More Healthy Bread, Maybe Not!

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

By Dr. Laura Pawlak (PhD)

The vast variety of breads available in supermarkets and bakeries reflects the unquenchable appetite of Americans for this grain-based food.  Breads labeled as “whole grain” appear to be a smart way to add fiber to your diet.

Whole grains improve regularity, slow digestion, reduce appetite, improve cholesterol, and prevent spikes in blood sugar — a major driver of obesity, high blood pressure, and Type 2 diabetes.

A whole grain bread uses the entire grain seed:  the bran (an outer layer with fiber, antioxidants, and B-vitamins); the endosperm (the middle layer of starchy carbohydrates); and the germ (the inner core, which has vitamins, minerals, some protein, and a drop of oil).

Commercial whole grain breads differ in the relative amount of whole grain content in the product.  A simple calculation, called the “10 to 1 Rule,” can guide you in choosing healthy whole grain breads:  Using the nutrition facts on the label, identify the grams of total carbohydrate and fiber.  Divide the total grams of carbs by 10.  Is there at least that much fiber stated on the label?  If so, it is considered a healthy bread.

But wait, there’s something more to consider before purchasing a whole grain bread.  Andrew Weil, M.D., an expert in Integrative Medicine, states:  “A true whole grain food retains all three parts of the seed intact.  A recent government study linked the fiber found specifically in intact whole grains to a longer, healthy life, that is, a lower risk of death at any age from conditions such as cardiovascular, respiratory and infectious diseases and possibly some cancers.”

To make bread, the intact whole grain is ground into flour.  Some of the physical properties that promote good health are less effective when whole grain seeds are processed into flour.

There are many tasty, intact whole grains available, including: amaranth; barley; brown rice; buckwheat; bulgur; cracked wheat; farro; kamut; kasha; millet; oats; quinoa; rye; wheat berries; and wild rice.  Use intact whole grains as side dishes or stuffing, in soups, stews, and salads — and as a hot, breakfast porridge.

Despite research reporting some differences in the positive effects of intact whole grains as compared to processed (ground) whole grain flour, here’s the most important message:  Aim for at least three servings of whole grains every day, including cooked, intact whole grains, whole grain cereals, and whole grain breads.  Enjoy!

Note to Self

Posted on Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Anthony Bourdain. Kate Spade. Robin Williams. They had what most people dream of having: massive success; fame; money; and a fabulous lifestyle. And yet, on the most profound and intimate level, they were utterly miserable. They couldn’t find a way to love themselves enough to keep living.

They are not alone. Millions of people, known only to a few folks around them, suffer the torment of suicidal thinking. We’ve known for decades that most suicide victims see some sort of health care professional shortly before they die. There is no shortage of studies, articles, committee meetings, and conferences on the subject. But somehow very little seems to change.

Two days ago I heard an “expert” on TV insist we should ask every patient about his or her personal life, marriage, relationships, family and financial problems, and work stress. I’ve been quite ill in recent years, and I’ve seen multiple physicians. No one has ever asked me about any of these matters. Perhaps, since I’m a physician, they feel too uncomfortable to ask. I suspect, however, that the larger issue is our obsession with time and money. Herd ‘em in, herd ‘em out, generate more revenue. A discussion about personal problems can become lengthy and emotionally charged. It’s difficult to get a tearful, distraught patient out of the office. In far too many cases, we’d really rather not know about it. Besides, when someone is crying, it’s tough to stay focused on your computer.

We live in an ever more detached, isolated, dissociated, overstimulated, and under-loved culture. All the “fans,” “likes,” and “followers” in the world cannot take the place of one sincere, sympathetic listener who actually cares.

Morals, Manners and Mindsets

Posted on Posted in Brain Science, Continuing Education, Elder Care, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Our culture appears to be in free fall.  Movie moguls assault young women.  Campus doctors exploit and molest patients.  Gymnastics coaches and doctors engage in appalling sexual crimes.  The abuse of women and children has occurred for millennia. However, as individuals and as a civilization, we’re supposed to be advancing.

The human person, the human body, must be treated with dignity and respect at all times, at every stage of life.  The notion that we can do whatever we want, whenever we want is wrong.  It always has been, it always will be.

Professional stature is non-existent without self-restraint and honor.  And those in leadership positions who merely look the other way bear just as much guilt as the perpetrators.  It’s shocking to realize how much disgraceful behavior is tolerated out of ineptitude, laziness, greed, or complacency.  Virtually every sector of our society is at fault here.  Until we reach a critical mass of people willing to challenge this horrid behavior, nothing will change.

In our professional realm, there are a few things we can do to restore respectfulness:

  • Call patients or clients by their proper names: , Mrs., Mr., Dr., Reverend, Judge, etc. are all appropriate until someone invites familiarity.  Using first names with a new patient is not “friendly” as we have been led to believe.  It merely signals a sloppy level of unearned familiarity and unprofessional demeanor.  A medical or dental office is not a nail salon.
  • Male professionals should not be alone in an examination room with a female patient. The “expense,” “inefficiency,” or “inconvenience” of having a nurse or assistant present is an unacceptable excuse for this breach of protocol.
  • Manners matter. “Old school” nurses and doctors were taught to ask the patient’s permission before we touched him or her.  “May I listen to your heart?”, “May I examine your abdomen?”  No doubt some youngsters in health care would roll their eyes at this.  But we should never make assumptions about touching anyone (apart from emergencies), and yet it happens routinely today.
  • It’s good to remind ourselves, our colleagues, and our students that decorum and propriety are not old-fashioned and unnecessary. On the contrary, they are critically important, and their absence is palpable.

Morals, manners, and mindsets do not exist in a vacuum.  When someone is disrespectful or unethical in one domain, that vice will eventually metastasize.  Regardless of our age, culture, or profession, we should always try to treat others the way we’d like to be treated.  It’s not corny.  It’s not outdated.  It’s our only path forward.

A Little Reminder

Posted on Posted in Continuing Education, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien. M.D.

Are you a terrorist?  Are you a drug dealer?  Perhaps a criminal of some other variety?  The fact that you are reading this makes any of those possibilities quite unlikely.  And yet, our culture now assumes the worst of nearly everyone.  In an airport, we’re all treated like potential terrorists.  Hand the clerk in a grocery store a hundred dollar bill and she checks it to see if it’s counterfeit.  Anyone needing pseudoephedrine to breathe normally is treated like as if she may be running a crystal meth lab in her garage.  That’s ridiculous.  I don’t have a crystal meth lab in my garage.  It’s in the attic.  These days, too many people can’t recognize humor, much less reality.

Needing to fly somewhere does not make someone a terrorist.  Wanting to pay cash for groceries does not make someone a counterfeiter.  Trying to breathe more easily does not make someone a meth dealer.  Hoping for some pain relief does not make someone an addict.  As a society, we are making some very misguided judgments.  I recall that seven years ago I sought help from another internist when a long list of autoimmune diseases began spiraling out of control.  The “medical assistant” asked me what my main complaint was.  When I explained I had increasingly severe pain in my hands and feet, she quipped, “We don’t do pain management.”  I had to restrain myself.  I was there for a diagnosis, not a prescription.

Pain is the single most common symptom of most malignancies, autoimmune diseases, vascular diseases, and serious infections.  Renal disease, neurological disorders, metabolic diseases, and any inflammatory process can cause agonizing pain.  And we haven’t even touched on trauma.  Most patients who complain of pain are totally genuine and honest.  Some people exaggerate, some are manipulative.  Some, but not most.

Today, we have many veterans suffering constant pain from multiple amputations and other terrible conditions.  In many cases, they cannot obtain a month’s supply of pain meds.  They are forced to endure preposterous “policies” and “protocols” created by sanctimonious idiots.

If we really understood as much as we think we do about pain, pathophysiology, or pharmacology, we would ensure that patients have the pain medications they need to function.  Opioid addiction and overdoses are devastating problems.  But forcing patients with documented causes of severe pain to suffer needlessly is simply wrong.  Everyone who has had a cocktail, a beer, or a glass of wine does not become an alcoholic.  Everyone who needs chronic opioid treatment does not become an “addict.”

The whole point of health care is to relieve pain and suffering.  Perhaps we all need a little reminder.

homestudy

The Shock Value of Anything

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars

By Mary O’Brien, M.D.

Our culture is in big trouble.  Civility is under assault.  Over the past 20 years, most of us have heard increasing use of vulgar language in public and even professional settings.  Some of us have even heard vulgar language used at funerals, especially when celebrities are involved.  It’s typically done in an effort to lighten the mood.  It doesn’t work.  It’s not appropriate, it’s not funny, it’s not hip, it’s not “cool.”  More of us need to speak up and call people on it.

Rude, crude, vulgar language merely announces to the world a limited vocabulary, emotional immaturity, and a lack of class.  The timid giggles elicited by comedians using crude language is nothing more than the nervous response of an insecure audience.  When a joke is truly funny, people laugh in a genuine, spontaneous manner because they recognize a universal truth.  Really talented people don’t need to rely on incessant efforts to shock an audience.  They actually have a gift for seeing everyday realities in novel, insightful ways. The shock value of anything wears off quickly.  Before long, the whole gig becomes tiresome.

The use of vulgar language often signals a nasty, vicious, vituperative mindset. Unfortunately, most offenders don’t even realize how badly they embarrass themselves.  The disgraceful monologue inflicted on people at the recent White House Correspondents’ Dinner was a case in point.

Cruel attacks on anyone’s appearance, wishing someone would be crushed by a falling tree, and “jokes” about abortion are not funny.  The nonstop use of the “F” word only underscored the pathetic mentality of the “comedienne.”  Some folks had the spine to walk out.  Too many sat there like overdressed lemmings.

Regardless of our age, gender, profession, economic status, political perspective, race, or creed, no one will ever think more highly of us for spewing vulgar language and nastiness.  Two thousand years ago, a very wise person said, “Out of the fullness of the heart, the mouth speaks.”

Truth is timeless.

Chocolate: A Smart Food

Posted on Posted in Brain Science, Continuing Education, Homestudy, Nutrition, Psychology, Seminars, Webinars

By Dr. Laura Pawlak

There is universal agreement that chocolate is a feel good food.  Chocolate melts in your mouth, releasing its sweet, creamy, cocoa flavor, and the brain follows with a burst of “happy” chemicals.

Beyond the sensory joy of eating chocolate, there are claims that chocolate is a healthy food for the brain.  Most of us would gladly eat more chocolate if proven to benefit the brain.

Several ingredients in cocoa have been proposed to explain the possible cognitive benefits of chocolate.  Cocoa contains caffeine, a substance that enhances cognitive functioning and alertness.  Major nutrients have also been identified in the cocoa bean.  Presently, studies focus on the chemical group called flavanols.

Flavanols are micronutrients found in many fruits and vegetables, especially the fruit called the cocoa bean, the basis of chocolate.  Flavanols have antioxidant and anti-inflammatory properties — important for brain health.

Small studies, often supported by chocolate manufacturers, state that the cocoa flavanols can boost mood and cognitive performance — as well as blood flow to the brain.  Researchers are now evaluating the significance of these small studies by conducting large, clinical trials using a cocoa extract with known flavanol content, not chocolate.

A dose of 600-750 milligrams of flavanols is considered healthful for the brain.  To obtain this dose, you would have to consume 4.75 ounces of dark chocolate, a total of 750 calories, or 40 ounces of milk chocolate, which has 5,850 calories.

A day with adequate flavanols from commercial chocolate is also a day heavy in sugar, saturated fat, and calories — not a formula for a sharp brain.  Perhaps future studies examining chocolate’s healthful ingredients in the cocoa extract will provide more healthful ways to capture the goodness of the cocoa bean.

Meanwhile, manufacturers divert your focus from calories to health by presenting chocolate paired with a superfood, the avocado.  Called a health food, the Avocado Chocolate Bar is made of freeze-dried avocado pulp powder, 70 percent dark chocolate — plus added sugar — and has nearly 600 calories.

The bar is a convenient, but calorie-laden, snack.  The alternative — consuming whole, fresh plant food — is always a good choice for the brain.

My suggestion:  Eat dark chocolate in moderation if you like it, not because you think it will make you smarter.  For added flavanols, focus on the abundant amounts of this nutrient in grapes and berries.  Enjoy!


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renowned biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

A Class Act

Posted on Posted in Continuing Education, Elder Care, Psychology, Seminars, Uncategorized

By Mary O’Brien, M.D.

The lady was a class act.  In a sea of loud, silly, and shallow people, Barbara Bush stood like a lighthouse, radiating wisdom and grace.  She demonstrated remarkable equanimity, regardless of circumstance.  Blessed with razor sharp wit and a penchant for fun, she was nonetheless known to her family as “The Enforcer.”  Candid, caring, committed, and tough, Mrs. Bush had a massive impact on everyone around her.  She set the standards high and refused to indulge any twinge of narcissism in herself or others.  It’s a testament to her character that everyone around her succeeded.  She had the longest marriage (73 years) in American presidential history and was the mother of two governors, one of whom (George W. Bush) was also the 43rd president.

There were, however, those who bemoaned the notion that she was “only” a wife and mother.  Those folks ended up looking foolish.  Mrs. Bush had no misgivings about the value of family.  She was fiercely loyal and protective, but she did have boundaries.  When pestered by the media about her role in the political campaigns of family members, she quipped, “I’ll do anything to help.  But I won’t dye my hair, change my wardrobe, or lose weight.”

The reality was that Barbara and George H.W. Bush, in the late 1950s, lost their three-year-old daughter, Robin, to leukemia.  Barbara’s hair turned white shortly after that tragedy.  She refused to hide her age, stress, or heartache by dyeing her hair.  There was nothing coy, contrived, pretentious, or conniving about Mrs. Bush.  She possessed a refreshing candor and confidence that come from authenticity.  It was clear she had no interest in impressing or manipulating others.  As was the case with Billy Graham, she said what she meant and she meant what she said.  This surely must have perplexed the glitterati in Washington.

Historians will write about Mrs. Bush for years to come.  She was a smart, gracious, strong, and virtuous woman.  Countless children learned to read as a result of her efforts.  No doubt her opinions influenced domestic and foreign policy behind the scenes.  However, Mrs. Bush possessed an uncommon degree of humility, maturity, forgiveness, and forbearance that enabled her to rise above conflict and petty partisanship.  As she once explained, “Politics is what we do.  It’s not who we are.”  Have we ever been in greater need of her example?

 

Steady As She Goes

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Are you afraid to open your financial statements for March? Have the recent market gyrations triggered a sudden interest in Xanax? Nonstop news cycles and social media postings have spawned massive overreactions to every comment made by political or business leaders. Down drafts of 1,000 points can cause even the most seasoned investors to panic. Over the past two months I’ve had to curtail my exposure to the business networks. Watching the Dow Jones Industrial Average plunge 700 points at 2 P.M. can make me feel as if I’m about to go into ventricle fibrillation. I’d rather stay in normal sinus rhythm.

Sadly, that is not a joke. I have a vivid memory of sitting at a stoplight in Little Rock, Arkansas, on October 19, 1987. It was about 5:30 P.M., and I was headed home from my office. Over the car radio I heard, “The Dow Jones Industrials are down 517 points.” I distinctly remember thinking, “Oh, he’s reading that wrong! The DOW couldn’t possibly be down that much.” It was.

Shortly after I arrived home, my beeper went off. One of my favorite patients was in the emergency room (ER) with a massive myocardial infarction. George A. was a 76-year-old gentleman from Hope, Arkansas. He had grown up in poverty but had educated himself and built up several successful businesses. He was bright, witty, charming, dapper, and gracious. But on that day, George A. had lost over a million dollars, at least on paper. He was devastated.

I grabbed my bag and raced back to the hospital. We got George admitted to the cardiac care unit (CCU). His electrocardiogram (EKG) looked awful, and he looked worse. He was utterly convinced that one dreadful day on Wall Street had destroyed his future. Around 8 P.M., George become very ill (coded). We worked on him frantically for over an hour, but we couldn’t bring him back. There was no doubt in my mind that the thought of financial ruin had literally scared George to death. I felt numb.

Later that week, two of my colleagues committed suicide. They had also lost a fortune, at least on paper. Everyone was stunned and afraid that week. One year later, however, the market had recovered nearly all of its losses. Thirty years later I still mourn the loss of three good people. For all intents and purposes, they died from acute financial panic.

I am no financial genius. But forty years of investing have taught me a few lessons that may help someone else:

  • Don’t watch market moves minute to minute. Before long, you’ll need heavy sedation.
  • Don’t dump stocks when everyone is panicking. You’ll almost always miss out on the best part of the recovery phase.
  • Remember the wisdom of the ancient Greeks: Moderation in all things. Balance stocks, mutual funds, bonds, certificates of deposit (CD’s), cash, real estate, and precious metals based on your age, health, family needs, and risk tolerance.
  • Don’t give in to ignorance, laziness, fear, or greed. Sixty-six percent of millennials have nothing stashed away for retirement. Failure to invest is one of the greatest mistakes of all.
  • No matter what happens, avoid the temptation to overreact. You are infinitely more important than your financial statements.

Now take a deep breath and open the statements from March. Steady as she goes. You’ll be fine.

Water: The Fountain of Youth?

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

By Dr. Laura Pawlak

Based on the fact that about two-thirds of the body is composed of water, it seems obvious that consuming water is important for health.  Water requirements have been studied for decades.  Recommendations are narrowed to two alternatives:  Consume a minimum of eight cups of liquid per day or drink to quench thirst.

Research now reveals that drinking water when feeling thirsty boosts the brain’s performance in mental tests.  Dr. Caroline Edmonds, the author of a lead study, found that reaction times were faster after people drank water, particularly if they were thirsty before drinking.

Drinking more water than normally consumed is associated with a reduced intake of calories and sodium.  The study, led by Prof. Ruopeng An, showed that people who increased their consumption of plain water by one to three cups daily lowered total energy intake by 68-205 calories each day and their sodium intake by 78-235 grams per day.

A popular trend these days, alkaline water is promoted as a healthier choice than plain water. Several brands of alkaline water are available or machines can be purchased that make alkaline water.

Proponents claim that alkaline water kills cancer cells, banishes belly fat, lubricates joints, protects bone density, reduces acid reflux, and improves hydration.  What scientific evidence lies behind these claims?  Despite the promotion of alkaline water by the manufacturers of the product and by the media, there is very little research either to support or disprove the claims.

The pH of water is neutral, a pH of 7.  Chemicals and gases can alter the pH of water.  For example, rainwater’s pH is slightly below 7, as carbon dioxide in the air dissolves in the water and increases acidity.

Water that is too alkaline (pH above 7) has a bitter taste.  It can cause deposits that encrust pipes and appliances.  Highly acidic water tastes sour and may corrode metals or even dissolve them.  Fortunately, as the kidneys filter blood, the pH of blood and all cells are rebalanced close to neutral, avoiding any unhealthy effect of liquids or foods that raise or lower pH.

Citrus fruits are named for their citric acid content, but don’t be fooled by that fact.  Citrons, lemons, limes, oranges, and grapefruits — all citrus fruits — produce alkaline byproducts once digested. So, you can squeeze juice from a lemon or other citrus into plain water and make your own alkaline water.  Enjoy!


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renowned biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

A Bit of Common Sense

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

By Mary O’Brien, M.D.

Do you take care of patients?  Are you in a position to teach students or other caregivers?  These days, everyone in healthcare is simmering in a sea of policies, protocols, rules, regulations, and algorithms.  Some of them are reasonable.  A few even make good sense.  Unfortunately, however, many of them are downright dumb.  Often, by the time someone reaches the lofty position of creating assorted rules and policies, she has lost touch with her sector of the real world.  The results are not good.

In recent years I’ve been sidelined with a growing list of autoimmune diseases. I used to joke with audiences that with red hair, green eyes, and see-through skin, I was a walking collection of recessive genes.  It’s not a joke anymore.  Being in constant pain and steadily losing functional ability is not fun.  However, in my new role as “patient,” I have learned a few things that are not taught in most training programs.

In the hope that it might help a few other folks, here’s some of what I’ve learned:

  • Sunshine is our friend.  Over the years, I’ve spent far too little time outdoors.  I was a sickly little kid and a natural-born bookworm.  From the mid-1980s on, I was afraid of “skin damage.”  Swell.  Now I have decent-looking skin but my musculoskeletal system is so badly compromised I struggle to get in or out of a chair.  Please encourage patients to get some fresh air and sunshine on a regular basis — especially if these patients suffer from any chronic illness.  Vitamin D supplements are fine, but they can’t undo the damage of decades of deficiency.
  • Small comforts matter.  The point of health care is to relieve pain and suffering.  Many of our colleagues have apparently forgotten that.  Computers can provide information.  They cannot provide comfort and consolation.  There is a true art to easing another person’s misery, and it usually involves small, simple measures.  “Hugging” a king-size pillow while lying on your side can ease pressure and strain on shoulders, elbows, and knees.  Massaging a nicely-fragranced body butter into hands, arms, legs, and feet before bed can help ease the achiness that accompanies chronic illness.  It’s not a substitute for proper medication, but these measures can provide a few moments of respite.
  • Being squeaky clean feels good.  I was obsessed with hygiene even as a little kid.  But chronic pain and illness can make taking a shower, washing your hair, and brushing your teeth feel like a triathlon.  Nearly anyone who has had the flu can relate.  The most simple measures can make a difference:
    • Change pillow cases every 12–24 hours.  I did this for patients when I was a nurse’s aide 45 years ago.  I do it for myself now.  If feels nice.
    • Step up oral and dental care after meals and before bed.  This feels nice, too.  And, there are discernible medical benefits.
    • Try a shower in the morning and a warm bath at night (as long as it’s safe).  Baby wipes, facial wipes, and dry shampoo are essential for travel and chronic illness.
  • Never wake a sleeping patient for vital signs.  I can hear nursing instructors screaming right now.  However, if a patient is sound asleep, her vital signs are probably fine.  Despite all of our impressive technology and sophisticated medications, we have found nothing more restorative than good, deep sleep.

If policies and protocols eased misery, everyone would feel fine by now.  Sometimes what we need is a bit of common sense.