask your pediatrician since I don't treat kids). Why is it so important? Because for these folks, the flu is a life-threatening illness.

Q: Does the flu shot protect you from the dreaded "bird flu?"

A: No. Unfortunately, modern medicine has absolutely nothing that can prevent or cure the "bird flu." Your best bet is still to avoid frolicking in Asian live poultry markets.

Q: I've heard that the flu vaccine doesn't protect you from all normal flu viruses. Is this true?

A: Yes. Flu viruses mutate every year, which is why the flu vaccine has to be made from scratch every season. Sometimes the flu viruses circulate in greater variety. For example, in 2006 the vaccine was quite good, protecting against over 75% of common flu viruses. Last year, the vaccine was relatively mediocre (60% protection or so at best). Unfortunately, we don't know how effective a given flu vaccine will be until we are well into the flu season.

Q: When should I get the flu vaccine?

A: As soon as your doctor, office, pharmacy, or local clinic has it available.

Q: When is it "too late" to get the flu shot?

A: When there are none left. It's amazing how long flu season lasts- while fall and winter are the worst times, we still see cases well into spring. So if you haven't made it in for a checkup until January and your doctor offers you a flu shot, I recommend you take it.

THE VARIETIES OF THE SHELLFISH EXPERIENCE

Many people are allergic to shellfish; most of those people, however, can eat regular fish, or "finfish" as they are called in the nutritional literature. One of my dear friends, however, is allergic to "finfish" but not to shellfish, prompting me to look into the health benefits of eating these animals. After all, they sure are tasty!
It turns out that the data are somewhat mixed, but on the whole I can thankfully say: SHELLFISH ARE GOOD FOR YOU, with a few qualifications. In fact, many shellfish are EXTREMELY GOOD FOR YOU! Let's break them down by pros and cons:

1. SCALLOPS: in my literature review, it turned out that scallops were probably the healthiest shellfish out there. While they are not as high in the beneficial omega-fatty acids as some of the other shellfish, they are very high in protein, vitamins, and minerals, and relatively low in cholesterol. I would say with no reservations that if you want to eat shellfish frequently, scallops are the way to go. They are easy to grill, which is another benefit, and they freeze well.
2. CRABS AND LOBSTERS: these are a mixed bag. Believe it or not, these spiny crustaceans actually have the most beneficial omega-fatty acids of all the shellfish. So in terms of their anti-oxidant and anti-inflammatory properties, crabs and lobsters are the best shellfish choice. Some problems: First, they are overfished and numbers are declining. Second, they are high in cholesterol, which itself can contribute to heart disease. Balancing out the risk/benefits however, these are still healthier food choices than most animal meats.
3. CLAMS: not a bad food by any means. They are loaded with protein, B vitamins (who knew?) and lots of minerals. They are moderately high in cholesterol, but not as much as most animal meats. They can also be farmed, and for reasons I don't understand farmed shellfish do not seem to cause environmental degredation (the way some farmed finfish do). Of course, all filter feeding shellfish such as clams, mussels, and oysters can cause outbreaks of disease when they feed on toxic algae. But this can be avoided by cooking them.
4. MUSSELS: similar to clams, with a bit more cholesterol but also more minerals.
5. OYSTERS: similar to mussels. Naturally, they are delicious raw. They have a modest amount of cholesterol but also a modest amount of healthy omega-fatty acids. I say: eat them all you want. Yes, you could get food poisoning from them when you eat them raw, but in recent years there have been VERY few reports of food poisoning from oysters. It's fast-food beef and commercial vegetables you need to watch out for in this regard.
6. CRAWFISH (otherwise known as crayfish, crawdads, and mudbugs): nutritionally these are similar to lobsters and crabs, but lack much of the beneficial omega fatty-acids. So they are not as good for you as crabs and lobsters, and they have quite a bit of cholesterol. They are a treat when fresh, but hard to find, so most of you probably don't eat a ton of these anyway. I order them from Louisiana once a year and pig out on them for about a week, and it's fun. But I wouldn't recommend doing that every weekend.
7. SHRIMP: unfortunately, our beloved shrimp round out the bottom of the list, nutritionally. They are a great source of protein and minerals, but they are also the highest in cholesterol of all the shellfish. They do have some anti-inflammatory fatty acids in them, which might offset this a bit. But they don't have much. They are also filling, and filling foods can help reduce calorie intake for people who need to lose weight. I don't think they are a bad choice overall, and the prevalence of shrimp farming has led to less overharvesting of shrimp from the sea. My concern is that if you eat shrimp more than once every 1-2 weeks, they can increase your cholesterol numbers. Personally, I'm going to start eating less shrimp and a lot more scallops.
NOTE: I did not investigate thoroughly the "sustainability" of the above shellfish foods. However, people in the know have told me that "farmed" shellfish are both healthy and neutral to the environment. So unless you know something I don't, go for farmed shellfish and learn how to like scallops if you can.

BACK IN ACTION

I apologize to all 3 of my readers for my prolonged absence. I was at an amazing art festival in the middle of the desert in Nevada, for over a week. There was no internet access there. I was totally out of touch. Blogging was impossible.

TODAY'S TOPIC: YET MORE BITE-SIZED HEALTH TIPS!
1. What sort of fish should I eat? Check out this concept: the lower on the food chain, the better. A dude wrote a whole book (a great one) on that. The idea is that the higher you go up the fish food chain, the more MERCURY you are exposed to. What you want is the little fish, the ones that eat plankton, algae, and tiny shrimps, etc. What do I mean? Herring, sardines, and anchovies, especially. Yes, they are not that exciting to most people- so ask me if you want some "exciting recipes" using these fish!
2. Sun protection? Look for SPF 30 sunscreens. Evidence does not support the use of higher SPF lotions for most people. As I sit here with fried, cracked, burnt lips, I am reminded to tell you: don't forget your lips when you are trying to protect yourself! Get an SPF 15 or 30 lip balm, better yet get a few since they are easy to lose.
3. Are eggs unhealthy? No, unless you are allergic to them. In recent studies eggs have come through as perhaps the MOST complete form of protein (meaning essential amino acids) on the planet, at least for humans. The cardiac risks of egg consumption have been vastly overrated, and in fact eggs may have some good fats as well as some unhealthy cholesterol. Doctors in the know are now saying you can have an egg a day and that's probably a good thing. Or save your "egg credits" all week and have a big 4-egg omelette on the weekend!
4. Gary Null is full of shit: weeks ago I was trying to support some of Gary Null's nutritional advice, since the guy knows food. That's before I heard him claim that "I don't wear sunscreen, and I'm in the sun all day. I eat antioxidants, and they protect my skin better than any sunscreen, without the chemicals." First of all, if you've seen Gary Null on TV, you know that his skin actually looks like crap. Second, the above statement is so profoundly misguided that I'm afraid I must abandon any support for anything that guy says. You can eat all the antioxidants you want, and your unprotected skin will still get fried and develop skin cancer. The antioxidants are clearly not slowing down Gary Null's dementia either.
5. Don't waste your money on magnets. There are various wristbands, socks, and other crap with magnets in them to help you relieve pain. If you believe in these, I can't help you. You don't believe in these, do you?
6. Reader question: Is skateboarding exercise? You bet it is! Just wear a helmet, please.
That's all for today, folks; please send me more comments and reader questions!

MORE BITE SIZED TIPS FOR YOUR WEEKEND

As I do every four years, I've been watching the Olympics fairly religiously. This one in Beijing is the best summer Olympics I can recall. I have to commend China, whatever you might feel about them: they have done a hell of a job building facilities and running a fantastic sports extravaganza. I personally could care less how old their gymnasts are. In watching these sports, it's interesting to see the athletes and what sort of shape they are in. I've come to some conclusions about the relative health of athletes, and these conclusions are not just opinions. They are well substantiated by studies of athletes as they age.


THE HEALTHIEST OLYMPIC SPORT: SWIMMING
Why? Simple. Swimming provides good cardiovascular training, the involvement of most if not all muscle groups, and is very low-impact. Swimming injuries are few, far between, and generally minor. Drawbacks: requires a pool and silly clothing. Michael Phelps may be dull as a post, but you can't deny that dude is in good shape.



THE LEAST HEALTHY OLYMPIC SPORT: GYMNASTICS
Why? Gymnastics is not exercise, it's torture. The constant impact on the joints, especially in young girls, combined with anatomically harsh angles and hard falls, is a recipe for poor health. In the best of cases, gymnastics can lead to Olympic medals. In most cases, it leads to recurrent severe injuries and chronic pain. Don't believe me? Consider this: the age range of our Olympic women's gymnastics team is 16-20 years. All of them, with the exception of 1, have already had orthopedic surgery. Ask Mary Lou Retton (my childhood hero) about her hip replacement. Nobody as young as Mary Lou should need a hip replacement. If you have a young daughter who wants to do gymnastics, I suggest you gently but firmly tell them to take up something safer, such as motorcycle racing or BASE jumping.

READER QUESTION: FLOURIDE?
A friend of mine recently blew me away by getting a letter published in The Economist, then stumped me with a question about flouride in kids' toothpaste. I'm a big fan of flouride, and I get pissed when I see toothpaste in health food stores marketed as "flouride free." Turns out that it's DIFFERENT FOR KIDS. While flouride is in most toothpaste for school-aged kids, younger kids are supposed to brush their teeth with FLOURIDE FREE toothpaste. This is because flouride hardens the teeth and makes the tooth enamel more permanent. But when kids are still growing their permanent teeth, they don't have hard, permanent enamel established. When you use flouride toothpaste in young kids, especially before age 2, the enamel hardens prematurely on the new teeth as they grow in. The results are not awful, but they can get abnormally bright white spots on otherwise "cream colored" new teeth, and these spots are both noticeable and permanent.
Close to age 2, kids are supposed to have their first dental checkup. That makes it easy to decide when to use flouride. The bottom line is: DON'T use toothpaste with flouride on your kids UNTIL they have had an exam with a dentist and the dentist has told you to start using flouride.
Adults: you need flouride, even if you've never had cavities. That's because it prevents bacteria from infecting the gums, which leads to gum disease and root canals. If you've never had a root canal, you're lucky. The only thing I liked about mine is that I ended up with a sweet gold tooth that only cost $4500!

ORGANIC? PESTICIDE FREE?
If you can afford it, organic produce is probably worth buying. Today, I found a website I just have to tell you about, because it helps you spend your money wisely. This site actually quantifies the amount of pesticide residue on common commercial fruits and vegetables, so that you can choose WHICH to buy organic, if your grocery store or your pocketbook limit your choices. Kudos to: www.foodnews.org for good research and a great website- you can even download a wallet-size list of commercial produce to buy (and to avoid), so that you can take it to the market with you. And the list is surprising.

THE PINNACLE OF FASHION: CAMO

Last night as I sat around the airport for 6 hours waiting for another delayed flight (I can't recall the last time I flew on a flight that was on time), there was a kid sitting across from me and another kid sitting next to me; both were dressed head-to-toe in green camouflage outfits. My first thought was, "right on!" I myself was wearing a more subtle, "mossy oak desert sagebrush" camo shirt in tan, black, and hints of sage green. As I sat around the airport, pretending to read and making mental notes of passengers' poor fashion choices, I counted at least half a dozen people with camouflage clothing. None of them were soldiers, and none of them appeared to be going hunting.

If you haven't purchased camo clothing lately, you should know that the world of camouflage has exploded, much like the world of portable electronics. There are literally hundreds of camo patterns for various uses, and almost all stores, from high-fashion to variety to Army surplus, carry some camo items. You can buy camo sunglasses, watchbands, hats, towels, coolers, dinnerware, tents, shoes, socks, and infant pajamas- and that's just at the Super Target in north Denver. I personally think this is a wonderful thing. Camo, like many great things, was invented for military use (as was the Internet), and I think it's a triumph of civilization when a military invention becomes "demilitarized," and co-opted into peaceful civilian uses.

WHY YOU SHOULD WEAR CAMOUFLAGE CLOTHING

1. If you get a food or wine stain on camo clothing, no one will notice-not even you.

2. If you're into "supporting the troops," you can show your solidarity without all that "sacrificing your life for your country" business.

3. If you're opposed to the military, you can rebel by wearing camo at a peace rally or knitting circle.

4. If you like bird-watching, hunting, or fishing, camo potentially allows you to get closer to wildlife (hint: neon orange is not the best pattern for this use)

5. With all those earth-tones blended together, camo matches almost any other color or fashion accessory.

6. Children everywhere will think you're cool, or at least into dressing like they do.

7. Camo is not "stuck up." It's available everywhere- thus, it's the true "clothing of the people."

8. Camo compels complete strangers to ask you amazingly interesting questions, such as: "bagged any rutting elk on the Western Slope lately?"

9. Matching shoes are readily available. Can you say, "camo Crocs?"

10. Doesn't it sound fun to buy your new fall wardrobe at a store called "Bass Pro Shops?"

IN SUMMARY: Camo has nothing to do with your health. But my friends seem to love it so much when I wear it, that it must just make people happy somehow. Try it: you'll find it strangely compelling.

SUPERFOODS TO MAKE YOU LIVE LONG TIME

Last night I was watching PBS and there were some shows featuring Gary Null, PhD. For those of you who don't know Gary Null, he's basically a health food guru who believes that aging, cancer, heart disease, depression, and most other ailments are caused in part by unhealthy food; and that these processes can be reversed by changing the diet.
I think you have to take Gary Null with a grain of salt, or spirulina, to some degree- some of his statements, or rather about 50% of them, are conjecture, and not supported by science. But overall, I think he's still a positive force, because the other 50% of what Gary Null says is pretty accurate. What impresses me is that he's been talking about the wonders of nuts, honey, berries, peppers, and other nutrients for over 30 years- and every year there are more studies in the medical literature showing benefits of these food. If Gary Null is 50% correct today, he might be 60% correct next year, and so on. On balance, I think he is worth checking out.
Last night's show was on Gary Null's 15 "Superfoods for Optimum Health." Let's see if I can remember them all:
GARY NULL'S SUPERFOODS FOR OPTIMUM HEALTH:
1. Garlic
2. Onions
3. Carrots
4. Shitake Mushrooms
5. Whole grains
6. Beans and legumes
7. Oranges
8. Peppers
9. Ginger
10. Blueberries
11. Apples
12. Bananas
13. Leafy greens such as kale, collards, and spinach
14. Almonds
15. Soy products
Damn, I have a good memory. That's Gary Null's list of what are, in his opinion, the healthiest foods out there for reversing aging and preventing disease. I have to agree, it's a fairly good list. I just think it needs a few additions. So let's increase Gary Null's list up to a combined list of 20 foods, to provide a bit more variety:
DR. TOFUHEAD'S ADDITIONAL SUPERFOODS
16. Walnuts
17. Small fishes (sardines, anchovies, herring)
18. Grapes, including wine
19. Olive oil
20. Fresh herbs, such as: oregano, thyme, sage, rosemary, marjoram, parsley, cilantro, tarragon, etc.
Are you seeing a pattern here? I am. You can distill this food list down a bit to a more simple concept: A HEALTHY DIET IS PRIMARILY VEGETARIAN, WITH AN EMPHASIS ON FRESH FRUITS AND VEGETABLES. Think "Mediterranean." Gary Null waxes poetic on how healthy the food is in coastal Italy. I'd have to add Greece as the country I've been to with the healthiest food. Everything you've seen above is abundant in Mediterranean diets.
OTHER RELATED ISSUES AND QUESTIONS:
1. To cook or not to cook? Contrary to what you might hear from "raw food" experts, Gary Null and I are in agreement that you can cook these superfoods with little impact on their nutritional value. And if you cook them in healthy oils such as olive, canola, safflower, or walnut, you can enhance their nutritional impact.
2. What about meat? I personally don't think a healthy diet has to be devoid of meat. I do agree with Gary that commercial meats are full of preservatives, hormones, antibiotics, and pathogenic bacteria, as well as fat. But nowadays, there are great alternatives. In short,
HOW TO MAKE YOUR MEAT HEALTHY:
-Buy free range, hormone-free meat when possible.
-Stick to lean meats. These include skinless chicken breasts, turkey "white meat," and lean cuts of "the other white meat," i.e. pork. Lean pork cuts include pork tenderloin, pork chops, and ham. Some beef cuts like flank steak, strip steak, and beef tenderloin are fairly lean as well. Buffalo is another good choice.
-Avoid preserved meat with sodium nitrates, nitrites, and sodium benzoate. Even if you like salami and sausage, you can get these without the preservatives. But you might need to go to a health food store.
-Keep your portions small. Avoid the 22-ounce T-bone steak.
3. What about dairy? Gary Null is just plain wrong when he states that dairy products cause "mucus." He should know better- that myth was debunked years ago. I think dairy is fine, just keep your cheese portions on the small side and choose less fatty cheeses such as mozzarella, feta, and goat cheeses when possible. If you drink milk, choose hormone-free organic milk if you can afford it.
4. Should I get a juicer? I think juicers are wonderful, and they are a great way to get many servings of fruits and vegetables at one time. You lose some of the fiber, but few of the nutrients, when you have juice as opposed to whole fruits and veggies. I'm going to do a whole blog on juice and juicers soon, so more on that later-
Any questions?

HOMEOPATHY: HEALTH CARE OR VOODOO?

    Aren't you lucky, dear reader: 2 new posts in one day!   The truth is, I have a ton of new topics to cover, because I have been out of touch with the blog and have left my readers hanging for weeks without a new entry.   I apologize for this.    I think in return for the wonderful support and interest I've gotten from my readers, I owe it to you to put up a new entry at least a couple times per week- even if it's a quick note about fashion that my friends will riducule.

READER QUESTION: WHAT IS HOMEOPATHY?

     Homeopathy is a branch of medicine which started in Europe not long ago- hundreds of years ago, not thousands of years ago like acupuncture or some other modalities.   It gained wide acceptance in Europe and America starting in the 1800s and going well into the early 1900s, until the American Medical Association (the AMA) launched a concerted effort to discredit homeopathy and ostracize its practitioners.   As a result, homeopathy really fell to the wayside as a "fringe" practice, offered by clinicians that the AMA widely ridiculed as "quacks."

      Without getting too political or straying from the subject, let me first give you Dr. Tofuhead's take on the AMA: this is one of the dirtiest, most corrupt organizations in the history of medicine.    Never afraid of taking huge amounts of money from tobacco and firearms companies, the AMA until very recently spent much of this money trying to increase the power and prestige of high-paid, private medical specialists, at the expense of all and sundry alternative medical practitioners.   Even primary care doctors like your beloved Dr. Tofuhead have suffered from the malignant antics of the AMA.   So when the AMA widely comes out AGAINST something like homeopathy, it makes me think: THERE MUST BE SOMETHING TO HOMEOPATHY!

HOMEOPATHY: BASIC CONCEPTS

1. Toxic or disease causing entities, in very small amounts that do not cause harm, can be introduced into the human body and actually compel the body to fight those entities and overcome disease.

2. Toxic entities must be serially diluted in a very specific and time-consuming way in order to produce effective homeopathic remedies.

3. The homeopathic serial dilution method not only yields a remedy with a tiny amount of a toxic substance, but the chemical makeup of the solution itself (in which the toxin is dissolved), is itself altered in the process, in a clinically significant way.  This point has been supported by some very complex and surprising experiments, done by physical chemists in recent years.

HOMEOPATHY: DOES IT WORK?

      The most honest answer is: we don't really know.   To date, there have not been many good scientific studies looking at homeopathic remedies and whether or not they really work.   My own opinion is that homeopathy, like any branch of health practice, will turn out to work for some things, and to not work for others.   What I hope to see in future research is studies that will help us pinpoint just what homeopathy can treat.   For the time being, I would not rely on homeopathic remedies to treat conditions for which their are proven treatments: for example, strep throat (which is treated with antibiotic drugs).    

       However: small studies have been compelling when it comes to treating viral respiratory illnesses with homeopathic remedies.    For example, there is a homeopathic medication called "Occillococcinum" which many of my patients swear by, for fighting colds and flus.   Years ago, when I worked in an acupuncture and homeopathic practice, I had access to this medication for free.   My own experience here is not worth much, but I do believe that if I took occillococcinum at the onset of a cold, it either disappeared completely or the duration of the cold was shortened.   It's worth looking into; after all, traditional western medicine or "allopathic medicine" has nothing that can cure or prevent a cold.   If any of my readers have had experience with this or another homeopathy remedy, please share.

WHERE CAN I FIND HOMEOPATHIC REMEDIES?

     You can find popular homeopathic medicines such as Occillococcinum at health food stores, vitamin shops, and even some grocery stores.   My optometrist even gave me a homeopathic eye drop recently, which really worked for me.   But keep in mind that there are thousands of homeopathic remedies with odd names; names that don't really reflect the condition they are designed to treat.   So except for a few exceptions, see someone who knows what they are doing.   I recommend seeing a homeopathic doctor for advice and for remedies if you want to treat something other than a cold or flu.   And if you're taking a homeopathic remedy for an illness and it's not working, please: see your allopathic primary care doctor!

BOTTOM LINE: My take on homeopathy is that there IS something to it.   I also think it's an exciting field, in which we will see some compelling new research in our lifetimes.   So watch these pages- I'll return to the topic again in the future.

RECENT READER QUESTIONS ON FASCINATING TOPICS

     To all my friends who pointed out my own fashion mistakes when I posted my last blog choc-full of essential fashion tips, I just want to give this reasonable feedback: dress as I say you should dress, not as I do dress. I'll admit- I take a special pleasure in occasionally wearing hideous or outdated clothes, just to elicit reactions. That doesn't mean you should, unless you enjoy people laughing at you.

READER QUESTION: WHAT IS HYPOCHONDRIASIS?

Or more specifically, "what causes someone to be a hypochondriac?"

     This was a tough question for me to answer. In fact, it took me weeks to find information that I felt was reliable. Essentially, being a hypochondriac means that you have an "exxagerated concern or worry about having a health problem or health problems, despite evidence to the contrary." This actually used to be classified in the psychiatric literature as a form of a "personality disorder," in other words a mental illness all its own. That was probably both innaccurate and unhelpful, since personality disorders are not often treatable. Currently, hypochondriasis is generally seen as a symptom of a treatable mental illness, the most common illnesses being depression, anxiety disorders, and post-traumatic stress disorder (PTSD). Hypochondriasis can also be seen in other mental illnesses such as obsessive-compulsive disorder (OCD), and psychotic syndromes.

     By far the most common underlying illness in someone who is a hypochondriac is depression. Part of that is because we are recognizing, with increasing frequency, that major depression can cause physical symptoms, which are often ill defined. Another factor is that a majority of depressed patients are very resistant to being diagnosed as having depression, and depressed patients are often hard to convince that their physical symptoms are coming from a psychological rather than a physical source.  Hypochondriacs  who are depressed and are treated for depression do very well, and are able to overcome their hypochondriasis is most cases.

    This is also true for patients who have hypochondriasis in the context of an anxiety disorder, PTSD, or other mental illnesses.

MORE QUESTIONS AND ANSWERS ABOUT HYPOCHONDRIASIS

1. DOES EVERYONE WITH HYPOCHONDRIASIS HAVE A MENTAL ILLNESS?

No.   Honestly, I think many hypochondriacs just have too much time on their hands, or they're too focused on their own needs.   In these folks, it tends to be a temporary problem.   After a few doctor's visits and normal tests, and hopefully some encouragement from a doctor, they realize that they are wasting their time- and that rather than worrying about non-existent health problems, they should use their mental energy to work, have fun, and pursue more productive hobbies.  

     There are also hypochondriacs who are justified in their hypochondria, in my opinion.   For example, cancer survivors often become hypochondriacs, and for good reason.   The last time they thought they had a serious illness, they did!   I don't even think it's fair to call cancer survivors hypochondriacs.    It's better just to offer them the tests they want, whenever they want, to help reassure them that they don't have cancer again.   At least, that's what I do.

2. WHAT'S WRONG WITH BEING A HYPOCHONDRIAC?

I think the biggest problem for hypochondriacs is that they are unhappy, and their hypochondria keeps them that way.   It's really no fun to think you have an undiscovered illness.   Not only does the hypochondriac worry about his or her health, but he or she wastes a lot of time- time in doctor's appointments, getting tests, searching for health information on the internet, and seeing various health practitioners.   Hypochondriacs put a big time and financial burden on themselves, and they also can make their loved ones and family members unhappy or frustrated with them.

3. WHAT IF OTHER PEOPLE THINK I'M A HYPOCHONDRIAC, BUT I REALLY HAVE A SERIOUS HEALTH PROBLEM?

See a doctor.   If your doctor treats you with annoyance or insults you, get another doctor.   If there are tests that are reasonable to do, ask your doctor to run them.   But you should trust your doctor's judgement to some degree- demanding complex tests that your doctor doesn't think you need will generally get you nowhere.    And keep in mind the most important fact here: there are very few health conditions out there that "no one can detect" or "multiple doctors can't diagnose."   A recent book on the subject reviewed a number of studies of patients with "hard to diagnose, undiscovered health problems."   The studies revealed that only a tiny fraction of these patients turned out to have a real physical ailment; most had either stress-related conditions or depression.    So if you've been to a few doctors, had a number of tests, and "no one can figure out what's wrong with you," the painful truth is this: there probably is nothing wrong with you, physically.   You might do yourself a favor and seek a therapist.

EASILY DIGESTIBLE FASHION TIPS FOR MEN

Here's another short, easy-to-read, digestible blog. Don't worry if you've submitted a reader question this week; I assure you, I'm working on those. I will be blogging on those only after I've done the comprehensive research required. I don't answer any question "off the top of my head." But I can comment on men's fashion off the top of my head. That's because "men's fashion" is an oxymoron. It's like talking about "Mormon cocktails" or "fun skin rashes." Men's fashion leaves much to be desired. Here's how you can avoid making it even worse. All you have to do is avoid making the following common men's fashion mistakes.

LAME MEN'S FASHION HABITS TO AVOID:

1. Oakley blades. In fact, just because they invented Oakley blades, I recommend that you avoid purchasing any Oakley product, unless it's BMX bike grips, which Oakley actually made exclusively when the company started, before they started making ugly sunglasses.

2. Pants without a belt. Only wear these if they are sweats. But do yourself a favor: don't wear sweats. There are much nicer sloppy clothes to wear.

3. Brown belt with black shoes or vice versa. You can wear this combination if you're colorblind and you have a large sign around your neck that says, "HI, I'M COLORBLIND."

4. The upside-down visor. In case it's not obvious, this simply sends the message, "My I.Q. is lower than yours."j

5. Puffy white shoes with jeans. In fact, if you have white shoes you should be:

-a nurse

-a guest at a disco party

-working out at the gym

6. Socks with sandals. You can wear socks with sandals if you have a broken foot and you're wearing an "orthopedic sandal," which is basically a shoe that makes it obvious that you have a broken foot. Make sure you have at least one crutch with you at all times.

7. Dress slacks with black athletic shoes or hiking shoes. Do you really want people to mistake you for a primary care doctor? If you do, go for it! Also, consider wearing a plaid shirt with a knit tie.

8. Pants with flip-flops. See my earlier blog on this subject.

9. Short running shorts. Why do men still wear these to Safeway? These are of questionable integrity even if you're actually running. Opt for something more aesthetically pleasing, like a Swedish thong or a Spandex body suit.

10. Windbreakers. Is there even any such thing as a "windbreaker" anymore? Unfortunately, yes. Feel free to wear one if you live in the Wyoming plains or if you're at a 70's party. In short, you should wear a windbreaker in any situation in which you might normally wear a "Members Only" jacket, or a plastic "poncho."

11. Flannel shirts with the sleeves cut off. I know it's shocking, but people in Denver still wear these, believe it or not. NOTE: these are still cool if you're a gay lumberjack with nice arms.

12. No underwear. There is a reason underwear was invented. It's called "civilization." If you don't wear underwear, consider adult diapers or checking yourself into a mental facility.

Sorry to be so harsh. I don't know why men's clothing concerns me so much. Women are just better dressers, at least most of them are.

HOW DO I KNOW I DON'T HAVE CANCER?

I see new patients every day, and some of them ask me to be "tested to make sure I don't have cancer." The truth is, there is really no test that can do this. The problems are:
1. There are too many cancers, and one test can't evaluate for all of them.
2. Most cancers are diagnosed by complicated imaging tests and biopsies, both of which are not completely safe. So it's generally not a good idea to do these tests unless your doctor has a high suspicion that you have cancer.
3. Some of the tests for cancer, particularly CT or CAT scans, can actually cause cancer. So again, you shouldn't get one unless you really need it.
However, there are "screening tests" for cancer- these are tests that are performed on healthy people to try to detect certain cancers early. There are only a few of them, because only a few tests have been shown to save lives by providing reliable information about cancer at an early stage. All people should get cancer screening tests, starting at various ages depending on the test. Please note: IF YOU HAVE A FAMILY HISTORY of cancer, your doctor may want to start doing screening tests on you at an early age. The below applies only to people who do not have a family history of cancer. Also: FAMILY HISTORY of an illness like cancer, in most cases, means that you have a parent or sibling with the disease in question, usually at a certain age. I know it sounds complicated. For example, if your mother had breast cancer before age 50, you have a family history of breast cancer. If your aunt had breast cancer at age 70, you don't have a family history of breast cancer. You really need to talk to your doctor about your family history to know what's relevant.
CANCER SCREENING TESTS YOU SHOULD HAVE:
1. Pap smears: this may actually be the single best cancer screening test in terms of lives saved. You need to start getting this test:
-if you're a woman
-at age 19
-at an earlier age if you're sexually active (within the year of becoming sexually active)
-how often? Yearly at first, but if you have 3 normal pap smears in a row and you're monogamous, you can then change to every 2-3 years.
2. Mammograms: there is controversy over whether to start these for women at age 40 or 50. I get them every 2-3 years in women 40-50, and yearly after that. If you want to make it easy to remember, just do one at the same time every year starting at age 40. All women should get mammograms, even if no one they even remotely know has ever gotten breast cancer!
3. Colon cancer screening. There are actually 3 total tests and you need at least 2 of them at various intervals. It works like this:
-start getting colon cancer tests at age 50.
-EVERY YEAR you should do a "stool card test", which detects blood in your stool.
-HAVE YOUR FIRST COLON SCOPE AT AGE 50. This may be what's called a "flexible sigmoidoscopy," a "colonoscopy," or a "virtual colonoscopy." Ask your doctor which is right for you, but do it at age 50.
-After your first colon scope, you need to do it again every 5 to 10 years, depending on what they found on the first scope. If you have any precancerous "colon polyps," you'll need to get a scope every 5 years.
-People seem terrified of colon scopes. But the whole thing takes 20-30 minutes and you can be sedated for the procedure. It's easy to do!
FOR THE GENERAL POPULATION, that's it, believe it or not. There are other cancer screening tests, and some of them are worth doing if you have a family history of cancer. But these 3 are the only ones in wide use for the general population. Beating cancer is not easy. But as you can see, getting your cancer screening done is.

MORE INFO ON RECENT TOPICS

1. WHY NO PICTURES LATELY?
My brother Randy does the photos, and he's been staying with me. We haven't been blogging much. So there is a temporary hiatus from pictures on Dr. Tofuhead. Sorry for all those waiting eagerly for a visual image of a douchebag. While waiting, check the Oprah show: she has douchebags as guests on her show all the time!
2. REALLY NO CAFFEINE IN DECAF?
Randy dug up some fairly interesting study that compared decaf levels at various coffee shops. It turns out I was wrong- some purveyors of decaf actually do have a significant amount of caffeine in their decaf beans. Starbuck's was the highest- some of their decaf drinks approach 30% as much caffeine as in regular caffeinated coffees. And caffeine amounts seem to be highly variable in different types of beans. So if, for some reason, your doctor has told you to completely avoid caffeine, you probably need to avoid decaf coffee most of the time. Or you can drink Sanka, that 70s powdered instant decaf coffee that has survived the test of time. Sanka ain't that bad, and it's caffeine quantity is not noticeable. I bring it camping frequently and enjoy it immensely. But I'm not that picky about coffee.
3. IF I PEE A LOT, DO I HAVE DIABETES?
Frequent urination can be a sign of diabetes, especially if it is accompanied by frequent thirst and visual blurring. Just remember that most people who pee a lot, or think they pee a lot, don't have diabetes. People also tend to overestimate how much they pee. If your pee is clear and you pee a lot, chances are it's because you are drinking a copious, and HEALTHY, amount of water. There are a number of benign conditions that cause people to pee a lot, such as "overactive bladder," prostate enlargement, nervousness, some allergy medications, and yes, even caffeine. Caffeine does not actually dehydrate you, but it probably stimulates the bladder to contract a bit more frequently, and some people find they are peeing a lot when they drink it. If you are concerned that you are peeing too much, talk to your doctor- there are easy tests to run that can tell you if your frequent urination is a serious problem.
4. MORE QUESTIONS PLEASE
Presumably because it's summer and you are all exercising all day, eating well, sleeping like babies, and feeling fantastic, I haven't gotten many health-related questions lately. Even in my office, I'm seeing fewer patients and many of them are healthier than me. My medical brain is undergoing atrophy. You, dear reader, can help me: post a health related question in the comments! Remember, no question is stupid and all questions are answered anonymously.