Women's Wellness Blog

There are some things a dad just shouldn’t do. Now this is not going to be some sexist, misogynistic diatribe about why men should only eat meat and watch football and women should bake pies and pump out kids like a Krispy Kreme assembly line. What I mean is that in the course of everyday life, dads need to exercise restraint and good judgment which, in turn, benefits the entire family. It’s like in those old National Geographic films where the unsuspecting Gazelle wanders close to the watering hole and gets his head eaten by the lurking alligator. “Yes Marlin, watch as the normally cautious creature simply wants to have a drink and...Oh! Heavens to Betsy! Did you see how agile that gator was? Just lopped off that head in one manly snap! Yep, that Gazelle is having a bad day!” Sometimes all us dads want to do is get a drink of water and Bam! Off with our heads! Let me give you an example.
Not long ago I was minding my own business relaxing in our kitchen with a manly cup of dark roast java, and my two daughters were discussing whatever daughters discuss (in my usual manly stupor I had no idea of the topic), yet I detected a somewhat disrespectful tone to the conversation. I was brought up in a house where showing disrespect to anyone, anytime was tantamount to committing a war crime, so I have this “disrespect” radar that can sense such activity even if my mind is focused on other things like a Glen Beck rant. I sensed this tone in their conversation so I commented that I thought they could discuss boys or clothes or global warming with a bit more congeniality. Mistake! As soon as the words came out of my mouth they both turned to me and like the aforementioned Gazelle, Snap! Off with my head! A sure fire way to cure your teenagers from arguing is to instantly give them a common enemy. Never mind the fact that all the women in my household are on a synchronous hormone pattern that would make a Swiss watch maker envious. So not only had I intervened in a conversation in which I was not welcomed or needed, I had done it at a time when the alligator in each was in its most ravenous state. There are some discussions that dads just need to stay out of, and I have been rendered headless many times to validate that conclusion.
Dads don’t need to do the wash. I can hear the NOW supporters bristling in their “I Am Woman” tee shirts but hear me out on this one. I do believe in a division of labor around the house. In today’s society almost 70% of women work outside the home, so it is only fair that the responsibilities be divided from those according to their ability to those according to their need. (Where have I heard that before?) For example, I love getting the dishes out of the dishwasher. I imagine each time I am doing this that the items I am placing on the shelves are new (even if they are the same ones we have had since 1991). This somewhat delusional game makes emptying the dishwasher fun as it seems like I have a big Christmas package that I get to unwrap every night. On the other hand, my wife , who is mysteriously grounded in reality, hates doing this chore, mainly because she sees it for what it really is, a drudgery akin to working an assembly line checking bananas for bruises. So the fact that she despises this and I adore it makes it easy to understand who empties the dishwasher at our house. Don’t get me started about getting the kids to do such a thing. That would be like trying to get Barney to go straight...a battle not worth fighting at this point. So why, you ask pensively, should dads not do the wash? I guess I should clarify my statement somewhat by saying that dads with teenage daughters shouldn’t do the wash. There are things you discover in folding clothes that you were not meant to know. The other day I was sorting and folding a load of wash (yes ladies, my wife married a jewel!), and I came across a piece of fabric that confused me. It was close to Halloween and for all the world it looked like an eye patch. I tried placing it on my head in the right position and the triangular, stripped fabric barely covered my eye. During my investigation my wife walked in the room and gave me one of those “What in the name of fabric softener are you doing” looks. I asked her who was going to be the pirate for Halloween and, knowing my propensity for delusion, she just laughed and said no one that she knew, and then she calmly asked me why I was wearing my youngest daughter’s underwear on my head. Jerking the minuscule swath of cloth off my head I look incredulously at the nearly non-existent fabric and shook my head in an attempt to grasp that this microscopic snippet was used for anything besides a blanket for a baby hummingbird. Once my wife gained her composure and I voiced my fatherly objections, we agreed that maybe I should go back to emptying the dishwasher.
Dads should not dress themselves, especially if they are older like myself. We have a propensity for wearing such atrocious items as high water pants, dad jeans, and wife beater shirts. If you don’t know what these fashion items are then you certainly don’t want to adorn your form by yourself as you are probably wearing all of them. If your sole goal in life is to embarrass your children and humiliate your wife, go ahead and pick out your wardrobe everyday and you will most likely accomplish this task. Most dads get excited when we see a sale on jeans at Target or find a stash of ties for a dollar at a garage sale. Wise up guys, they are on sale for a dollar for a reason as most of these ties were rejected by Goodwill! Not everyone needs another salmon colored tie with a swordfish the size of New Jersey on it. ( I have three).
I have what I call my “bringing sexy back” line of clothing for the middle aged dad. It can be one or a combination of items that can illicit nausea and uncontrolled laughter from anyone within viewing distance. There are the “Richard Simmons” workout shorts and shirt. I got these from a clearance sale (first red flag) and the shorts look like hot pants from the 80s and the shirt is mesh see through. The first time I wore these to go exercise, my family, once they stop seizing from laughing so hard, threatened to move to California if I ever wore them in public. Then there are my black “compression socks”. Now these are legitimate tools for recovery after a long race, they just happen to look like support hose. So picture, if you dare, a middle aged man in black support stockings up to his knees, plastic like gym shorts, and a Boston Marathon tee shirt and you can see why my family wants me on house arrest.
I love being a dad, but I have learned that there are just some things we have to avoid if we want to excel at it.

As another birthday steamrolls over my consciousness, I find myself searching for that Holy Grail of anti-aging solutions that has proven so elusive. A quick survey of my current understanding of the ant-aging literature revealed that this whole body of work is misnamed. There is no such thing as not aging! It happens! We are all captives of time and space and no matter what we do or say, we will get older. A better goal is learning how to age well. Live long and healthy, then crash and burn for a brief time! I love the term "compressed senescence" because it encapsulates what I perceive as the real goal we all strive for; that is living life in a state of good health and vigor and when it is time, and there will come a time, having a rapid decline. I would much prefer to live to a vigorous ninety and die at ninety one than live to ninety five and be dependent and sickly for the ten years prior. In that vein let me expound on a few things that may help both you and me achieve that goal.

If you have read anything from me in the past you know that I feel exercise is the fountain of youth. A 30-45 minute daily routine that gets your heart rate up and your body moving is quite possibly the best thing you can do to keep healthy longer. A close second is diet. What we eat really does determine what we become. My simple rules are; eat balanced meals, whole foods as close to how God made them as possible, eat mostly plants, low sugar, low fat, high fiber, and generally less than you have been. If you follow those two things you are ahead of about 90% of the population and well on the road to a healthy longevity.

I am often asked about vitamins and supplements and their role in living a long healthy life. The simple answer is that if we eat right you don't really need anything additional...but honestly, who eats right all the time. Reality dictates that we benefit from a basic multivitamin. Don't fall for the hype of slick markerters that say their vitamin is far superior to the their guys. Most of the products from reputable companies provide what you need.

The only additional supplement that I almost universally recommend is the Omega 3 Fatty Acids. I think the data is overwhelming that an abundance of these substances in either your diet or supplements can reduce inflammation, oxidative stress, and free radical formation, all which have been associated with more rapid aging and disease. Honestly I know of very few folks who wouldn't benefit from a healthy dose of Omega 3s. Here there is a difference in the quality of the product. Numerous studies show that some fish oil capsules (a great source of omega 3 fatty acids) either contain minimal omega 3s or an improper balance of the various types. Quality and dose does matter greatly when considering the scientific data on the benefits of these substances. I recommend a proprietary brand of Omega 3s called Omega XL. It has stood rigorous independent evaluation and has shown to be consistent in dosage and effectiveness. The company that manufactures it, Great Health Works, has a long history in the supplement world and is well respected for the quality and integrity of its manufacturing process. I take it, and so does my family. That's the best endorsement I can give!

Live Well!

I have been doing some research into the literature on omega 3 fatty acids and attention deficit disorder in kids. The literature is pretty clear that this is a metabolic/genetic/environmental/structural problem that runs the gamut as far as presentation of symptoms. Neuroscientists largely agree that there probably is a nutritional component also, with ADD kids almost always showing below normal serum levels of essential fatty acids. A few studies (see below) have suggested that supplementation with Omega 3 PUFAs may improve behavior in some kids with this disorder. I will continue to search the literature for reliable information on this topic. I suspect many of you are already aware of this, but I just wanted you to know this is another area of interest on my part. I have attached the abstracts of several relevant studies with the important conclusions highlighted and the sites on PubMed where they can be found. Let me know if this stuff is helpful. I will be addressing this in next months blog posting and newsletter.

Ron Eaker,M.D.

http://www.ajcn.org/cgi/content/abstract/71/1/327S

American Journal of Clinical Nutrition, Vol. 71, No. 1, 327S-330S
Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder1,2
John R Burgess, Laura Stevens, Wen Zhang and Louise Peck
From the Department of Foods and Nutrition, Purdue University, West Lafayette, IN.
Attention-deficit hyperactivity disorder (ADHD) is the diagnosis used to describe children who are inattentive, impulsive, and hyperactive. ADHD is a widespread condition that is of public health concern. In most children with ADHD the cause is unknown, but is thought to be biological and multifactorial. Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. We reported previously that a subgroup of ADHD subjects reporting many symptoms indicative of EFA deficiency (L-ADHD) had significantly lower proportions of plasma arachidonic acid and docosahexaenoic acid than did ADHD subjects with few such symptoms or control subjects. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n–3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n–3 fatty acids. The reasons for the lower proportions of long-chain polyunsaturated fatty acids (LCPUFAs) in these children are not clear; however, factors involving fatty acid intake, conversion of EFAs to LCPUFA products, and enhanced metabolism are discussed. The relation between LCPUFA status and the behavior problems that the children exhibited is also unclear. We are currently testing this relation in a double-blind, placebo-controlled intervention in a population of children with clinically diagnosed ADHD who exhibit symptoms of EFA deficiency.

http://www.ncbi.nlm.nih.gov/pubmed/16962757

Omega-3 fatty acid status in attention-deficit/hyperactivity disorder.
Antalis CJ, Stevens LJ, Campbell M, Pazdro R, Ericson K, Burgess JR.
Department of Foods and Nutrition, West Lafayette IN 47909-2059, USA.
Abstract
Lower levels of long-chain polyunsaturated fatty acids, particularly omega-3 fatty acids, in blood have repeatedly been associated with a variety of behavioral disorders including attention-deficit/hyperactivity disorder (ADHD). The exact nature of this relationship is not yet clear. We have studied children with ADHD who exhibited skin and thirst symptoms classically associated with essential fatty acid (EFA) deficiency, altered plasma and red blood cell fatty acid profiles, and dietary intake patterns that do not differ significantly from controls. This led us to focus on a potential metabolic insufficiency as the cause for the altered fatty acid phenotype. Here we review previous work and present new data expanding our observations into the young adult population. The frequency of thirst and skin symptoms was greater in newly diagnosed individuals with ADHD (n = 35) versus control individuals without behavioral problems (n = 112) drawn from the Purdue student population. A follow up case-control study with participants willing to provide a blood sample, a urine sample, a questionnaire about their general health, and dietary intake records was conducted with balancing based on gender, age, body mass index, smoking and ethnicity. A number of biochemical measures were analyzed including status markers for several nutrients and antioxidants, markers of oxidative stress, inflammation markers, and fatty acid profiles in the blood. The proportion of omega-3 fatty acids was found to be significantly lower in plasma phospholipids and erythrocytes in the ADHD group versus controls whereas saturated fatty acid proportions were higher. Intake of saturated fat was 30% higher in the ADHD group, but intake of all other nutrients was not different. Surprisingly, no evidence of elevated oxidative stress was found based on analysis of blood and urine samples. Indeed, serum ferritin, magnesium, and ascorbate concentrations were higher in the ADHD group, but iron, zinc, and vitamin B6 were not different. Our brief survey of biochemical and nutritional parameters did not give us any insight into the etiology of lower omega-3 fatty acids, but considering the consistency of the observation in multiple ADHD populations continued research in this field is encouraged.

http://www.ncbi.nlm.nih.gov/pubmed/17629918

Nutr J. 2007 Jul 13;6:16.
Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder.
Sorgi PJ, Hallowell EM, Hutchins HL, Sears B.
Hallowell Center, Sudbury, MA 01776, USA.
Abstract
BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is the most common neurological condition in children. This pilot study evaluated the effects of high-dose eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation on the isolated plasma phospholipids and behavior in children with ADHD (primarily inattentive subtype and combined subtype). METHODS: Nine children were initially supplemented with 16.2 g EPA/DHA concentrates per day. The dosage was adjusted dependent on the ratio of arachidonic acid (AA) to EPA in the isolated plasma phospholipids at four weeks to reach a level normally found in the Japanese population. RESULTS: At the end of the eight-week study, supplementation resulted in significant increases in EPA and DHA, as well as a significant reduction in the AA:EPA ratio (20.78 +/- 5.26 to 5.95 +/- 7.35, p < 0.01). A psychiatrist (blind to supplement compliance or dosage modifications) reported significant improvements in behavior (inattention, hyperactivity, oppositional/defiant behavior, and conduct disorder). There was also a significant correlation between the reduction in the AA:EPA ratio and global severity of illness scores. CONCLUSION: The findings of this small pilot study suggest supplementation with high-dose EPA/DHA concentrates may improve behavior in children with ADHD.

http://www.ncbi.nlm.nih.gov/pubmed/18072818

Altern Med Rev. 2007 Sep;12(3):207-27.
Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids.
Kidd PM.
University of California, Berkeley, California, USA.
Abstract
The omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are orthomolecular, conditionally essential nutrients that enhance quality of life and lower the risk of premature death. They function exclusively via cell membranes, in which they are anchored by phospholipid molecules. DHA is proven essential to pre- and postnatal brain development, whereas EPA seems more influential on behavior and mood. Both DHA and EPA generate neuroprotective metabolites. In double-blind, randomized, controlled trials, DHA and EPA combinations have been shown to benefit attention deficit/hyperactivity disorder (AD/HD), autism, dyspraxia, dyslexia, and aggression. For the affective disorders, meta-analyses confirm benefits in major depressive disorder (MDD) and bipolar disorder, with promising results in schizophrenia and initial benefit for borderline personality disorder. Accelerated cognitive decline and mild cognitive impairment (MCI) correlate with lowered tissue levels of DHA/EPA, and supplementation has improved cognitive function. Huntington disease has responded to EPA. Omega-3 phospholipid supplements that combine DHA/EPA and phospholipids into the same molecule have shown marked promise in early clinical trials. Phosphatidylserine with DHA/EPA attached (Omega-3 PS) has been shown to alleviate AD/HD symptoms. Krill omega-3 phospholipids, containing mostly phosphatidylcholine (PC) with DHA/EPA attached, markedly outperformed conventional fish oil DHA/EPA triglycerides in double-blind trials for premenstrual syndrome/dysmenorrhea and for normalizing blood lipid profiles. Krill omega-3 phospholipids demonstrated anti-inflammatory activity, lowering C-reactive protein (CRP) levels in a double-blind trial. Utilizing DHA and EPA together with phospholipids and membrane antioxidants to achieve a triple cell membrane synergy may further diversify their currently wide range of clinical applications.

http://www.ncbi.nlm.nih.gov/pubmed/16188207

Reprod Nutr Dev. 2005 Sep-Oct;45(5):549-58.
Effect of randomized supplementation with high dose olive, flax or fish oil on serum phospholipid fatty acid levels in adults with attention deficit hyperactivity disorder.
Young GS, Conquer JA, Thomas R.
Human Biology and Nutritional Sciences, University of Guelph, Guelph, Ontario N1G 5B6, Canada.
Abstract
Dietary intake of omega-3 fatty acids has been positively correlated with cardiovascular and neuropsychiatric health in several studies. The high seafood intake by the Japanese and Greenland Inuit has resulted in low ratios of the omega-6 fatty acid arachidonic acid (AA, 20:4n-6) to eicosapentaenoic acid (EPA, 20:5n-3), with the Japanese showing AA:EPA ratios of approximately 1.7 and the Greenland Eskimos showing ratios of approximately 0.14. It was the objective of this study to determine the effect of supplementation with high doses (60 g) of flax and fish oils on the blood phospholipid (PL) fatty acid status, and AA/EPA ratio of individuals with Attention Deficit Hyperactivity Disorder (ADHD), commonly associated with decreased blood omega-3 fatty acid levels. Thirty adults with ADHD were randomized to 12 weeks of supplementation with olive oil (< 1% omega-3 fatty acids), flax oil (source of alpha-linolenic acid; 18:3n-3; alpha-LNA) or fish oil (source of EPA and docosahexaenoic acid; 22:6n-3; DHA). Serum PL fatty acid levels were determined at baseline and at 12 weeks. Flax oil supplementation resulted in an increase in alpha-LNA and a slight decrease in the ratio of AA/EPA, while fish oil supplementation resulted in increases in EPA, DHA and total omega-3 fatty acids and a decrease in the AA/EPA ratio to values seen in the Japanese population. These data suggest that in order to increase levels of EPA and DHA in adults with ADHD, and decrease the AA/EPA ratio to levels seen in high fish consuming populations, high dose fish oil may be preferable to high dose flax oil. Future study is warranted to determine whether correction of low levels of long-chain omega-3 fatty acids is of therapeutic benefit in this population.

http://www.ncbi.nlm.nih.gov/pubmed/19436468

Paediatr Child Health. 2009 Feb;14(2):89-98.
Omega-3 fatty acid treatment of children with attention-deficit hyperactivity disorder: A randomized, double-blind, placebo-controlled study.
Bélanger SA, Vanasse M, Spahis S, Sylvestre MP, Lippé S, L'heureux F, Ghadirian P, Vanasse CM, Levy E.
Department of Pediatrics, CHU Ste-Justine, Montréal, Québec.
Abstract
BACKGROUND: Although several clinical trials have evaluated the impact of n-3 polyunsaturated fatty acid (PUFA) on patients with attention-deficit hyperactivity disorder (ADHD), changes in plasma PUFA composition were not always assessed following n-3 supplementation. Furthermore, no reports are available on the efficacy of n-3 PUFA in Canadian youth with ADHD. OBJECTIVES: To determine fatty acid (FA) composition, and the efficacy and safety of n-3 PUFA supplementation on ADHD clinical symptoms in French Canadian primary school children. PATIENTS AND METHODS: The Strengths and Weaknesses in ADHD and Normal Behaviors (SWAN) and Conners' questionnaires were used to assess changes in ADHD symptoms in 37 children (only 26 children completed the study from zero to 16 weeks). They were divided into two groups (A and B), and participated in a 16-week, double-blind, one-way, crossover randomized study. In the first phase, group A received the n-3 PUFA supplement and group B received n-6 PUFA (sunflower oil) as a placebo. During the second phase, group B received the active n-3 PUFA supplement that was continued in group A. FA composition and lipid profile were assessed during the phases of the study. RESULTS: FA differences between groups were observed in the 26 patients. Supplementation with n-3 PUFA resulted in significant increases in eicosapentaenoic and docosahexaenoic acids in group A, while group B was enriched with alpha-linolenic, gamma-linolenic and homo-gamma-linolenic acids. The n-3 PUFA supplement was tolerated without any adverse effects. A statistically significant improvement in symptoms was noted based on the parent version of the Conners' questionnaire from baseline to the end of phase 1, and this amelioration continued from phases 1 to 2, although the latter changes from phases 1 and 2 were not statistically significant in any of the subscales except for the subscale measuring inattention in group B. The improvement was greater in patients from group A in phase 1 and in patients from group B in phase 2. A subgroup of eight patients (four in each group) displayed a statistically significant clinical improvement following the administration of the n-3 PUFA supplement, particularly for the inattention and global Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, total Conners' subscales. CONCLUSIONS: A subgroup of children with ADHD who used n-3 PUFA supplements achieved and maintained symptom control. The data of the present study also supported n-3 PUFA safety and tolerability, but limited changes were noted in the FA profile in French Canadians with ADHD.

http://www.ncbi.nlm.nih.gov/pubmed/14669965

Lipids. 2003 Oct;38(10):1007-21.
EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors.
Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR.
Department of Foods & Nutrition, Purdue University, West Lafayette, Indiana 47907, USA.
Abstract
This pilot study evaluated the effects of supplementation with PUFA on blood FA composition and behavior in children with Attention-Deficit/Hyperactivity Disorder (AD/HD)-like symptoms also reporting thirst and skin problems. Fifty children were randomized to treatment groups receiving either a PUFA supplement providing a daily dose of 480 mg DHA, 80 mg EPA, 40 mg arachidonic acid (AA), 96 mg GLA, and 24 mg alpha-tocopheryl acetate, or an olive oil placebo for 4 mon of double-blind parallel treatment. Supplementation with the PUFA led to a substantial increase in the proportions of EPA, DHA, and alpha-tocopherol in the plasma phospholipids and red blood cell (RBC) total lipids, but an increase was noted in the plasma phospholipid proportions of 18:3n-3 with olive oil as well. Significant improvements in multiple outcomes (as rated by parents) were noted in both groups, but a clear benefit from PUFA supplementation for all behaviors characteristic of AD/HD was not observed. For most outcomes, improvement of the PUFA group was consistently nominally better than that of the olive oil group; but the treatment difference was significant, by secondary intent-to-treat analysis, on only 2 out of 16 outcome measures: conduct problems rated by parents (-42.7 vs. -9.9%, n = 47, P = 0.05), and attention symptoms rated by teachers (-14.8 vs. +3.4%, n = 47, P = 0.03). PUFA supplementation led to a greater number of participants showing improvement in oppositional defiant behavior from a clinical to a nonclinical range compared with olive oil supplementation (8 out of 12 vs. 3 out of 11, n = 33, P = 0.02). Also, significant correlations were observed when comparing the magnitude of change between increasing proportions of EPA in the RBC and decreasing disruptive behavior as assessed by the Abbreviated Symptom Questionnaire (ASQ) for parents (r = -0.38, n = 31, P < 0.05), and for EPA and DHA in the RBC and the teachers' Disruptive Behavior Disorders (DBD) Rating Scale for Attention (r = -0.49, n = 24, P < 0.05). Interestingly, significant correlations were observed between the magnitude of increase in alpha-tocopherol concentrations in the RBC and a decrease in scores for all four subscales of the teachers' DBD (Hyperactivity, r = -0.45; Attention, r= -0.60; Conduct, r = -0.41; Oppositional/Defiant Disorder, r = -0.54; n = 24, P < 0.05) as well as the ASQ for teachers (r = -0.51, n = 24, P < 0.05). Thus, the results of this pilot study suggest the need for further research with both n-3 FA and vitamin E in children with behavioral disorders.

http://www.ncbi.nlm.nih.gov/pubmed/20491709
Acta Paediatr. 2010 May 19.
EPA supplementation improves teacher-rated behaviour and oppositional symptoms in children with ADHD.
Gustafsson PA, Birberg-Thornberg U, Duchén K, Landgren M, Malmberg K, Pelling H, Strandvik B, Karlsson T.
.Department of Child Psychiatry, Linköping University, Linköping, Sweden.
Abstract
Abstract Aim: Measure efficacy of eicosapentaenoic acid (EPA) in children with attention deficit hyperactivity disorder (ADHD). Methods: Randomized controlled trial (RCT) of 0.5 g EPA or placebo (15 weeks) in 92 children (7-12 years) with ADHD. Efficacy measure was Conners' Parent/Teacher Rating Scales (CPRS/CTRS). Fatty acids were analysed in serum phospholipids and red blood cell membranes (RBC) at baseline and endpoint with gas chromatography. Results: EPA improved CTRS inattention/cognitive subscale (p = 0.04), but not Conners' total score. In oppositional children (n = 48), CTRS total score improved >/=25% in 48% of the children receiving EPA vs. 9% for placebo [effect size (ES) 0.63, p = 0.01]. In less hyperactive/impulsive children (n = 44), >/=25% improvement was seen in 36% vs. 18% (ES 0.41, n.s.), and with both these types of symptoms 8/13 with EPA vs. 1/9 for placebo improved >/=25% (p = 0.03). Children responding to treatment had lower EPA concentrations (p = 0.02), higher AA/EPA (p = 0.005) and higher AA/DHA ratios (p = 0.03) in serum at baseline. Similarly, AA/EPA (p = 0.01), AA/DHA (p = 0.038) and total omega-6/omega-3 ratios (p = 0.028) were higher in RBC, probably because of higher AA (p = 0.011). Conclusion: Two ADHD subgroups (oppositional and less hyperactive/impulsive children) improved after 15-week EPA treatment. Increasing EPA and decreasing omega-6 fatty acid concentrations in phospholipids were related to clinical improvement.

http://www.ncbi.nlm.nih.gov/pubmed/20424008

J Atten Disord. 2010 Apr 27. [Epub ahead of print]
The Impact of Polyunsaturated Fatty Acids in Reducing Child Attention Deficit and Hyperactivity Disorders.
Transler C, Eilander A, Mitchell S, van de Meer N.
Sensation, Perception and Behavior Department.
Abstract
Objectives: To review the impact of polyunsaturated fatty acids (PUFA) in reducing ADHD symptoms in children. Methods: Peer-reviewed experimental literature published from 1980 to Mai 2009 is consulted (Psychinfo, Medline, and resulting reference lists). Results: Placebo-controlled studies with ADHD or hyperactive children show no effects on behaviors or cognition when only n- 6 (omega-6) PUFA, only docosahexaenoic acid (DHA), or n-6 and n-3 (omega-3) short-chain PUFA are supplemented. Yet three out of four studies suggest that a combination of long-chain n-3 and n-6 fatty acids (DHA, eicosapentaenoic acid [EPA], and gamma-linolenic acid [GLA]) supplemented daily for 3 to 4 months could lead to a reduction in ADHD symptomatology. Results on cognitive outcomes are inconsistent. Conclusions: Evidence is too limited to reach definitive conclusions but suggests that research on the impact of long-chain PUFA (n-3 and n-6) should continue with special focus on individual differences (genetic and fatty acid markers), mechanisms (brain imaging), and new enhanced methods of systematic observations of behaviors.

http://www.ncbi.nlm.nih.gov/pubmed/20146180

Tijdschr Psychiatr. 2010;52(2):89-97.
Omega-3 and omega-6 fatty acids in the treatment of children and adolescents with ADHD
Aben A, Danckaerts M.
Abstract
Background There is a growing trend towards the use of alternative forms of treatment for attention deficit hyperactivity disorder (adhd), such as the food supplements omega-3 and omega-6 fatty acids. AIM: To study biochemical aspects, important hypotheses regarding the role of these fatty acids in brain development, the mode of operation and research results concerning the effectiveness of treating adhd with these supplements. METHOD: A Medline search was performed using the Mesh-term 'fatty acids' and the search terms 'omega-3 and omega-6 fatty acids' and 'attention deficit hyperactivity disorder'. results Some rct's (randomised controlled trails) involving children with adhd didn't show any improvement after treatment with omega-3 and omega-6 fatty acids. Some other rct's, however, did show a reduction in adhd symptoms and learning difficulties, but the children concerned had not been officially diagnosed with adhd. A recent rct showed a substantial reduction in adhd symptoms in children with the inattentive type of adhd and in children with adhd and comorbid problems. CONCLUSION: There are indications that there is a theoretical rationale for the effectiveness of fatty acids in the treatment of adhd; research is ongoing. At the moment, however, treatment of adhd with omega-3 and omega-6 fatty acids is not recommended because it does not qualify as being evidence-based.

http://www.ncbi.nlm.nih.gov/pubmed/18448859

J Atten Disord. 2009 Mar;12(5):394-401. Epub 2008 Apr 30.
Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents.
Johnson M, Ostlund S, Fransson G, Kadesjö B, Gillberg C.
Department of Child and Adolescent Psychiatry, Göteborg University, Göteborg, Sweden. mats.k.johnson@vgregion.se
Abstract
OBJECTIVE: The aim of the study was to assess omega 3/6 fatty acids (eye q) in attention deficit hyperactivity disorder (ADHD). METHOD: The study included a randomized, 3-month, omega 3/6 placebo-controlled, one-way crossover trial with 75 children and adolescents (8-18 years), followed by 3 months with omega 3/6 for all. Investigator-rated ADHD Rating Scale-IV and Clinical Global Impression (CGI) scale were outcome measures. RESULTS: A majority did not respond to omega 3/6 treatment. However, a subgroup of 26% responded with more than 25% reduction of ADHD symptoms and a drop of CGI scores to the near-normal range. After 6 months, 47% of all showed such improvement. Responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders. CONCLUSION: A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with omega 3/6 fatty acids for 6 months responded with meaningful reduction of ADHD symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/18622940

Z Kinder Jugendpsychiatr Psychother. 2008 Mar;36(2):109-16.
The treatment of Attention-Deficit/Hyperactivity Disorders with polyunsaturated fatty acids - an effective treatment alternative?
[Article in German]
Frölich J, Döpfner M.
Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universität zu Köln. Praxis-dr-froelich@t-online.de
Abstract
OBJECTIVES: Both omega-3 and omega-6 long-chain polyunsaturated fatty acids (PUFA) have a substantial impact on human brain development and function. However, in western industrial countries omega-3 LC-PUFA in particular are often lacking in diets. Increasing evidence indicates that LC-PUFA imbalance or deficiencies may be associated with Attention Deficit/Hyperactivity Disorder (ADHD) through involvement in the dopaminergic corico-striatal metabolism. Preliminary study result suggest that dietary supplementation with LC-PUFA might be effective in the treatment of ADHD. METHODS: This review summarizes the knowledge in terms of a hypothesized pathogenetic relationship between fatty acid metabolism and ADHD and discusses the possible clinical benefit of a primary or combined treatment with LC-PUFA. RESULTS: Actually it is unclear whether a deficit in intake or metabolism of LC-PUFA may play a major role in the pathogenesis of ADHD. Moreover treatment studies yielded conflicting results. A combination of Omega-3 and Omega-6 - fatty acids might attenuate the symptoms of ADHD significantly, thus making this dietary intake useful. CONCLUSIONS: Considerable research has to be done in the future to identify ideal therapeutic combinations and dosages of various fatty acids, and to develop reliable ways of defining those individuals to benefit from this treatment access.

For additional info on a great product that concentrates Omega 3 fatty acids go to www.OmegaXL.com.

Some folks say there is a fine line between ambition and obsession. My wife insists that I cross that line all too often. I have decided to try a new challenge this fall and she is convinced I am either deluded or just plain senile. I like to think I am simply not acting my age. I have decided to do a half marathon marathon. I know on the surface that sounds a bit confusing and you may be agreeing with my bride at this point, or simply thinking I didn’t proofread this well and am repeating myself; but I intend to run four half marathons in four successive weekends in October. So indeed it is a marathon of half marathons. Of course you may be thinking, as does she,”You nut, you are 52 years old and you wear black socks with sandals. You have no business running that number of long races in a short period of time.” She has a point, but I think it can and should be done for a variety of reasons. Allow me to eloquently explain why.

First, I agree with my bride that I am a bit obsessed. Over the past 10 years I have made a careful study of healthy lifestyle habits, not only for myself but for my patients, and I have concluded that exercise is the true fountain of youth. There is no single thing a person can do that will more comprehensively prolong the quality of life and reduce morbidity and mortality as a 30-45 minute daily aerobic session. I have preached exhaustively that this doesn’t have to be training for a marathon, wind sprints until you throw up, or bench pressing 300 pounds. Just walking at a brisk pace and throwing in some hills will achieve remarkable results for weight management, disease prevention, and mental health. Those of you already practicing this and yet finding you are still gaining weight or not improving fitness need to fool your body. Years ago there was a commercial on TV that had the tag line,”It’s not nice to fool mother nature”. In this case that’s exactly what you want to do. If you’re in a rut as far as weight for example, you simply have to change your regimen a bit to jump start the gains. If I run 5 miles every day soon my body adapts to that and I no longer see the dramatic benefits I once did. I fool my body by altering my exercise and my weight improves and I get fitter. Instead of always running I cross train 2 days a week by lifting weights or cycling. The variation keeps things interesting and leads to additional benefits. My wife has recently introduced me to cycling (not menstrual cycling you understand ... a gyn joke there) and since I have been bike riding on my non running days, I have seen my running improve. The take home here is to first: start exercising, and second: if you are already exercising, vary your activity for the greatest benefits.

Second, I find that if I have a goal I tend to be more productive and focused. That applies to everything from exercise to work. A study done at Harvard (someYankee school up north) a few years ago concluded that those individuals who had written goals tended to be higher achievers in all aspects of their lives. I know for myself that if I have a race, or in this case a series of races, that I am planning for, then I am much more motivated to train and stay focused. It’s a lot easier to get up at 5:45 AM for a long run when you know there is a specific goal you want to achieve. That doesn’t mean you have to sign up for the next 5K in your town. Your goal can simply be to lose 10 pounds or to reduce stress. Whatever the reason, find a specific goal for your exercise and write it down. Include a timeline and signposts along the way to measure your progress. Make it both fun and achievable, and reward yourself as you successfully complete the milestones.

Third, I am running this half marathon marathon with the proper tools. By that I mean I am using the supplements, gadgets, and gizmos that are available to both make it fun and keep me healthy. I have told you in previous communications of my love affair with a product called OmegaXL. It is a concentrated dose of omega 3 fatty acids which act as both an anti inflammatory agent and an anti oxidant. In exercise, or just walking around, your body produces an enormous amount of metabolic products called free radicals. These are not college kids holding protest signs, but chemicals that can have a destructive effect on joints, tissues, and other organs. The anti oxidants in OmegaXL act like little Pac men going around in the bloodstream gobbling up the nasty little free radicals thus both preventing things like muscle fatigue and arthritic pain and creating an environment where the body functions more efficiently.

Fourth, I’m running to set an example for my kids. One of the greatest legacies I can leave is that of a healthy lifestyle. My kids are no different from most. They tend to do the opposite of what their parents do or say, but I’m hoping that one day when they visit me in the nursing home they will tell me of the latest race they completed with their kids. I take solace in knowing that I laid the foundation while they were growing up. The example we set as parents has more of an impact than we often realize. Your teens may be committed couch potatoes now but as they get a bit older, I trust they will remember the things you taught them about exercise and nutrition.

“There is evidence from multiple studies supporting intake of recommended amounts of DHA and EPA in the form of dietary fish or fish oil supplements lowers triglycerides, reduces the risk of death, heart attack, dangerous abnormal heart rhythms, and strokes in people with known cardiovascular disease, slows the buildup of atherosclerotic plaques ("hardening of the arteries"), and lowers blood pressure slightly.”
Mayo Clinic

So begins the entry on omega 3 fatty acids on the Mayo Clinic website. A little deeper digging reveals the following report from the journal Current Atherosclerotic Reports:

“Clinically important anti-inflammatory effects in man are further suggested by trials demonstrating benefits of n-3 fatty acids in rheumatoid arthritis, psoriasis, asthma, and inflammatory bowel disorders. Given the evidence relating progression of atherosclerosis to chronic inflammation, the n-3 fatty acids may play an important role via modulation of the inflammatory processes.”

Now granted I am not as bright as some government community organizers, but I can pick up on something valuable when it slams me in the face. The only logical conclusions from these and literally hundreds of additional studies is that ingesting the proper amount of these little fatty acids is good for you on a number of levels. In this world of “pharmaceuticals:bad - naturals:good” we should all be embracing tools available to us to extend lives and reduce morbidity.

I have said on numerous occasions that exercise is the fountain of youth. I still believe it is the single most advantageous activity a person can undertake to promote health. Exercise will do more for you physically and mentally than anything else out there, yet it takes you actually doing it for there to be any benefit. Likewise, proper nutrition is another big piece of the health puzzle. I am not telling you something you don’t already know. In fact I preached this for the length of an entire book in Fat Proof Your Family. So if we all know the importance of exercise and nutrition, why don’t we practice it? Psychologists, doctors, multi level marketers, and the biggest losers have all pondered this question and come up lacking. I wont tease you into thinking I have the answer either. My libertarian instincts lead me to simply say, the data is there and it is up to each individual to do with it what they may.

So why did I start this rant off with the benefits of omega 3 fatty acids and then swerve into a rave on lack of discipline and initiative? Simply to show that, thanks to modern research, there are things you can do that don’t involve treadmills or tofu that can enhance your health. I am a critical consumer when it comes to supplements and “natural” remedies. However, I do embrace those approaches when the science supports them and there are few of these over the counter products that have as much scientific and clinical validation as the omega 3s. Most of you know that these substances are abundant in cold water fish (tuna, salmon etc.) and many soybean products, flaxseed, and walnuts. As with most nutrient benefits, they are most realized when consumed in their natural state, i.e. fresh from the ocean or the ground; yet, in many cases this is not practical or cost efficient. This is one of the few areas where supplements in pill or capsule form are still as effective (and in some cases more effective) than the natural occurring nutrient. As I have mentioned before, I am a fan of the supplement OmegaXL, as my research of the literature confirms this product contains one of the greatest concentrations of the types of omega 3 fatty acids that are beneficial to humans. In addition, there are numerous studies using this actual product (which is very important) that show the anti inflammatory benefits are product specific.

The conclusion to all this for each of us; exercise daily, consume fewer calories, and take supplements that have been proven to have a benefit.

For more information go to: www.omegaxl.com

When we think of inflammation most of us envision the reddened swollen toe of the gout sufferer or the hot tender knee of the weekend warrior. Indeed these devilish conditions are a direct result of inflammation, yet this natural process impacts much more than over used appendages. For example, many people don’t associate inflammation with heart disease, yet research is conclusive that the inflammatory response is partly responsible for the artery clogging plaques that lead to chest pain and heart attacks.

Let’s take a brief repose to review what happens in a typical inflammatory response. I promise to not make your eyes bleed by using eight syllable medical jargon, but a basic understanding is critical in knowing how reducing inflammation can promote long term health and wellness.

Inflammation is basically a response of tissue to any type of insult. I don’t mean the liver retaliates against the heart for hurting its feelings. I’m not talking about that kind of insult, but more as something that causes an injury like infection, trauma, lack of nutrients (like a decreased blood supply), or intense heat or cold. This life saving cascade is responsible for both protection and healing and is characterized by the production of chemicals that have a multitude of effects on the injured tissue. This is a good thing, right? Yes it is…in most cases. However, if the inflammatory response is not limited or becomes chronic, problems arise; kind of like when your in-laws come to visit. A typical inflammatory reaction leads to redness and swelling in the surrounding tissue often accompanied by tenderness. That is why anti-inflammatory drugs like ibuprofen and naproxen are some of the most popular medications consumed by folks. None of us like pain, except the guy wearing the leather pants and carrying a whip, and the meds medicate the ouch by reducing the inflammation. Most of the time the body will stop the inflammation on its own, but in our “I want it yesterday” society sooner is always better than later. The real problem with inflammation is when it stakes its claim more permanently. Certain conditions like arthritis and auto-immune disorders stimulate “inflammation gone wild” and set up environments where pain and tissue destruction becomes more long lasting. We can also see this inflammatory tsunami from poor dietary choices, chronic couch potato-hood, and smoking.

The more we learn about the inflammatory response the more we discover the wide ranging impact it has on multiple tissues and organ systems. I mentioned earlier that clogging up the heart pipes is linked to inflammation. The cells that line the blood vessels like wallpaper are called endothelial cells and they can get irritated and inflamed by fats and other nasties in your diet. This sets off a whole cascade of events that leads to the gunking up of the artery and soon, Poof!, you get chest pain while chasing squirrels from your rutabaga garden. Doctors now use some simple blood tests that analyze your total body’s state of inflammation (called inflammatory markers), and they can predict your chance of getting a heart attack. There also seems to be a connection between chronic inflammation, Alzheimer’s disease, and certain cancers. I don’t claim to be as smart as Barak Obama, but it would make sense to me then that reducing the inflammatory response (especially the chronic kind) would be a very good thing, and science, in fact, agrees.

So how do we make the response to inflammation a happy face and not a sad face? The obvious answer would be to take a daily dose of anti-inflammatories with the same gusto that a wino sloshes down a quart of Ripple. But often the obvious response is the wrong answer, as it is in this case. Yes, taking an aspirin (the mother of all anti-inflammatories) a day has been associated with a number of benefits, and I will not dispute that some are helped from this, but there is a better way. In fact there are a number of better ways. One such healthy approach is to eat what I call an anti-inflammatory diet. By that I mean hog down on almost any fruit or vegetable you can get your little meat-stained hands on. Most fruits and vegetables contain substances such as omega three fatty acids that have a natural anti inflammatory effect. These substances swim around in the bloodstream and act like little vacuum cleaners sucking up bad stuff that would otherwise make you forget where you left your keys or who that chubby person standing next to you in the picture on the mantle is. Eat whole foods that are as close to the way God made them; the more processed the less beneficial. A good rule of thumb about eating is that if you can get it from a window without ever leaving your car, it’s probably not good for combating inflammation. Decrease your consumption of white flour products and sugar then double up on whole grains and nuts. Boycott saturated fats, like those found in most red meats and oils, and instead ingest polyunsaturated fats from cold water fish (salmon, tuna) and use olive oil. Drink enough water to drown a camel and eat fiber like it is banana cream pie.

Everyone would agree that the ideal source of anti-oxidants are whole foods, but the reality is that most of us don’t follow a consistently healthy diet think that chocolate is one of the four main food groups. Therefore supplements can be of great benefit, especially with the content of the Standard American Diet (SAD). You must be a critical consumer when assessing vitamins and supplements as there is shelf after shelf of expensive garbage in every grocery store and pharmacy in the country. These products are not regulated by any government agency (yet) so you have to rely on the integrity of the manufacturer, and just let me say that is a bit like trusting the IRS to be compassionate. As a marathon runner and a physician I have both a personal and professional interest in natural anti inflammatories that are effective and have minimal side effects, so I have done my due diligence in researching what is out there. I believe I have come upon a product that satisfies both my scientific cynicism and my personal requirements. I would have never thought that one of the most powerful anti-oxidant, anti-inflammatory substances commercially available was extracted from the New Zealand Green Lipped mussel (I’m not kidding!).

Omega XL is a concentrated powerhouse of omega 3 fatty acids that has stood the rigor of numerous double blind studies and shown to be a stupendous reliever of pain, muscle soreness, and irritation secondary to both acute and chronic inflammation. Of course the most important test was the highly touted “Eaker study” which consisted of a 51 year old middle of the pack marathoning gynecologist and his use of Omega XL while training and recovering from his last 4 marathons. Needless to say I wouldn’t even be mentioning this product if I hadn’t had great results from its use myself. In 21 years of medical practice I have never endorsed a specific product, but my own experience and the bountiful, credible studies convinced me that Omega XL is the real deal. To give you some perspective, most people understand the benefits of fish oil supplements, well, a recent study from Australia showed that Omega XL was 200 times more powerful in reducing the inflammatory changes of arthritis than standard fish oil extracts. And that’s just the beginning of the remarkable wealth of literature that has documented this product’s benefits.

I won’t bore you with my own sordid tales of marathon agony, but let it suffice to say that for years I would struggle for days, sometimes weeks, after a marathon to recover from muscle soreness and weakness. Once I started Omega XL I found I recovered from training runs quicker and therefore was able to not only run more marathons in a shorter period of time, but also run them faster than I had ten years earlier! My wife doesn’t share my enthusiasm as she says this new found vigor has only fueled my obsession with running and further kept me from my household chores. My kids love it as it gets me out of the house more often and at greater intervals so I bug them less about their homework.

The bottom line in the war against the ravages of acute and chronic inflammation is to eat well, exercise, get adequate rest, and use supplements wisely. For my money (and for my knees) Omega XL is a vital part of that regimen.

To find out more go to www.OmegaXL.com

At age fifty-one I ran my 17th marathon faster than I had run a decade earlier, and I owe it to a rare sea mollusk from New Zealand! I am no elite athlete. I am just an average Joe who enjoys distance running, but I, like most runners, thought I would get slower with age.
I began running marathons at age 37 with a trip to San Francisco and a race raising money for the Leukemia and Lymphoma Society. It was a glorious event but I hobbled around like a crippled old man for weeks afterwards. For the next decade I could average one, occasionally two, marathons a year. It literally took so much out of me that I couldn’t properly train and recover for any more than that
At age 50 I decided to challenge my “mature status” by training and completing three races in a year. By this time I had become fairly well educated about nutrition, effort, and the limits of my own ability. I still struggled with post run soreness and delayed recovery. As apart of my research ( I am a type “A” physician) I discovered the critical role of antioxidants and anti-inflammatory mechanisms in healing and recovery.
Most exercise generates chemicals and changes in the body that promote inflammation. This is a conundrum as stress pushes the body to adapt and become more fit, yet it also leads to soreness, muscle fatigue, and joint pain. As a physician biased towards natural mechanisms for reducing the effect of inflammation, I did extensive research into natural anti inflammatory tools for both my own benefit and that of my patients, as I had observed the same set of problems in their lives.
It was in the midst of this research that I came across a product called Omega XL. Omega 3 fatty acids are nature’s anti-inflammatory medicines, and I discovered that Omega XL contained the highest concentration and bioavailability of omega 3 fatty acids than any other product I could find. This little capsule derived from the green lipped mussel of New Zealand was thoroughly researched, and there was a voluminous literature published by independent investigators about its benefits. However, I wanted to see if it worked for me. Two months prior to my first “post 50” marathon I began taking Omega XL, careful to not alter any other aspect of my training such as diet and mileage as to properly asses the effect of this product. What I discovered confirmed the research; I recovered quicker and had less post-run soreness and discomfort. I didn’t measure all the inflammatory markers that were collected and followed in the research papers, but I knew how I felt and it supported the claims of the product. For me the biggest difference was how I felt after a training run or a race.
Prior to using Omega XL, I was hobbled and in agony after a marathon, unable to run or train for 2-3 weeks. Recently, however, after running the recent Albany Marathon I was back on the roads three days later looking forward to my next race. I initially thought that this recovery was just a fluke. Maybe I had trained harder or rested more, so I continued the Omega XL through my training and running of the North Carolina Marathon a few months later. Again, I was amazed at not only my time in the race but by my post race recovery.
Understand that I am a skeptic and not given to endorse any product on a whim, but here was a product that had both credible research and my own experience to support its value. Currently I am a few months from running in the 114th Boston Marathon. Not only has my training been injury free but my seasonal allergies have abated! (an unsuspected anti-inflammatory benefit)
You don’t have to train for a marathon to reap the benefits of Omega XL. Anyone who suffers from inflammatory conditions such as asthma, arthritis, back and joint pain, and even heart disease may potentially benefit from this anti-oxidant powerhouse.
I will continue to take Omega XL and will encourage my patients to do likewise.

Two roads diverged in a wood, and I- I took the one less traveled
by,and that has made all the difference.
Robert Frost

It began innocently enough, but in the end would have been grounds for divorce in twenty two states! I was speaking at a conference at a beautiful lake side resort and was hoping to get in a run before my morning presentation. The hotel was magnificently situated on hundreds of wooded acres with two golf courses cut from the fabric of the landscape. My wife had accompanied me on this trip as she knew of the splendor of the location and wanted to drink it in for herself. We don't normally run together as our schedules and biorhythms rarely coincide, but on this early October morning we had both the opportunity and motivation to venture out side by side. I had measured the distance from the entrance of the property to the hotel and had mapped out a simple 5 mile route for the occasion. It was a brisk morning, enough for a long sleeve shirt and gloves, and we stretched and warmed up by the first tee. It was too early for the golfers so we speculated that a run on the golf course was not out of the question if we wanted to "live on the wild side". About that time I spotted a jogging path lying parallel to the first hole and suggested we follow that instead. Susan agreed, so I started my Garmin 405 watch and off we went.

The first few miles were surprisingly hilly and we easily broke into a cool sweat. We kept a slow pace because of the topography and enjoyed the scenery. Three deer ran across our path onto the golf course ahead and with their abundant numbers, the squirrels looked like they were having a convention of their own. I had planned our departure to allow for about an hour run to get me safely back to the hotel in time to shower and prepare for my talk.

After going about a half hour I noticed that the color coordinated trail markers had changed from their original yellow color to black. I remember taking a few turns and forks, but thinking this was a simple circular route, I didn't pay much attention to the details. I mentioned this change to Susan and she didn't seem too concerned so we ventured on. After another mile it became clear that we were not going in a circle but were in fact traveling farther and farther from our home base. I have the sense of direction of a cross eyed pelican and Susan is not much better, so we soon realized that we were lost and about 5 miles from whence we started. We were obviously in a golf course neighborhood, but at 7 AM and dressed in black tights I was not about to knock on any doors and ask directions. We did the only logical thing we could think of and started to retrace our path in hopes of rediscovering the way home.

Mistake! As I said I could get lost in a mall parking lot so depending on me to follow the bread crumbs home is like a blind person following Google Maps. At this point two concerns were percolating in my brain, first, would I make it back in time for my talk, and second, would my wife kill me for turning our 5 mile fun jog into a 10 mile juggernaut?

I tell this tale to illustrate the universal law of unintended consequences. I started out with a plan in mind and ended up with my wife asking a passing motorist for the name of a good divorce attorney. President Obama's health care debacle reeks of unintended consequences. Regardless of the moral high ground and good intentions of universal coverage, it cannot and will not arrive without unforeseen and unintended consequences. Herein lies the dilemma; we won't know many of those effects until after years into the change.

The HIPPA laws passed by congress are a perfect example. They were intended for a noble purpose, protecting the privacy of the patient; however they have morphed into regulations that make nuclear facilities look tolerant and paper work that has singlehandedly deforested the Amazon basin. Be prepared for some form of restrictions (i.e. rationing) tax hikes (there is no other way to pay for it all), lower quality care (dumbing down just like in the public schools), and more fraud (unscrupulous doctors and executives unwilling to give up the house in the Hamptons). The system is indeed in need of repair, but to strap us all with a complete overhaul is like buying a new car when all you need is a lube job. Let's look at real reform like prevention, tort reform, portability, non exclusion clauses, and free deep fried candy bars on a stick for everyone. Okay, maybe we can leave off the candy bars, but we need a heavy dose of common sense so step number one is, in the words of Shakespeare, "let's kill all the lawyers." (and politicians, I might add)

Oh by the way, I did make it back in time from the run to give my presentation and my wife has not filed for divorce, so far.

A Prevent Defense
With the health reform debate blazing forward with the speed of a pregnant turtle, it seems only right to mercilessly show the political hacks where they have fallen off the bus. I know that sounds a bit presumptuous but trust me, I’m a doctor and I don’t just play one on TV.
First, what Washington is gobbling up then spewing out is not health care reform but heath coverage and insurance reform. No sane individual debates the merit of health care for all; it’s how that is achieved that befuddles the legislators, many of whom cannot find their way out of a wet prescription bag. Having Washington revamp the health care industry is akin to having the Chemistry department at your local community college write education policy for the nation; it’s just not what they do.
The key to real health care reform is not in legislation but in prevention. And you can’t legislate prevention! True honest to goodness prevention begins with the individual, and, in the case of kids, the family. Before we explore some practical tips for family disease prevention allow me to make the distinction between prevention and early detection. Pap smears, mammograms, and colonoscopies are techniques for early detection, not prevention. The disease already exists when these tools are utilized. They are incredibly useful and important tests and I strongly recommend their use, but don’t be under the misconception that getting a regular Pap smear will prevent cervical dysplasia and that yearly mammograms will keep breast cancer at bay. True prevention is designed to prevent or delay the onset of disease, not find it earlier once it exists. If we are to truly reform health care in this country it must begin with every family taking responsibility for prevention.
Let’s examine some methods of prevention especially suited for the family.
1) Get your kids vaccinated. If you are one of those wild-eyed, Jenny McCarthy worshiping, whack jobs that thinks childhood immunizations cause autism or any other disease, then you may already be too far gone. Not only is there no credible scientific evidence that vaccines cause autism, but not vaccinating your kids leaves them, and those around them, vulnerable to known diseases that can kill them! Measles, rubella, influenza, pertussis, and encephalitis still exist and still have serious consequences.
2) Insist on at least 30-60 minutes of physical activity for your child every day. This is an absolute minimum, and you can’t rely on the school gym program to meet this need. The average teenager spends 17 minutes actively moving in an hour long physical education class! Put a lock on the computer, blow up the TV, pour molasses in the back of the Xbox, and buy your kid a nice pair of running shoes. Childhood obesity is one of the top health problems in the country and the cure for obesity is exercise.
3) Teach good dental hygiene. We don’t often think about this as a public health issue, but many good health habits are taught early and this is one that will pay lifelong dividends. Dentists report that more and more kids (and adults) are foregoing routine check ups and preventive care due to economic concerns. Have a few less Grande Mocha Latte espressos and get your child’s teeth cleaned on a regular basis.

Now a few tips for the adults. Remember, you set the tone for the family. What you do often becomes the norm for everyone else.
4) Let’s get this out of the way right up front: eat healthy and exercise! There, I said it, you heard it, so do it! Enough said.
5) Wear seat belts. If you don’t know by now that buckling up saves more lives than Bruce Willis in Die Hard II then you have been living in a cave in Afghanistan. We all freak about the H1N1 virus that has killed 1000 people so far this year, but forget that not wearing seat belts kills an average of 5500 persons and injures 132,000 every year!
6) Join a church. Now before you write me hurtful and angry emails telling me that I am an ignorant, fundamentalist, Southern fried religious nut, hear me out. A study from Harvard (that close minded, Bible thumping bastion of evangelism) concluded that people who belonged to a religious community (i.e. church) had not only lower incidences of hypertension, diabetes, and senile dementia than their non church going brethren, but they also had longer lives on average. I am not advocating populating the pews just to live longer and healthier, but what a great side effect! In fact many studies show that people who regularly attend church tend to practice fewer risky health behaviors, are more emotionally stable, and have a greater sense of purpose.
7) Go back to school. This should convince you that I have gone completely bonkers. The reality is that people who keep their mind engaged in some meaningful activity have fewer risks for Alzheimer’s disease, senile dementia, and even some forms of cancer! Granted, this doesn’t mean you have to become a freshman at your local college, but staying mentally challenged through reading, working puzzles, journaling or a thousand other activities of the mind can be as healthy as jogging a mile a day.
You want health care reform? Start today by practicing family prevention

There is nothing like getting up in the morning and reading the latest medical pronouncements from a government bureaucrat whose greatest accomplishment in life is deciding between Lucky Charms or Coco Puffs for breakfast. That is how I felt the other morning when I read about the government's new "suggestions" regarding mammograms and Pap smears. As a service to patients and friends, I am putting out this special edition of the newsletter to address these important issues and allow me to vent so my head won't explode!
Let me say at the outset that I think these new recommendations are at best horrible and at worst dangerous. Just so there is no confusion about where I stand on this, let me reiterate my position: you can take these recommendations and make Origami giraffes out of the paper they are printed on because it will be worth more (I've heard there is quite the market for Origami giraffes) and at least you won't die from folding paper; whereas you might from these guidelines.

I could spend the next few thousand words giving you example after example of patients in my own practice who are alive today because of screening mammograms and timely Pap smears, but that would only prove my point too easily, so let me opine on a deeper level and dissect not only the recommendations but also the not so subtle reasons behind them.

First, the mammogram controversy. In a world besieged with pink ribbons and "Save the Ta Ta s" bumper stickers, you would think that anything we could do to lesson the impact of breast cancer would be a good thing. A survey a few years back listed the fear of breast cancer as the greatest health concern of women over 40. The controversy surrounding when to begin mammograms and how often to follow up has raged for years, but now the government appointed Preventive Services Task Force has said that those low risk women under 50 should simply bury their heads in the sand and not only not get mammograms but forget about doing self breast exams. Why, you ask? It's all about the money! Doing early routine mammograms are not cost effective they profess, which is a fancy way of saying the accounting wonks have determined that saving the life of 5 women per 5000 is not worth the expense of early detection. Try telling that to those 5. The arrogance of this group is astounding. Dr. Otis Brawly of the American Cancer Society said it well, "The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not. That stance is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them."

What you have here is a government controlled group of statisticians, ivory tower research doctors, and scientists who have rarely cared for patients making "recommendations" based on population statistics and cost analysis. Interestingly, this same Preventive Services Task Force is given frightful influence in the new "health care reform" legislation slithering through Congress. This is simply a blatant attempt to ration care. Essentially the government is saying that you may have this screening but your younger sister may not. Supporters clamor that these are simply suggestions and that the final decision is between you and your doctor. Whereas this is exactly where the choice should rest, the real world dictates that as soon as insurance companies adopt these guidelines as the "standard of care" (and history proves that is exactly what happens) then even if your doctor thinks a screening mammogram is a good idea, if you don't fit into one of the categories designated by this powerful task force, your insurance company may not pay for the procedure. They will quote the oft spoken diatribe, "We are not saying you can't have the test, we are just saying we are not going to pay for it."

The bottom line is that science, good medicine, and common sense dictates that low risk women get screened by age 40, every 2 years until 50, and then yearly after that. And for goodness sakes (and your sake) do your self breast exams! They actually save more lives than mammograms.

It is embarrassing as a member of the American College of Ob-Gyn to hear of their latest dictates surrounding Pap smear frequency. As a clinician for the past 21 years, I have treated numerous young women with pre-cancer changes of the cervix that, if they had abided by the new Pap guidelines, would have been subjected to hysterectomies, radiation and even death from missed cervical cancer. We are living in a time of epidemic infections of the Human Papilloma Virus (HPV) the causative agent of cervical cancer. We have never seen the volume of infections nor the mass of girls under 21 infected with the virus as we are documenting now, and we have no clue as to the long term impact of these infections. The rate of cervical cancer has plummeted over the past several decades due solely to early detection ( by means of regular Paps) of changes that are easily and completely curable. To revert back to a time when women walked into my office with large cancer lesions on their cervix from neglect and a lack of detection seems ludicrous. What the American College of Ob-Gyn won't say is that the biggest risks for these infections are early onset sexual activity and multiple sexual partners. The liberal leaning political hacks that make up the leadership of this organization will support your 15 year old getting an abortion but will never promote an abstinence program, and they now say young women don't need the "stigma" of being labeled as having a sexually transmitted infection. It is hard for me to take the advice of a group that is supposedly championing women's health when I see them making recommendations that hurt women.

The bottom line for Paps: get them yearly and begin when you become sexually active (not like the woman who answered my question, "Are you sexually active? with, "No, I just usually lie there!").

Folks, if you want a taste of what government run health care will be like, check out the rationing in these guidelines. After all, they did such a great job in getting plenty of H1N1 vaccines distributed, didn't they!

Blessings,
Ron

P.S. address hate mail and dissenting opinions to obamacare@stayoutofmyhealthcare.com

We are all students, whether we are returning to high school or taking an adult education course in the evenings. Of course not all learning is in a formal setting like the classroom. Most of us continue to soak up knowledge from life experience, smart friends, or good books. I have recently come across several manuscripts that are not only interesting reading but also provide excellent medical advice. Specifically I want to recommend three books that directly and practically address the broad topic of healthy aging.
It is a misnomer to talk of anti-aging concoctions or secrets because everyone and everything ages. In spite of late night infomercial’s claims, we all are going to get older. Time travel has yet to be perfected and that would truly be the only way to thwart the aging process. Between you and me I wouldn’t want to go back to the seventies even if it was possible. Disco gave me headaches and Puka beads clashed with my acne. The point is that aging is an unalterable law of physiology. What we really crave are tools for slowing the process or aging in such a way that minimizes morbidity. I think an admirable and achievable goal is to live as long as possible, but live it well. It is in that spirit that I offer three books that capture this philosophy, each specific to their own concentration, but unified in that they all agree that living a long life is valuable if it can be done in a way that allows for physical and emotional independence and productivity.
In 2008 Dr.John Ratey published Spark: The Revolutionary Science of Exercise and the Brain. I know, it sounds like some science fiction account of monkey brain experiments, but it is a masterful explanation of why those of us who exercise feel the way we do, and more importantly why those who don’t exercise, should! Ratey embarks upon a fascinating and entertaining journey through the mind-body connection, presenting startling research to prove that exercise is truly our best defense against everything from depression to Alzheimer's disease. “Spark is the first book to explore comprehensively the connection between exercise and the brain. It will change forever the way you think about your morning run---or, for that matter, simply the way you think”, states a review from Amazon.com. It is chock full of case histories from real persons who have transformed their lives by incorporating exercise as part of both prevention and treatment of disease. It will motivate you to get off “the couch of doom”, throw away your bag of Cheesie Poofs, and get moving…literally.
The China Study by world renown epidemiologist T.Colin Campbell,PhD, is a groundbreaking description of the findings of one of the largest studies ever done on nutrition, disease and longevity. This should be distinguished from The China Syndrome which was a very bad movie with Jane Fonda that watching can actually shorten your life…but I digress. This study examines more than 350 variables of health and nutrition with surveys from 6,500 adults in more than 2,500 counties across China and Taiwan, and conclusively demonstrates the link between nutrition and heart disease, diabetes, and cancer. While revealing that proper nutrition can have a dramatic effect on reducing and reversing these ailments as well as curbing obesity, this text calls into question the practices of many of the current dietary programs, such as the Atkins diet, that are widely popular in the West. The bottom line in this book (not to spoil it for you I hope) is that a whole-food, vegetarian based diet is unquestionably the most healthy and, along with overall calorie restriction, associated with longevity. Finally some validation that my tofu casserole surprise is the master food!
The final must read to ruin your family’s dinnertime is The Blue Zones by Dan Buettner. This is the most recent book by National Geographic explorer (and husband of Cheryl Tiegs) that focuses on several areas in the world that have an unusually high number of people over 100 years old. What I found fascinating is that even in diverse cultures, the basic principles of longevity are congruent. Exercise, stress control, dietary discipline, and having a sense of purpose all headline ways to age well. The strength of this book lies in the vigorous and voluminous data collection and the personal approach to telling the story. Translated: it’s a fun read that leaves you with some important insights.
So pack a lunch of bean sprouts and cabbage, hop on your bike, and merrily peddle off into longevity and don’t forget to tote these three books along with you as your guides to living well for a long, long time.

Men make horrible patients. Men doctors make even worse patients. Men doctors who are wimpy about pain make inexcusably, embarrassingly horrible patients. I can say this with both authority and confidence as I am all of those things. Case in point: I turned fifty not so very long ago and my perpetually helpful wife reminded me that a stroll down colonoscopy lane was in my near future. I realize this is an absolutely essential screening exam as there are more curable cases of colon cancer picked up early through this test than there are crooks in Congress, but to say I am somewhat hesitant goes beyond an understatement. Let’s just call it what it is; unbridled terror! The thought of some long flexible tube traveling up unchartered territory gives me goose bumps on top of my goose bumps. Now I don’t want to get any angry emails accusing me of advocating avoiding this helpful and necessary exam. I am all about prevention…as long as it’s you that’s doing the prevention. I don’t have any trouble wallowing in someone else’s bowels and body fluids in surgery, but if I cut myself shaving I contemplate calling 911. I actually think this is a man thing, sort of like asking for directions, making your own sandwich, and lifting the lid. For most guys having a lighted camera charting territory never before mapped is about as manly as Liberace in full bloom. Actually I’ve heard the procedure itself is not that bad (mainly from sadistic so-called friends who want you to share their misery) but the prep before the scope receives universal disdain. There is nothing like drinking four gallons of lightly sweetened motor oil while all the time knowing that it is designed to sand blast your colon. And that it does, so I’ve been told. One sarcastic soul simply advised me to have a good book and a Sam’s card to bulk buy your TP.
Let me reiterate, this diatribe is in no way meant to dissuade you from having your intestines surveyed and projected on a screen like some National Geographic special. It needs to be done. So as the fine folks at Nike say… Just Do It! I would, however, make a few requests before the procedure. Ask the gastroenterologist to refrain from a play by play of what he sees. “And over there is what looks to be a hyperplastic polyp. If we come in real slow and close we won’t scare it and you can see it feeding!” Also, I would pick a place that does not employ everyone you normally see at Sunday school. There is nothing more distracting than getting an enema from the woman you were having a spirited discussion about “women being silent in the church” just the week before. Remember, she chooses how much and how hot that water is! Finally, I would not have your wife drive you home afterwards. If your household is anything like mine you would go straight from the colon cleanse to the carpool line and have to explain to four eighth grade girls why you were sitting on a doughnut and were the color of a three day old carp. Find someone to bring you home that doesn’t have to make thirteen stops and has at least a smidgen of sympathy.
I know this may all sound chauvinistic hearing a gynecologist speak about not having uncomfortable procedures done after what we routinely do to women. Believe me I understand that Pap smears and pelvic exams are not exactly a stroll in the garden. As the Pap-er and not the Pap-ee I realize I have no grounds to complain about invasion of privacy, but I also recognize that women are the master race. They are strong in mind and spirit whereas men generally have the pain threshold of a grasshopper. Childbirth is a perfect example. If men had babies there would only be single child families. If men carried a baby for nine months performance anxiety in the bedroom would shoot to new heights as men would constantly be reminded of the cause and effect of pregnancy. “If I do this, I might get that, and I don’t want to do that again, so that’s that.” Now some of you guys may be defensive and attempt to counter this with the old “what about the prostate exam” diversion. You have got to be kidding! One finger for ten seconds verses a bivalved metal prong and a spiked brush rubbing the skin from the cervix! That’s like comparing a Tonka Toy to a Hummer SUV.
One final point. Colon cancer is one of the leading causes of death for both men and women, and it is largely preventable. There is no excuse for not having this done and done soon if you are over fifty. I am preaching to myself here as I will soon make the call to set up my dance through the diverticuli. Life is full of uncomfortable challenges but to live long enough to face your share, get your Pap (not you, John) your colonoscopy, your mammogram and your cholesterol checked. You know what they call someone who practices good prevention? Old!
Now has anybody seen my fiber?

We hear a great deal today about health care reform. The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform. It is politically and philosophically prudent to be on the side of some type of change in the health care system. No one disagrees that the system is unsustainable in its present configuration. I concur that the situation is dire, the patient is in cardiac arrest and something has to be done. However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over. I realize that sounds somewhat contradictory, simpler yet impractical, so let me explain.
We will never cure this country’s ills without a strong dose of personal responsibility. The government, politicians, insurance magnates and even doctors are not only inadequate to change the system, but incapable of effectively bringing about change, because the change has to begin from within. It has to come from the individual, the man in the mirror. The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or funding, it is people not making healthy lifestyle decisions. Until we as individuals start doing the things we know to do to stay healthy, we will be a nation of sick care delivery not health care. Part of the problem is one of education. For example many feel that getting regular mammograms and doing self breast exams are excellent preventive tools for breast cancer. They are not! They are simply tools of early detection. The cancer already exists when the utility of mammograms and self breast exams is realized. These tools prevent nothing other than higher morbidity and mortality, which is a good thing. But we have to move back one level if we are to truly prevent breast cancer. For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat can reduce the occurrence of breast cancer 40%! Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer. Are mammograms and self breast exams important? Of course they are. They have been shown time and time again to increase survival rates in breast cancer victims, but our focus should be not only on early detection but absolute prevention. If the government wants to have an impact on breast cancer, focus more on exercise programs and dietary instruction rather than new and expensive imaging technology. With breast cancer or any illness, it goes back to decisions and actions that an individual takes. That is not to say that someone who is thin and a vegetarian will not get breast cancer. There are multiple factors that go into disease development, many of which we don’t understand. My point is that, in general, the skinny vegetarian has a lower incidence of breast cancer than the fat, couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.
Another example from my field of women’s health care is cervical cancer. The PAP smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages when it is 100% curable. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus. PAP smears can pick up changes in the cervical cells long before they develop as a cancer, but the PAP only detects the changes once they are there. There is nothing about the PA tat prevents cervical cancer. One of the only things that does prevent infection with HPV is minimalizing sexual partners. Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer. Again, prevention is different from early detection. If you want to prevent cervical cancer, develop effective programs supporting abstinence or monogamy. How many politicians are willing to handle that hot potato?
These are but two examples illustrating that the answer to our health care crises begins and ends at home. Simply providing health insurance to everyone will only reduce the number of uninsured, a rather obvious conclusion, but it will do nothing to solve the real problem; that of preventing disease. 48 million uninsured sick folks will become 48 million insured sick folks which will further bankrupt and already bankrupt system. Each and every individual has to take responsibility for making healthy choices if we are to resolve this sick care crisis. At the beginning of this piece I stated that the answer was simple, personal responsibility. I also said it was more impractical. I am no pie in the sky optimist that expects Billy Bob to give up his PBR and Twinkies. I understand that Suzie Sweatbelly will stay hermetically sealed to her couch of doom and not exercise. My point is that what we as a society have to decide is how to convince Billy Bob and Sally that they are killing themselves and their kids by living an unhealthy lifestyle. I realize the contradiction in this line of thinking. In individual has every right to live the life they choose. I agree. I as a fellow citizen have no moral authority to tell Billy Bob that he must lose 50 pounds. He chooses his lifestyle, but he also takes responsibility for his actions. Here is where the problem arises. We clamor for personal rights but we cower from accepting personal responsibility. Do we as a society have a moral imperative to take care of the sick and affirmed, yes, but that is paralleled by a moral responsibility of the individual to make decisions that improve their health. I am my brother’s keeper, but in turn it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.
Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.

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Ron Eaker

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