This past week, the New York Times ran a story covering “Meat Stock,” a convention for adherents of the carnivore diet (click here if you are interested in reading it).

For context, the carnivore diet is an extreme version of the keto diet that shuns all plant-based foods. Followers of this diet eat only meat, fish, and maybe eggs and dairy, without any fruits, vegetables, legumes, grains, nuts, or other plant-based matter. In effect, the carnivore diet is the precise opposite of a vegan diet. 

Combining two of my ongoing series on this blog, this week’s post will review a study and in so doing discuss a possible use for a supplement. 

A group of researchers in China took 200 patients with NAFLD (that’s “Non-Alcoholic Fatty Liver Disease,” a type of chronic inflammation of the liver that comes not from excessive alcohol consumption, but from excessive visceral fat, and that is highly correlated with such metabolic disorders as hypertension, high triglycerides, and type 2 diabetes) and randomized them to receive 40g per day of either a resistant starch supplement or a non-resistant starch supplement prior to mealtimes for four months. (The paper doesn’t specify, but a reasonable assumption is that the participants took 10-15 grams before each meal, totalling 40g per day).  

Before I go any further, let me just define terms here. Resistant starch is starch that your body cannot absorb. It therefore passes through the digestive tract and out into fecal waste without significant entry into the body, but in so doing it provides food for intestinal microbes, and therefore has been demonstrated to support a healthier and more diverse microbiome. Some natural sources of resistant starch include whole grains, potatoes, beans, and unripened fruit. By contrast, non-resistant starch is starch that your body absorbs and quickly converts into sugar for energy. Common sources of non-resistant starch include breads and pasta. 

I’ve written a few posts over the years about fasting, and about circadian biology, most recently of a Canadian study that showed significant improvements in Crohn’s disease patients when they stuck to an 8 hour per day eating window. Now a new study out of China (click here to see the original paper) suggests there may be benefits to this same eating window in colon cancer patients. 

As with all studies, there are nuances and limitations and this is by no means a final verdict. However, the results are promising. 

The showing of “The Cholesterol Code” film has been rescheduled due to logistical reasons. It is now slated to be shown on Monday, May 18th, at the AMC 11 in Dartmouth, MA.

Tickets can be purchased at

https://gathr.com/events/7fbc9aef/the-cholesterol-code-at-amc-dartmouth-mall-11

And you can watch the trailer here: https://www.youtube.com/watch?v=SGeDbI6nt1w

Now that I’ve covered the concept of NNT (“Number Needed To Treat” – a statistical measure of how many patients have to be treated with a medication before one patient benefits), we can move on to my thoughts on an article that the magazine Vox recently published regarding statins, the most widely prescribed class of cholesterol-lowering medications. The article came to my attention when the News app on my iPhone pushed it to me a few weeks ago. 

The article is titled “Why have Americans turned against this lifesaving medication?”  and is subtitled “Statin hysteria has made it hard to convince people that this effective drug is actually very safe.”

A new study suggests that following a “time restricted eating” pattern (often also referred to as intermittent fasting) can reduce the severity of Crohn’s disease.

Crohn’s disease, in case you aren’t familiar, is a type of “Inflammatory bowel disease,” in which an autoimmune process causes severe inflammation throughout the digestive tract, leading to abdominal pain, bloody stools, malabsorption of nutrients, and other serious and sometimes life-threatening complications. Like many autoimmune diseases, it has become more common over the past few decades, which strongly suggests (since our genetics have not, as a species, changed during that same time period) that environmental triggers such as pollutants, changes to our gut microbiome, stress, and poor diet likely play a role in its development.

This new study, conducted by a group of doctors in Canada, bolsters this idea. After all, if changes in the way we live can cause Crohn’s disease, then it follows that changes in the way we live should also help to alleviate it.

Last week I posted about a new documentary film, “The Cholesterol Code,” which highlights the efforts of engineer Dave Feldman to determine just how dangerous a rise in cholesterol is on those following a very low-carb/keto type of diet. 

I have previously posted on this topic several times over the past few years – you can read my prior posts by clicking here, here, and here. Having mentioned his film and the screening it will be having in the area (April 13th at the AMC 11 in Dartmouth – click here if you’d like to reserve tickets), I’d like now to come back to this research and discuss my latest thoughts on it.

In recent years, High Intensity Interval Training (aka HIIT) has become quite popular. If you aren’t familiar with the concept, HIIT involves alternating brief rounds of very intense cardiovascular exercise with lighter activity. For example, instead of going for a light jog for 30 minutes, a person engaging in HIIT might sprint as hard as they can for one minute, then walk for one minute, and repeat the process five times for a total ten minute workout. 

There are many, many, different HIIT protocols, with perhaps the most famously brief one being a “Tabata”, in which a person does intense exercise (say pedalling as fast as possible on a stationary bike) for 20 seconds, pauses for 10 seconds to catch their breath, and then repeats the process eight times for a total four minute workout. 

The advantages of this type of exercise are obvious to the time-crunched person, and I indeed frequently recommend doing a “Tabata” a few times per week to the patient who tells me they have no time for exercise. There is also a psychological appeal to HIIT training for the person who doesn’t feel like they are getting a good workout unless they leave the gym soaked in sweat. Crossfit for example has long incorporated a lot of HIIT work into their programs, and if you know any Crossfitters you will be aware these are not the type of people who are content to just go for a light walk or a gentle yoga class. (That’s not a knock on CrossFit nor the people who enjoy doing it by the way – the world contains many different personality types, and it’s great to have different fitness modalities that cater to these differences. It has simply been my experience that CrossFit tends to attract the “type A” personalities of the fitness world, people who really enjoy a workout that pushes them to the absolute brink of what they are physically capable of on a regular basis).  

But aside from all of the above, there is accumulating evidence that HIIT may have particular health benefits. In that vein, today I am going to comment on a study that came out about two years ago, in which patients with known coronary artery disease were “treated” with HIIT training.

_{The Fountain of Youth}

In last week’s post, I outlined what NAD+ is; how it declines with age and the role that plays in aging; how it can be boosted with healthier lifestyle habits; how it can also be boosted with IV infusions or by taking the oral supplements NMN or NR; and why these supplements have generated tremendous interest in recent years.

But I also explained that, at this point in time, I do not recommend supplementing with NAD+, NMN, or NR. (Needless to say, I do recommend exercise and a healthy diet, both of which have been shown to raise NAD+ levels). 

Happy New Year!

I’ve discussed in a few prior posts (for example here and here) the potential downsides of doing too much testing in medicine. This is an important topic, and one that can be difficult to discuss. Patients – quite reasonably – want to feel that their doctors are listening to them, and running all reasonable medical tests to prevent, diagnose, and treat disease. Any discussion of how medical testing can sometimes actually be detrimental to your health can therefore risk coming off as being callous and uncaring. “What do you mean I shouldn’t be tested for disease x?,” a patient may think.  “Don’t you want me to know if I have it or not?” Unfortunately it’s not so simple. 

A few patients have recently asked me about “liquid biopsy” tests. These are a new frontier of testing in which a single blood sample is analysed for evidence of multiple types of cancer. The idea is to analyze a single blood sample and – ideally – receive reassurance. However if you got an abnormal result, you’d then be referred for further testing to either confirm or exclude a diagnosis of cancer. This is much the same process as our current prostate cancer screening program in which a man has a PSA test as part of his annual physical to indicate the possibility of prostate cancer and then, in the event of an abnormal result, is referred for further workup (e.g. a prostate MRI or biopsy) to determine if he in fact does have cancer, or if he simply has a “false positive.” However, unlike with a PSA – which checks only for prostate cancer – a “liquid biopsy” would be able to test for dozens of different types of cancer at once.

It’s wonderful to imagine a (not so distant) future in which a blood test at your annual physical can screen you for virtually every known type of cancer (including ones for which we currently have no good tools for early detection such as brain, pancreas, or ovarian) and either give you reassurance that you are cancer free, or conversely pick up a cancer in the very earliest stages and offer a much better chance for cure. 

There are a number of such tests under development (the GALLERI test from Grail, and CANCERGUARD from the makers of Cologuard are two of the better known ones), and, as you can imagine, these are igniting great interest in both doctors and patients. And while none of these tests are yet to be FDA approved – nor to be covered by any type of insurance – a few are now commercially available for those who can pay out of pocket for them. Not surprisingly then, a few patients have asked me recently whether these are worth having. 

In honor of this week’s holiday, I’m taking the week off from writing a blog post. A happy Thanksgiving to all of my readers and patients, and I will post something more informative next week.

To my patients: we will be hosting the holiday at our house, so I will be in the area and available all weekend for any urgent matters.

In case you’ve never heard of it, Freakonomics is a sometimes interesting project co-founded by a University of Chicago economist and a New York Times reporter. Starting with a book by the same title in 2005, the pair have built a mini-empire of books, podcasts, and an NPR show, all examining facets of everyday life through the lens of an economist. (The original book, for example, looked at topics such as the incentives for public school teachers to sometimes help their students cheat on standardized tests, how people’s names can affect their odds of success in life, and the economic hierarchy of drug gangs in inner city Chicago).

This past week, Freakonomics had an episode on the causes of the current physician shortage. Do they do full justice to the topic? No, I don’t believe they do – but probably nobody could in just a one hour radio show. They spend a lot of time looking at the history of why we don’t have enough medical schools in the United States (certainly an important topic) and not enough, in my opinion, looking into how many work hours a typical physician is forced to waste navigating bureaucracy rather than focusing on patient care, and the generally demoralized and unhappy attitude that prevails amongst physicians, and which has led to an exodus from the field.

Nonetheless, it’s a reasonably interesting and informative episode, and if you want to know why it’s so hard to find a physician these days, you could do worse than listening to it, which you can do by clicking here:

https://freakonomics.com/podcast/the-doctor-wont-see-you-now

Recent headlines about a new study from Consumer Reports have created a scare about protein powders. For example, CBS has a typically alarmist opening paragraph:

“Some protein powders and shakes contain unsafe levels of lead, according to a Consumer Reports investigation. “

Let’s leave aside the pros and cons of protein powder for this post and just grant for the moment that:

a) people can get all the protein they need from a well balanced diet and don’t need protein powders, and
b) some people, for a variety of reasons, find benefit to including protein powders in their diets.

For those who fall into this later category, should they stop using protein powders simply for fear of lead contamination? 

Many people assume that the lack of pro-active testing for every possible problem in medicine is simply done as a cost savings measure. Patients will sometimes complain to me that their insurance won’t cover a periodic full-body MRI, or a routine stress test, or blood testing in the absence of any symptoms for this disease or that. And there is some validity to this critique: it’s certainly true that insurers like to spend as little money as possible on patients. But to be fair, there is another side to the argument, which is that – contrary to what many assume – testing for problems that aren’t apparent can sometimes in fact be harmful. 

This is a difficult topic to grasp, so I’m going to break this post down into two parts. Today, I will outline some of the logic behind why tests can sometimes create more problems than they prevent. In next week’s post, I will give a few actual anecdotes from my career that demonstrate the point. 

How could it possibly be that ordering tests to screen for health problems can be harmful?

I don’t think I’ve mentioned it before, but one of my favorite health podcasts is called “Zoe.” Zoe is a British-American company that offers a service of personalized testing: they mail you a kit so you can submit a blood specimen and a stool specimen, as well as wear a continuous glucose monitor for a few weeks. Then they analyze all of this data and come up with personalized nutrition recommendations for you that are supposed to best sync with your own biology. I have no idea whether this works well or not, but the podcast that they use to market their product often features great conversations with legitimate scientific experts.

At any rate, I enjoyed their latest episode, which covers a subject near and dear to my heart: how to sleep better. Included in the episode are some of the topics I hammer home a lot (such as having a steady wakeup time, getting morning sunlight, and developing good beliefs around sleep), as well as some new tips and tricks that I was not previously familiar with. If you’d like to give the full episode a go, you can listen to it here:

Here’s a quick review of an older study (from 1997). In the study, they took middle-aged diabetics and randomized them to do either nothing, or to do 45 minutes of vigorous cycling on a stationary bike twice per week, plus one session of high-intensity interval cardio training (consisting of two minutes of vigorous exercise followed by three minutes of light exercise for five cycles, for a total of 25 minutes).

After two months, the people who did the exercise had lost 48% of their visceral fat, and significantly improved their insulin sensitivity and blood glucose numbers, even though they didn’t lose a significant amount of weight overall. You can read the full study by clicking here.

This post is just for fun, and light on science. So if you’re looking for something firm to hang your hat on, skip it. On the other hand, if you want to be bored by my personal thoughts, read on. 

Regular readers of this blog will have picked up on the fact that two of my biggest interests are 1) preventative medicine, and 2) history, and that these are two topics that I sometimes intermingle. For example, some time back I created a short post on ancient Roman military training and what it can teach us about exercise today. I also gave a lecture a few years ago in which I touched on ancient Roman lifestyle habits and how many of these weave nicely with what modern science has to teach us about good health. 

Today, I’d like to briefly return to this topic by discussing how the ancient Romans ate. But before doing so, I want to make two points:

1. The ancient Romans lived, on average, much shorter lives than we do. So it’s not that we should copy their world completely.
   
   But as the old saying goes, there are “lies, damned lies, and statistics,” and in point of fact a major reason that average life expectancy in Rome is estimated to have been about 30 years is that roughly half of all people in the Roman empire died in childhood. Of those who did survive to adulthood, many young women died in childbirth, and many young men died of traumatic injuries (being a Roman soldier, or building aqueducts by hand, turns out to have been dangerous work). As a result, an enormous percentage of the population died at a very young age, which brought the average life expectancy down considerably. But of those who didn’t die young, many went on to live a fairly full life, and in point of fact quite a few Romans lived into their 60s, 70s, and 80s. And while we have no way of knowing exactly what happened to these folks, there are many lines of evidence to suggest that they suffered less than we do from obesity, diabetes, cancer, heart disease, or dementia. The point being, there might be some things these ancient folks can teach us about how to age well, despite the fact that the majority of them never got the chance to.
   
2. Secondly, I am using Rome only because it is such a cultural touchstone of ours, but there’s nothing unique to Rome in what I am discussing. Substitute in any other pre-modern civilization – the Persians, the Ottomans, feudal Japan, or whomever you choose – and you could likely draw a lot of the same insights. 

With that out of the way, what did the Romans eat, exactly? We do have a fair amount of historical evidence on this front (several cookbooks from ancient Rome survive to this day, for example, and amongst the well preserved archeological remains at Pompei are included many restaurants). Therefore, historians are reasonably confident that a “typical” Roman (which is to say a citizen who was part of what we might now call the middle class, i.e. somebody who was neither extravagantly wealthy nor desperately poor) would have frequently consumed the following foods:

1. Whole grain sourdough bread
2. Porridges made of whole wheat or barley
3. Olive oil and olives
4. Red wine
5. Cheese
6. Fresh fruit
7. Vegetables
8. Beans
9. Eggs
10. Fish

If we think about this pattern, we’ll note a few things. Firstly, that it contains no processed or packaged foods (duh). Secondly, the diet is high in fiber and plant matter. Third, it is low in sugar (in fact the Romans didn’t have table sugar the way we do, though they did eat fresh fruit and honey to satisfy their sweet tooth). Fourth, it contains a fair amount of fermented foods (sourdough bread, cheese, wine), which we now know helps to nurture a diverse and healthy gut microbiome. Fifth, it is not per se low fat, but it is low in saturated fats and, of course, is completely devoid of the industrial and processed oils that are common in the modern western diet. 

In fact, if we examine the above diet, we’ll note that it is pretty consistent with the dietary pattern that modern nutritionists call the “mediterranean diet,” still followed in many parts of Greece, Italy, Spain, and other mediterranean countries, and which numerous studies have shown is a healthy eating pattern for reducing the risks for obesity, diabetes, and cardiovascular disease.  

Therefore, one way to look at healthy eating patterns is that they are something to be discovered by modern scientists. But another is that they are something to be re-discovered from our pre-modern ancestors who by a mixture of intuition and limited options (Burger King, sodas, and packaged chips just weren’t available to anybody living prior to a few decades ago) tended to follow, at least in some regards, a healthier eating pattern than we do.

One suggestion I often give my patients is to forget for a moment about fat, calories, protein, etc, and simply try never to eat a food that didn’t exist a century ago. If you follow no rule other than that, you will likely have a healthier diet than about 90% of modern Americans.

Please be aware that the office will be closed during the weeks of August 11th and August 18th for summer vacation. We will be re-opening on Monday August 25th.

If you are a current patient and have an urgent medical concern, please go to the nearest emergency room or urgent care center. You can reach out to me afterwards with a text message, voicemail, or email to update me on things so that I can follow up with you upon my return.

By contrast, if you are a current patient and need to reach me for a non-urgent issue such as getting a refill or discussing a minor medical problem, you can text or email me and I will get back to you, but there may be a delay of 24 hours or so as we will be traveling abroad.

Thank you for your understanding, and I hope you are having a nice summer.

A recently published study has gotten some press coverage suggesting that olive oil consumption can make you fat. For example, the (supposedly) respectable BBC ran a story under the headline “Too much of this ‘healthy fat’ could be adding to your waistline, study finds.”

This is yet another example of what I have termed the “Academic-Media Complex,” in which bad studies are given hyped up reviews by the media, leading to more funding for research universities and more sales/clicks for news organizations, but poor information for the public. 

If you read the original study (which you can by clicking here) the results are – shocking, I know – hardly what they are hyped to be. 

What in fact did the study show?

I haven’t written yet about the new weight loss medications that are sweeping through society (Ozempic, Wegovy, Mounjaro, Zepbound, etc) but that’s not for lack of experience with them. Patients frequently ask me about these medications and yes – I do sometimes prescribe them. Given that interest in these medications is only growing, I thought it was about time to create a blog post on the topic. 

Recently, a patient asked me what I think of the tap water here in Marion, noting that many of her friends refuse to drink it, and choose instead to drink only bottled water. 

In fact, I had the water at my house tested by a private company a few years ago, and the report came out quite favorably. (I don’t recall the name of the company that did it, and have no endorsement of a particular company in this regard). I think getting the water in your home tested periodically is not a bad idea for anybody to do. It’s also possible to get a good quality water filter for your home if you want to ensure the purest water possible. Again, I have no particular brand to endorse in this regard, so if this interests you, do your own research. 

What I do wish to specifically comment on today is how awful bottled water is for you.

I’m excited to share that, as of last week, I am now licensed to practice telemedicine in Florida. I took the step of obtaining this extra license because I have a number of patients who spend part of the winter in that particular state, and it seemed like it would be useful to be able to dispense health advice (not to mention medications!) via phone or Facetime without having to worry about running afoul of medical licensing laws. 

Last year, I provided a link on this blog to a lecture I gave in 2023, about how lifestyle changes can improve arthritis and other musculoskeletal pains. If for some reason you want to watch that lecture, I will link to it here. 

But to give you the brief summary of what I covered in that talk: being overweight doesn’t just cause arthritis by increasing physical pressure on the joint, but also because fat cells have the effect of up-regulating inflammatory signals in the body, which in turn lead to weakening of muscle, increased pain receptors, and other factors that create more pain. 

Now a new study published in JAMA supports this point. 

Last year, I blogged in two separate posts about research into the topic of heart health and the keto diet. Now a follow-up study on this research has been published which sheds some important light on the topic.

Before getting into this new research, it would be worth your time to read (or re-read) my two prior posts on this topic, which can be found by clicking here and by clicking here.

One of the popular strategies for weight loss over the past decade has been intermittent fasting, or as some researchers call it, time restricted eating. 

In case you don’t know what this is, it’s simply setting a restricted schedule around when you eat and when you don’t. Studies have shown that the typical American spends more than 15 out of every 24 hours in a “feeding” state, meaning that they eat shortly after waking in the morning, and then consume multiple meals and snacks throughout the day right up until shortly before bedtime. As a result, the longest stretch they ever go without eating in a typical day is no more than 9 hours, most of which consists of the time they are asleep overnight.

By contrast, somebody who is intermittent fasting might follow one of the following schedules:

Today’s post will just be some musings of personal observation. 

If you follow any online “health influencers,” you will notice that they often attract a rather passionate set of followers and detractors. For example, you will commonly find influencers in the low-carb community (and their followers) denigrating anybody who disagrees with them as not just wrong, but as stupid or corrupt. I commonly see commentary around such influencers that doctors have “lied to” the public about sugar; that the data linking high cholesterol to heart disease is based on only a few flawed studies from the 1950s; and that Ancel Keys (one of the early leading proponents of reducing saturated fat and cholesterol) made up his research results – none of which is true. 

On the vegan side of things, one can find the same tendencies. I’ve seen interview clips of Michael Gregor (a prominent vegan physician and author) for example promoting the idea that a vegan diet is the “only” diet shown to reverse heart disease (it isn’t). And as a resident I once took care of a patient in the hospital who refused to believe – despite all evidence to the contrary – that she had had a heart attack, because she was a vegan and “if you don’t eat animal products, you can’t get heart disease.” (In fact, cardiovascular disease is the number one killer of all Americans – vegans included). 

I’d like to use this post to introduce a very simple, and important, concept that is a key idea to understanding metabolic health: the “personal fat threshold.”

Time for some inspiration. Last year there was quite a bit of media coverage about one Richard Morgan, a 93 year old Irish man who is a champion indoor rower. Scientists analyzed Mr. Morgan and found him to have the cardio-respiratory fitness of a man half his age. The reason this is so amazing is that Mr. Morgan didn’t take up any exercise at all until age 73, after he retired from his career as a baker. And while it’s impossible to ever draw broad medical conclusions based on one-single case, his story certainly lends credibility to the idea that it is never too late to start getting into better shape. 

The Daily Mail (a large newspaper in the UK) recently ran a sensationalist story under the headline: “Yale scientists who risked careers to publish bombshell Covid vaccine study issue message to shot’s victims“. 

This article – and in fact the entire conversation around COVID and its vaccines – is a good example of our society’s seeming inability to handle nuance and uncertainty. In effect, everybody now seems to claim that objective truth and “the science” are behind them on many issues, when frequently the facts are more shades of gray than of black and white. And as I’ve pointed out before, frequently the media feeds this, aiming more to sow fear and anger into the population than to educate us toward a deeper understanding of complex issues. 

I haven’t commented on the vaccines nor on COVID before, and I have a lot to say on the topic. So I am going to split this into two posts. Today I’m going to deal with the above article only; in my next post I will give you my thoughts more broadly on COVID and on the vaccines, as somebody who worked on the “front lines” during the COVID pandemic and has experience treating thousands of COVID cases. 

I discuss nutrition a lot on this blog, and two themes I come back to over and over again are the importance of avoiding processed foods and the benefits of increasing protein. I’ve also stated in the past that I am diet agnostic, by which I mean I believe a multitude of diets can work and the most important thing is to find the diet that works for you. With that said, patients and readers of this blog may have picked up on the fact that I tend to be partial to low-carb diets. This is not because I believe that low-carb diets are the only way to lose weight or that they are always the best choice, but because in my years of practice I’ve found many patients to have an easier time sticking to these plans and therefore achieving results than they do with other types of diets.

Where do plant based/vegan diets fall into my thinking? 

I’ve seen a lot of viral illnesses the past six weeks or so: COVID. Bronchitis. Sinusitis. And of course, the flu. This is the time of year when people get sick with all kinds of sniffles, sore throats, coughs, chills, and aches. Understandably when people are sick, they want to get better as quickly as possible. Ergo, many patients who test positive for flu will ask me for Tamiflu. 

I’ve previously alluded to the fact that Tamiflu is largely a fraud, but since this is flu season, I thought it would be a good time to review the story another time. 

One of the concepts I spend a lot of time talking to my patients about is the importance of maintaining muscle health. The reason for this is that virtually all people start to gradually lose muscle beginning somewhere in their 30s or 40s. At first these changes are barely noticeable, but by the time they are in their 70s many people will experience a huge degradation in their degree of fitness. 

This matters for several reasons:

Happy New Year! This is the time of year when many people make resolutions, with getting fit being amongst the most common. Of course, research shows that most people quit their new year’s resolutions by around March. So this year, I’d like to suggest you take a different approach: rather than giving yourself overly ambitious goals in the gym, instead learn to bake some very modest but high-yield habits into your life. 

While this may not sound as sexy as committing to some kind of “beach body” program, the fact is that with exercise, a little goes a long way. A very long way. To this end, I’d like to highlight two threads of research for you. 

One of the tools that I’ve gotten more interested in the past few years are Continuous Glucose Monitors (aka CGMs). These are patches that can be painlessly applied to the arm and that sync to an app on your phone, providing continuous information about your glucose levels. While they are not 100% accurate, they are close enough to more traditional methods for checking glucose (e.g. fingerstick) to give a pretty close estimate of your blood glucose at any particular moment, and since they can provide hundreds or even thousands of data points per day, can be used to track trends and see patterns. 

If, like me, you came of age in the 1980s and 1990s, you probably don’t remember a time when you weren’t warned to stay out of the sun. The message for the past few decades has been that sun exposure = skin cancer, and that if you absolutely have to go out during daylight hours for more than a nanosecond, to please not do so without first donning sunscreen and a full suit of body armor. 

It’s true that excessive sun exposure can cause skin damage and increase the risk of skin cancers. But there’s (pun intended) a wrinkle to this. And that is that limiting sun exposure might also increase your risk of getting lots of other diseases, including heart disease and virtually every other known cancer. I’ll discuss some data about this in a moment, but first I want to just share some thoughts about sun exposure in general:

Recently a patient asked me if I recommend any supplements for a particular medical condition. The answer is that I do, indeed, sometimes recommend supplements to my patients. (In fact, there’s a link on this website through which patients can purchase quality supplements at a discounted price – this is provided as a convenience to my own patients, though really anybody can use it, whether they work with me or not). However, readers of this blog will note that I don’t talk about supplements all that often, and this is consistent with my medical practice in general. 

This is not because I have anything against supplements per se. Some in fact have good evidence for them and can be quite beneficial. But it’s rare that a supplement is the most important part of the healing process, and often they are a band aid of sorts for something else that is going wrong in a patient’s life. 

This blog post is going to be a little different than usual. I’m not going to cover a study or discuss a particular medical topic. Rather, I just want to share some personal thoughts on this political moment. 

I am not going to endorse a particular candidate, nor a particular set of policies. Like any other citizen, I have my thoughts and ideas about this stuff, and I will be voting today for my preferred (or, more accurately, my less non-preferred) candidates. But as a doctor, I am meticulously non-partisan. I take care of Democrats and Republicans and anybody else equally, and it’s my job to stay out of the political fray and do my absolute best for each and every person who comes to me. I took an oath when I entered this profession, and that was to serve my patients to my utmost. If a person whose politics were truly loathsome showed up at my office (let’s just imagine Adolf Hitler himself, to make the point clear), I would still do my very best to help them with their medical issues. 

In my last blog post, I took the New York Times to task for incorrectly suggesting that new research demonstrates a connection between alcohol consumption and the rise of cancer in younger adults. And then just a few days after I wrote that, a patient asked me my thoughts on the health risks of alcohol. So I thought I’d dedicate a post to the topic. 

Let’s start with a simple fact: alcohol is toxic to the human body. There is now a lot of research to suggest that even moderate alcohol consumption may play a role in the development of some cancers and in neurological disease. It’s also well established that alcohol consumption is tied to an increased risk for atrial fibrillation, a common type of heart arrhythmia that can increase the risk of having a stroke. And the longstanding belief that moderate alcohol consumption is protective against cardiovascular disease has not held up under closer scrutiny. No, one glass of red wine per night will not cut your risk for a heart attack, and wine consumption is not the reason that countries like France, Italy, and Greece have lower rates of heart disease than we Americans do. 

Add to this the long established fact that heavy alcohol consumption is terrible for the body, and substantially increases the risk for liver, cardiac, and brain disease, and we can reasonably conclude that alcohol is bad for humans. Period, full stop. And looked at purely as a substance examined in isolation, this is a correct conclusion. However…

Recently I watched the documentary “Hack Your Health,” which is available for streaming on Netflix. The film covers the emerging science of the gut microbiome (the population of trillions of bacteria, most either harmless or beneficial to human health) that live inside our GI tracts, and that are increasingly being found to play a role in everything from our tendency to gain weight, to our mood, to our risk for various chronic diseases. 

I really wanted to like this film, because I think the gut microbiome is a fascinating and important emerging area in medicine, but the film suffered from some major flaws. Overall, I’d give it two out of five stars. 

I met a new patient recently who was quite concerned about his cholesterol after his last doctor suggested he go on a statin. After discussing this patient’s medical history and reviewing his labs, it became obvious that he does NOT have a cholesterol problem, and certainly not one that warrants medication. This is a common scenario I run into in clinical practice, so I thought it would be useful to take a few minutes to run through some of the thought processes that a doctor should take when evaluating a patient’s cholesterol.  

Without further ado, let’s delve in. Here are a few key points that are important to understand when thinking about cholesterol. Read through them, and then I’ll come back to the patient. 

This will be part one of a two part post. 

I’ve spent my last few posts focusing on some very bad studies that have been prominently featured in the media lately. Now I’d like to discuss a recent study that has gotten less attention, but that I think is far more interesting and useful. However, before I get to the study itself (in the next post), I need to go into some background. 

Not too long ago, I had a post (link here) about the fact that much of what is published in the medical literature are very poor quality studies, and the symbiotic relationship between academia and the media that hypes these studies up, thus sewing fear and confusion into the average person. 

I really can’t stress this point enough. It’s not that most medical studies are good, with a few poor ones thrown in. It’s that a large percentage of what is published and reported on in the news sheds absolutely no light at all on how you can live a healthier life, and is often frankly misleading. So it’s a point worth revisiting over and over. 

Take this new study that was published to fanfare last week. The headlines report that intermittent fasting can lead to the development of colon cancer. For example, here’s the link to an article in a British newspaper that gave this study the typical sensationalistic treatment. 

We will be closed for summer vacation from now until August 20th. Please note the following:

1. We will be traveling without perfect internet connection, so we will not be able to respond to messages on an urgent basis. If you are a current patient and are having an urgent issue, go to the nearest emergency room or to an urgent care center. You can leave us a message later telling us about it so that we can arrange any needed follow up as soon as we return.
2. If you have an issue that can’t wait for our return but isn’t an emergency (for example you need prescription refilled or you have a minor medical issue that you need assistance with), call or text the office and leave a message, and we will get back to you within 1-2 days. We also do have a trusted colleague who can see our patients for an in person visit for non-emergency issues, and if you indicate the need for such in your message, we can connect you to him.
3. If you are not currently a patient of ours but are interested in learning more about the practice, setting up a free “meet and greet” for after our return, or enrolling as a patient, you can still call the office and select the appropriate phone option. We have an outside business consultant who assists us with new patient inquiries, and she can field these calls on our behalf and assist you even in our absence.

Thank you for your understanding while we travel, recharge, and spend some time with our kids. We hope you are enjoying a happy and healthy summer.

-Dr. and Mrs. Fischer

Direct Primary Care (DPC) is really so different from the sort of corporate medical practice that I spent the first decade of my career in (and that most patients are familiar with) that at times it’s hard to convey to prospective patients just how different their experience can be at an office like mine. So in keeping with the aphorism that “a picture is worth a thousand words,” I’ve decided to give a few brief vignettes in this post that I think better illustrate what I offer than any bullet-point list of services you’ll find elsewhere on my website. 

Many patients want to lose weight, either for health or aesthetics reasons, and the question of “what’s the best diet?” is one I’m asked frequently. 

I’ve evolved my thinking on this in my years in practice. When I first started out, I used to recommend low-carb diets very frequently. And indeed, low-carb diets can work amazingly well. Both in numerous studies and in my experience with patients, there are a wide variety of low-carb diets (Keto, atkins, paleo, etc) that often work wonders. I still think that these diets are a great way to go for many people.

But I’ve also seen plenty of countervailing studies and patients, with the most obvious example being those folks who go onto a high-carb vegetarian/vegan diet and also see terrific results. 

Given this, when I’m asked about the best diet, my quickest answer is to advise people to follow the diet that they feel they are most likely to enjoy and be able to stick to. Even if, hypothetically, there was one particular diet that truly worked best with your unique biology, it would be of little use if you hated it and burned out on doing it after just a few weeks. 

But my real answer goes even a step further: you don’t need to follow a rigid “diet” at all. Rather, it’s often easier and more sustainable to adopt specific lifestyle principles that you can stick to indefinitely. What are these principles? 

This will be a VERY brief post. I just wanted to announce two things:

1. First off, our practice was featured this week in the local newspaper. Find a copy of the Sippican Week and turn to page 17, or else click here to read the story. Thanks to reporter Erez Ben-Akiva for taking the time to stop by the office and get to know us.
2. By way of reminder, this Sunday (June 30) we will be hosting an open house along with four other Marion businesses as part of the “Dose of Wellness” event. Feel free to drop by from 8am-12pm on Sunday to see the office, meet us, and have a complimentary body composition scan. You can read my prior blog post here for more details.

Have a nice weekend. – Dr. J

Lately, an ad keeps popping up on my youtube feed for the diabetes medication Jardiance. With apologies, I’ll provide a link to the ad here in case you want to see it for context. But warning – it’s very annoying. 

So annoying, in fact, that I googled it, and found out that there’s a whole culture of people out there who find the ad equally repellent. Many, unfortunately, have commented on the size of the main actress, and the backlash against the backlash against the commercial (isn’t everything in America these days a backlash against a backlash?) is that the haters of the commercial are simply “fat shaming” the actress. So let me state right off the bat that indeed, fat shaming is a horrible thing, and my objection to the commercial has nothing to do with the fact that the lead actress is overweight. 

Rather, what really irritates me about the commercial (other than the cloyingly obnoxious jingle) is that it perpetuates the great pharmaceutical lie about type 2 diabetes: namely, that it’s an incurable disease that is best controlled with medication. Nothing could be further from the truth. The fact is that type 2 diabetes is often curable, and almost always manageable, with lifestyle modification, and – provided they make the correct changes – many type 2 diabetics don’t require any medication at all. 

I’m excited to announce that on Sunday, June 30, we will be participating in “A Dose of Wellness,” a multi-business open house here in Marion.

On that date, anybody in the community is welcome to drop by our office (no appointment needed) between 8:00 am and 12:00 noon to get a free tour of our office, meet me, and learn more about the practice. And, as an added bonus, anybody who comes in that morning will be given a free body composition scan with my Styku device (see image below for an example scan – for best results, wear tight/form fitting clothes). In addition, any visitors will be entered into a raffle for a complimentary red light treatment session.

The man pictured above is Ivan Petrovich Pavlov (1849-1936) and if you are wondering why the photo of a long deceased Russian scientist is adorning this post, read on. I’ll come back to it by the end – I promise. 

This is part two of a series on how to sleep better. In my last post, I discussed how many people who complain of poor sleep are, in fact, already better sleepers than they think. I discussed how this was important to understand for two reasons: 1) because insomnia is often a self-perpetuating anxiety issue (we don’t sleep well and then start to stress about not sleeping well, which leads to not sleeping well, which leads to more stress about not sleeping well, and so on), and 2) because research indicates that just thinking you are a poor sleeper can in and of itself lead to feeling more tired and less focused during the day. I also promised that I would soon start giving some tips on how to actually sleep better. And I will. In a coming series of blog posts. But first, I really need to hit this point about anxiety a little bit more. Because, until you learn to stop stressing about your poor sleep, it’s going to be much harder to overcome your poor sleep. 

In my most recent post, I reviewed a study that demonstrated that simply cutting processed foods out of the diet can lead, on average, to consuming 500 calories less per day without any increase in hunger. Before moving on to any other topic, it occurred to me that I never defined what, specifically, I mean by processed food. Therefore I’ve decided to dedicate this brief post to that very topic. 

In today’s blog post, I will briefly review a fascinating study that was first published in 2005, and that should inform our approach to losing weight and improving our fitness and metabolic health. 

I’ve written a lot about the benefits of direct primary care to my patients. But here’s another one – unlike in my prior corporate job, I can actually take some time out of the office to recharge. Doctors are only human, and we actually perform our jobs with more intelligence, creativity, and compassion when we’re well rested and get to spend adequate time with our family and friends. Accordingly, I’m doing something this week that I’ve rarely done in my career as a physician before: closing shop in order to hang out with my kids, who have the week off from school for spring break.

We’ll be back in the office next Monday. Until then, my patients should feel absolutely free to text or call me for anything important. But otherwise I’ll be off, meaning no further posts to this blog nor uploads to our social media channels for the next seven days.

I wish you a happy and healthy week.

A few years ago, back when I was still an employee at a large corporate practice, a middle aged woman who I knew well came to see me complaining of abdominal pain. I took a history from her, examined her carefully, and reviewed her recent labs. After doing so, I was reassured that she had nothing serious going on and needed no further workup for the moment.

So I did exactly the sort of “irrational” thing that makes no sense to an insurance company but all the sense in the world to a doctor: I ordered an abdominal ultrasound. 

In my last post, I touched on some factors other than diet and exercise that can impact your weight loss efforts. 

Today I want to discuss three random studies. None of them have anything to do (at least not directly) with each other, and none of them represent “the” solution to weight loss. I highlight them rather to reinforce the point that, if you are paying attention to the ever expanding (no pun intended) science of obesity and weight loss, you should understand that eating more and moving less are only one part of the story. 

I bill myself as a “holistically minded” doctor. What I mean by this is not that I have any formal training in “holistic” care – I haven’t, for example, done a course in functional medicine, or in acupuncture. Rather, I have always had the bias that the human body is a wondrous and complex machine about which even we 21st century doctors know very little, and that many health problems can be either averted or healed if the body is simply given the optimal environment and left to do its own thing. 

My last post was about the basic biology of insulin resistance and about how it is the underlying root cause of type 2 diabetes, as well as a risk factor in its own right for many diseases. 

Today I’m going to answer the question of how to tell if you have insulin resistance. 

I was a history major in college, and to this day one of my great interests outside of medicine is learning more about the past. Sometimes I even like to combine these interests by considering whether people of the past have anything to teach us about good health (they certainly have a lot to teach us about bad health in terms of death from things like infection, trauma, and childbirth, but that’s a fairly obvious point that you probably don’t need me to explain in detail).

Thus it was that about a year back, I was watching a documentary about the Roman empire and got to wondering: just how exactly did the Romans prepare their soldiers for combat? 

This post will be extremely short. Back in October of 2023 – when I was still employed at my former practice – I was asked to give a lecture at a conference of physical therapists in Rhode Island. The theme of the conference was lifestyle (nutrition, exercise, sleep, etc.) and how it can positively impact joint health. The focus of my talk was on nutrition, with an emphasis on how proper nutrition can support better joint health and ease chronic pain, as well as on tips for losing weight. If you are interested, the folks who sponsored the conference have now posted a video recording of the talk on YouTube, embedded above.

Special bonus: if you forward to the 24:28 mark and watch just the last seven minutes of the video, you will hear my thoughts on what we can learn from the ancient Romans about how to have better health today – a topic that I will be returning to in another blog post soon.

The chances are you’ve noticed a decline in your primary care experience in recent years. Maybe you can’t find a primary care doctor at all.

Or you have a doctor, but have to wait months to see him/her.

Or you’ve found that most of the time when you call to see your doctor, you get booked instead with a nurse practitioner or physician assistant.