The Root of the Problem

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(Photo credit MARK RALSTON/AFP/Getty Images)

By Mary O’Brien, M.D.

Dozens of people are dead.  Dozens more are wounded.  Grief and shock have gripped the citizens of El Paso, Dayton, and the rest of the nation.  Politicians, as usual, will blame their opponents and insist more legislation is the answer.  They are misguided.  The answer begins with understanding the real root of the problem.  And the real root of the problem is complex.

We must ask a forbidden question:  What is normal?  Is normal defined by centuries of acceptable behavior?  Is normal that which enables individuals to form a stable, productive society?  Over the past 50 years, we have tossed aside our ideas of normal:  traditional marriage; nuclear families; the sanctity of life; respect for elders, authority, and other people.  We have ridiculed religion and tradition as old-fashioned, useless burdens.  We now worship fame and outrageous antics.  Young people lead virtual lives online, often devoid of any actual friends.  Hyped-up, exaggerated, and downright fictitious lifestyles are posted nonstop in a frantic effort to achieve celebrity status.  Many young people are desperate for attention.  Their behavior, however, often leads to rejection and isolation.  Everyone experiences rejection and isolation, but normal people gradually mature and learn how to cope.  They adjust their behavior in an acceptable, productive manner.

Unfortunately, when time-tested values and institutions are stripped away and replaced by whatever is bizarre, nasty, violent, vulgar, or self-indulgent, the results are disastrous.  Unstable, angry, young men with fragile psyches cannot spend endless hours playing “first person shooter games” without consequences.  Many of us over the age of 40 are completely unaware of how realistic and gruesome many video games have become.  We’re not talking about cartoon characters.  Virtual people and real people blend into one another.  Combine this with mental illness, anger, hatred, drugs, and a complete lack of any moral compass, and the results can be horrific.

Angry, unstable, amoral people should not have access to guns.  But sooner or later, we need to address the real root of the problem.  There is such a thing as “normal.”  Most of us are still sane enough to recognize its absence.

You Never Know Who Might Be Listening

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By Mary O’Brien, M.D.

Are you well-spoken?  Would other people agree?  There are many aspects of professional behavior, and speaking is one of the most important. Unfortunately, as a culture, our speech patterns, vocabulary, and grammar are deteriorating badly.

Incessant use of e-mail and texting has had a negative impact on speaking skills and vocal quality.  Parents, teachers, and bosses seem reluctant to correct anyone.  Someone might get upset.  People often confuse correction with criticism.  That’s misguided and it can undermine success.  Part of being an effective health-care professional involves conveying knowledge and inspiring confidence among patients and colleagues.  Bearing that in mind, here’s a little checklist to help polish your speaking skills:

  • Watch out for verbal crutches (um, uh, well, like, you know). Better yet, eliminate them.
  • Don’t start or end a sentence with the word “so.” So, we’ve had a lot of turnover lately, so.
  • Learn the correct use of the words “fewer” and “less.” Skim milk has fewer calories than whole milk.
  • Try not to begin or end a sentence with a preposition (to, of, with, for, on).
    • Incorrect: He doesn’t have any place to go to.
    • Correct: He doesn’t have any place to go.
    • Incorrect: We have many medications to choose from.
    • Correct: We have many medications from which to choose.
  • Learn when to use the subjunctive case.
    • Incorrect: I wish it was true.
    • Correct: I wish it were true.
  • Review the proper use of pronouns: Attention, Southerners.
    • Incorrect: Her and her husband went to the seminar.
    • Correct: She and her husband went to the seminar.
  • Recall the use of past perfect tense: Attention, Midwesterners.
    • Incorrect: Ordinarily I would have went home.
    • Correct: Ordinarily I would have gone home.
  • Eliminate redundant adjectives: Attention entire country.
    • Incorrect: The patient had a small, little bruise.
    • Correct: The patient had a small bruise.
  • Pay attention to singular or plural agreement between nouns and verbs.
    • Incorrect: There’s lots of options.
    • Correct: There is a lot of options.
  • Avoid constant self-reference.
    • “For me, this is not helpful.”  It’s not about you, but this phrase is ubiquitous.
  • Check your vocal quality. Is your voice loud, shrill, strident, or frenetic?
  • Watch out for bad habits in the cadence of your speech. Refrain from “sing-song” phrasing and “up-talking” at the end of a sentence.  It makes anyone sound like a silly school girl.
  • Slow down. Smart people often speak quickly, but you don’t want to sound like a toy machine gun or a cartoon character on amphetamines.
  • Diction is a crucial part of effective speaking.  It requires effort.
  • Guard against “whiny girl” or “lazy girl” voice. Irritating sound emanates from the posterior pharynx with inadequate volume.  The speaker comes across as bored and boring.  Modulate your voice to sound like a competent, knowledgeable adult.
  • Be careful with gestures. Many people overuse hand gestures.  It’s distracting and undermines the real message.  Excessive gestures can make someone look desperate.  Politicians take note.

We work hard to develop our careers.  Don’t allow poor speaking habits to sabotage your future.  You never know who might be listening.

Spotlight on Eggs

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

By Dr. Laura Pawlak

The hard-boiled egg, a breakfast omelet, and fancy deviled eggs — these are favorites among Americans. Eggs are also a good source of protein, along with meat, fish, and poultry.  But, is the egg considered a healthy choice?

In 1980, the U.S. Department of Agriculture began releasing dietary recommendations for Americans with a focus on cardiovascular health.  Dietary cholesterol was stated as a major contributor to heart disease.  Eggs, the number one source of cholesterol in the diet, took the spotlight.

While dietary cholesterol can be found in all foods derived from animals, one egg has about 200 mg. of cholesterol while a serving of beef, pork, or chicken has less than 100 mg. per serving.  The dietary limit for cholesterol (300 mg. per day) significantly limiting the choice of egg-based meals and snacks.

Decades of research have led to a very different interpretation of the role cholesterol plays in heart health.  There was no direct evidence to support the link between egg consumption and blood levels of cholesterol — the risk factor for heart disease. The liver produces most of the cholesterol measured in the blood.

By 2015, dietary cholesterol was no longer considered “the nutrient of concern” for healthy people. New dietary guidelines reflected an emphasis on whole foods, rather than individual nutrients.  For example, fish provides essential omega-3 fatty acids and protein, not just cholesterol.  Red meat contains multiple substances beyond cholesterol that negatively affect heart health.

Eggs made a comeback, but included a warning to eat eggs in moderation — only one or 2 eggs per day. Further restriction was recommended for persons with Type 2 diabetes:  Limit eggs to four per week.

This year, new research by Victor Zhong and colleagues (Journal of the American Medical Association, 2019) rekindles the debate about the role of dietary cholesterol from eggs and red meat in cardiovascular disease and all cause mortality, but official guidelines remain unchanged.

According to Dr. Frank Hu, of the Harvard School of Public Health (2019), “For persons who are generally healthy, eat fruits, vegetables, whole grains, nuts, and legumes and lower [the] consumption of red and processed meats and sugar.  A low to moderate intake of eggs can be included as part of a healthy eating pattern, but they are not essential.  There is a range of other foods one can choose for a variety of healthful breakfasts, such as whole grain toast with nut butter, fresh fruits, and plain yogurt.”

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Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown 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.

 

We Can Do Better

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

By Mary O’Brien, M.D.

The pendulum has swung too far.  Fifty years ago there were psychiatric hospitals full of mentally ill patients who were poorly treated and even abused.  “One Flew Over the Cuckoo’s Nest” was required reading.  National outrage peaked and psychiatric hospitals closed leaving thousands of patients unequipped to face the outside world.  Alcoholism, drug addiction, and homelessness began to spiral out of control.

Today major cities like New York, Seattle, Portland, Los Angeles, San Francisco, and others have homeless populations overwhelming local resources.  Los Angeles County now has over 60,000 homeless people, and San Francisco publishes a map to help visitors avoid piles of human feces and used syringes.  Police officers are becoming ill as a result of contact with infected people.  Tuberculosis, Typhus, Typhoid fever, Hepatitis A, and scabies are only a few of the conditions smoldering on the streets.  Rape and violent assault are routine.  California now accounts for one-fifth of the homeless population of the entire country.

The two largest contributors to homelessness are mental illness and addiction.  Most cities have laws against sleeping on the streets, but often those laws are not enforced.  Decriminalizing bad or problematic behavior does not make it go away, and permitting squalor is not compassionate.  Homeless people do not represent a big voting block, but government officials have a responsibility to protect public health and safety.  Experience over the last 40 years has taught me something about caring for homeless patients and starting free clinics, so here are a few thoughts:

  • Commit to addressing the problem. If inaction, complacency, and blame solved problems, we wouldn’t have any problems left.
  • Enforce existing laws and give the police the support and back up they need. That is not being “mean.”
  • Triage people in tent cities. Most need help from social services, many need treatment for addiction and mental illness, some may respond to help from church organizations, and some probably need to be arrested.
  • Organize a volunteer force (the local equivalent of the Peace Corps or the Job Corps). Those not in need of acute treatment for mental illness or addiction might be salvaged with a program that teaches basic living skills.  Such programs already exist in some areas.  College and graduate students could volunteer and earn “credits” toward paying off some school loans.  Colleges and universities would need to cooperate, but at some point you have to put your money where your mouth is.  Tax credits could be given to non-student volunteers.
  • Organize mobile free clinics to vaccinate, screen for infectious diseases, and begin basic treatment. Invite nursing and medical students as well as retired professionals to help.  Sometimes people simply need to be asked.  They would need legal protection from malpractice.  Non-controlled drug samples and old medical equipment could be donated.  I know whereof I speak here.
  • Create transitional housing facilities (like senior life care in reverse). Old warehouses and military style barracks could be refitted. California has the largest percentage of billionaires in the country.  Ask them for help.  No one becomes massively successful because he or she has a dearth of ideas.

Fifty years ago some people were abused in mental hospitals.  Now we allow them to abuse themselves and one another on the streets.  This is a massive, complex, and expensive problem.  But failing to address it will have catastrophic consequences for everyone.  We can do better.

An Idea Whose Time Has Come

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

By Mary O’Brien, M.D.

Are you an adult?  Are you sure?  Young people today are taking longer and longer to grow up.  Throughout history people worked hard and started families in their teens.  Only a privileged few could afford the time or money for an education.  Even a mere century ago, finishing high school was a relative luxury.

A few weeks ago, during the 75th anniversary of D-Day, we heard remarkable stories of 18- and 19-year-old boys fighting for freedom and civilization.  These boys grew up very fast.  They had no choice.  Mommy and Daddy could not indulge every whim of their sons.

Growing numbers of people now realize we have a problem.  Young people are graduating from high school and even college with minimal practical skills.  Changing a tire, cooking a real meal, or opening a bank account can overwhelm them.  This is not good.  Many of us were required to take shop class or home economics in high school.  Then, the “geniuses” in education had their way.  The results speak for themselves.

Happily, there is hope.  A young teacher at Fern Creek High School in Kentucky has begun three-day workshops called “Adulting 101.”  Sarah Wilson Abell has been instructing students in real-life skills:  how to handle basic food preparation and cooking; how to change a tire; how acquire the fundamentals of money management; how to read a map (in case Siri is sick); how to behave on a job interview; how to have basic table manners and etiquette; and how to tie a tie.

Parents used to teach these skills, but the days of June and Ward Cleaver and Ben Cartwright are long gone.  This timely idea is spreading.  More and more people in their thirties and forties realize they need these skills.  I recently encountered a 31-year-old woman who didn’t know how to sign her full name because, “We didn’t learn cursive.”  You can’t make up things like this.

Someone reading this is probably not a high school teacher, but many of our readers teach students in the health-care professions.  Starting your own “Adulting 101” class could be tremendously helpful.  In addition to the topics listed above, a few more are worth considering:

  • Good, old-fashioned people skills. Professional etiquette when dealing with patients and colleagues must be taught.  Translation:  Put down your cell phone and look up from your computer.
  • Principles of personal hygiene and dress. Don’t act outraged.  Most of us realize standards couldn’t have sunk much lower.  Our failure to teach and maintain such professional standards has compromised patient care and the career advancement of many students and trainees.
  • Essentials of appropriate speech and behavior in the workplace. As is the case with appearance and manners, there are boundaries that separate work, play, and personal life.  This comes as a shock to many young people.  We do them a great disservice when we fail to correct the situation.

“Adulting 101:” It’s an idea whose time has come.  It should have never gone away in the first place.

Memorial Day, D-Day and Cicero

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By Mary O’Brien, M.D.

Traffic Delays.  Slow Wi-Fi.  Dead phone batteries.  Forgetting a password.  Insufficient “likes.”  These are among the top stressors listed by millennials in a recent survey.  Contrast this with the real stresses endured by similarly aged men storming the beaches of Normandy in World War II and the absurdity of current culture becomes painful.

I’ve always been baffled by the number of people who confuse Memorial Day and Labor Day.  They’re not even embarrassed.  Ask nearly anyone much under the age of 50 what he knows about June 6, 1944, and prepare for a blank stare.  Twenty- and thirty-somethings may well scrunch up their faces in annoyed perplexity as only they can do.  People today lead frenetic, cluttered lives that leave little room for history.  But as Cicero wrote in 46 B.C., “To be ignorant of what occurred before you were born is to remain always a child.”

Memorial Day commemorates those who died in active military service.  Originally, it was called Decoration Day and was observed on May 30th.  Eventually, it was changed to the last Monday in May mostly as an excuse for another three-day holiday weekend.  This year Memorial Day falls on May 27th.  People will have barbecues, picnics, and parades. They will open neighborhood swimming pools and proclaim the unofficial start of summer.  A few thoughtful people will attend memorial services and place flowers on the graves of those who sacrificed all.  But millions will remain clueless as they consume hot dogs and beer.

This year, on June 6th, those of us fortunate enough to live in the free world will observe the 75th anniversary of D-Day (June 6, 1944).  The planning, hope, courage, determination, perseverance, and sacrifice of the Allied Forces on that momentous day cannot be overstated.  The unwavering commitment of thousands of men to stopping the onslaught of the Nazis despite the terror, horror, and agony of it all is beyond our grasp.  What those men endured makes our worries laughable.

The next time you find yourself upset by traffic delays, slow Wi-Fi, or a dead phone battery, remember Memorial Day, D-Day, and Cicero.  Some of us need to stop thinking like children.

A Heroine of the Highest Order

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

By Mary O’Brien, M.D.

Media reports described her as merely “an older woman.”  The implications are obvious.  “Older woman” translates into commonplace, generic, ordinary, and unimportant.  Nothing could have been further from the truth.  Lori Gilbert-Kaye was the 60-year-old lady who threw herself between the vicious 19-year-old gunman and the rabbi at the synagogue shooting in Poway, California.

Members of the congregation were observing the final day of Passover when they were attacked by unbridled evil.  Lori Gilbert-Kaye gave her life to save her rabbi. There is nothing commonplace, generic, ordinary, or unimportant about that.  Rabbi Goldstein described her valiant action at a deeply moving ceremony in the Rose Garden on the National Day of Prayer.  He lost several fingers in the horrific attack, but his wisdom, insight, courage, and compassion were only highlighted in the process.  He honored Lori Gilbert-Kaye in his brief but eloquent remarks.  A march in her honor is scheduled for early June.  No doubt many people will learn more about this kind, generous, devoted, and heroic “older woman.”

Is there something those of us in health care and education can learn from all of this?  Indeed, there is.  People have names.  They are not merely generic patients, students, or account numbers.  They are not simply old ladies or cases or room numbers.  Every human being has an identity, a personal story with challenges, heartaches, triumphs, and loved ones.  A woman who instinctively gave her own life to save another deserves to be known and remembered by her name.  Lori Gilbert-Kaye was heroic in life and in death.  She set a beautiful example for our nation.

Most of us will never have to make the split-second decision to sacrifice our own life to save that of another.  We do, however, have an opportunity everyday to honor others by using their proper names.  Lori Gilbert-Kaye was far more than an “older woman.”  She was a heroine of the highest order.

Guidance and A Good Example

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By Mary O’Brien, M.D.

Do you teach students? Do you manage employees? Are you setting a good example for those who will come after you? Last week, I heard Jamie Dimon, the chief executive of J.P. Morgan, discuss the importance of cultivating a bench of good people from which the board of directors could select a worthy successor. A truly wise leader in any organization thinks like that. Of course, in order to think and plan on that level, one needs tremendous maturity, discipline, humility, and prudence.

Many people today are too insecure and self-obsessed to train their own replacements. They’re more worried about who might threaten their power and position. But history is a good teacher. Socrates trained Plato, and Plato trained Aristotle. Jesus picked 12 apostles and numerous disciples. Sir William Osler trained an elite cadre of young physicians to follow in his footsteps at Johns Hopkins.

Superior leaders surround themselves with first-rate people, and these leaders cultivate several key attributes and skills. Whether you are a senior partner, a professor, or a parent, here are some of the qualities that are essential to your ultimate success as you pass the baton:

  • A deeply ingrained sense of right and wrong. Many people focus on what they can get away with. Moral relativism is not the secret to greatness or even long-lasting success.
  • A willingness to accept personal responsibility for success or failure. Expressions like “It’s not my fault,” “It’s not my job,” do not make for an acceptable mindset.
  • The ability to speak and act with courage. This one is tough in the age of social media nonsense and nastiness. The vast majority of people in board rooms and conference halls are afraid of what someone might say, so they hide behind the commonplace and comfortable. There is no honor in cowardice.
  • The wisdom to encourage and inspire others. Mediocre-management types make excuses. Top notch people bring out the best in others. When you have a great parent, teacher, coach, or boss, you can’t bear the thought of disappointing your hero.
  • The capacity to engage in independent thought and creative problem solving. The world is full of lemmings, parrots, copycats, and complainers. It takes a secure, confident leader to inspire real leadership in others.

Whether you work in a huge medical center, a small office, a corner pharmacy, or at home, someone is looking to you for guidance and a good example. Don’t be afraid to set the bar high.

The Keto Craze

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

By Dr. Laura Pawlak

Unlike any time in history, Americans are faced with an obesity epidemic.  The sensible weight-loss guidelines of a mere decade ago appear to be failing.

“The best foods to eat on a diet?  The best foods to eat to keep weight off?  The same foods you should eat when you are not on a diet, but just less of them.”  Dr. Frank Sacks, Harvard School of Public Health, 2009.

The above statement was based on the study of 48 popular diets. All diets failed to produce significant differences in sustained weight loss.

Fast-tracking to 2019, the American diet has drifted far from the standard of what should be consumed. The foods we eat are primarily processed, containing almost 90 percent of the diet’s added sugar.  Also, these foods contain too much salt, very little fiber, and lots of saturated fats.  Eating less of these foods may result in weight loss, but the body and brain remain unhealthy.

When it comes to dieting, today’s fast-changing lifestyle demands novel, quick fixes.  The hype in the latest keto diet craze is infectious:  Fast weight loss without exercise;  novel tools to measure rising ketone levels;  easy-to-find processed keto foods; and keto pills when the diet is too tough to follow.

You eat lots of fat (at 80 percent of calories), moderate amounts of protein (at 20 percent), and very few plant foods, sugar, or starch (at 5 percent).  The excess intake of calories from fat triggers metabolic, nutritional, and hormonal changes not meant to be sustained for long periods of time.  Guidance by a registered dietitian is definitely recommended.

The Atkins program proposes a moderate approach to the keto craze:  A choice of 20 percent or 40 percent of the diet as carbohydrates for a limit of one month — and progression toward more plant foods.

If weight loss is achieved on a keto diet, a major challenge still remains:  The need to maintain your lower, healthy weight with a diet that offers protection against disease — not a keto plan.

A 25-year study evaluating healthful longevity and diet, published in 2018, identified the foods you should eat for a long, disease-free life:  Consume approximately 50 percent of your calories as carbohydrates, primarily as whole plant food; eat proteins, mainly from fish and plants; and add healthy oils from olives, avocados, nuts, and seeds.


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.

Nuts About Nuts

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

By Dr. Laura Pawlak

Americans love nuts. Their passion has led to an increased consumption by almost 40 percent in the last 15 years.

Contrary to the belief that nuts are fattening, nuts are nutritious foods categorized as superfoods.  Nuts offer a wide variety of nutrients especially protective for the brain and cardiovascular system.

A trio of nutrients in nuts — healthy fat, fiber, and protein — make them a satisfying snack that won’t affect your waistline, assuming the portion size is a handful each day.  In fact, researchers at the Harvard School of Public Health found that regular nut consumption was associated with a slightly lower risk of weight gain and Type 2 Diabetes than a diet devoid of nuts.

A caveat is noteworthy:  If the nut is adulterated, i.e. honey glazed or chocolate coated, the word fattening would be an appropriate description of the nut.

Although nuts vary slightly in nutrient content, all varieties are beneficial. Almonds are especially high in fiber.  The macadamia nut has the most fat, mostly as monounsaturated oil.  Brazil nuts are famous for their selenium content. Pecans and hazelnuts are loaded with a variety of antioxidants.  Pistachios contain more potassium than a banana.  Cashews excel in the nutrient, lutein, a protectant for your eyes.  Walnuts provide anti-inflammatory fats similar to fish oil.

The peanut, really a legume, is a valuable addition to the nut family, offering more protein than any nut.  Ground into a nut butter, this spread is a tasty alternative to butter or margarine.

Before purchasing a peanut butter, read the label.  Unnecessary emulsifiers may be added to prevent the separation of oil.  There’s no need to purchase peanut butter with added sugar even if you have a sweet tooth.  Spread plain or crunchy peanut butter on slices of a crisp apple.  Your sweet tooth will be as satisfied as your gut.

Has your doctor asked you to lower your intake of sodium?  A few brands of peanut butter are just ground, unsalted peanuts.  Here’s a suggestion for adapting your taste buds to salt-free peanut butter:  Mix a small amount of unsalted peanut butter with the regular salted version.  Over time, increase the amount of the salt-free spread until you reach 100 percent.

In my opinion, the best-tasting peanut butter is freshly ground.  Grocery stores often place a grinder and containers next to the bulk peanut supply.  Enjoy!


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown 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.