Category Archives: Uncategorized

Recently I got to go on live radio to discuss GLP-1 drugs like Ozempic. The show possibly came about as a publicity move for the bariatrics department, but they tapped me to balance things out. Around the studio table sat a bariatrician, who performs gastric sleeve and bypass surgery, and her dietician colleague who helpsContinue reading “Afterthoughts on Ozempic”

I recently attended a close friend’s wedding and was happily inundated with positive testimonials around plant-based diet and lifestyle change. The groom’s childhood home was our hangout spot starting in middle school. His Mom was always whipping up something delicious, and while I accepted plenty, I would pass on any red meat per my ownContinue reading “Disease reversal on the dancefloor”

The 2022 Inflation Reduction Act included a historic provision allowing the government to negotiate with drug companies for the first time. 10 particularly expensive drugs were already negotiated, with reduced costs taking effect in 2026. Just in the first year, Medicare beneficiaries are projected to save $1.5 billion out-of-pocket. This is significant, but also highlightsContinue reading “A peek at the 15 drugs chosen for Medicare price negotiations”

By its “sheen.” This is what a septic tank service guy told my friend in Florida when he thought his backyard tank was overdue. “Ya’ll don’t really need a pump,” the septic man said in his blue-gray coveralls. My friend was unsure: his neighbors needed their septic tanks pumped every few years. Inspecting the filter,Continue reading “How do you know a plant-based septic tank?”

The other day I received a special edition of a reputable family medicine journal in the mail. Let’s flip through. The first article reviews clinical cases where continuous glucose monitors came in handy and encourages primary care doctors to utilize them. The author sits on the advisory board for five device and pharma companies, includingContinue reading ““Hot Topics in Primary Care””

This fall, toward the end of a glorious apple season in upstate New York, I started offering an apple to every patient. Office staff, who seem to consider me some cross between a rabbit and puppy, would affectionately roll their eyes or say “aww” on first witnessing the routine. But any cuteness in the gestureContinue reading “An Apple a Day”

Show me a pill for that! This is a paper recently published in the American Journal of Lifestyle Medicine that I co-authored with Dr. Sandy Musial and team. Dr. Musial runs the non-profit Plant Docs whose jumpstart program includes cook-along demonstrations of her epic recipes.

Physicians Committee for Responsible Medicine has coordinated a national effort to replace pigs with high-fidelity manikins in training emergency room doctors how to perform a cricothyrotomy or surgical airway. Over 95% of emergency medicine residency programs now use manikins, but Brown University continues to breed and slaughter pigs unnecessarily. Here’s my recent opinion in theContinue reading “Pigs at Brown”

Today was the latest Moving Medicine Forward show with Dr. Klaper on Chef AJ Live. We give a status report on the avian influenza or bird flu outbreak and discuss related issues. Did you know chicken manure is routinely fed to dairy cows? This and other reassuring info here.

How does sleep impact type 2 diabetes mellitus (T2DM) risk? A prospective cohort study following nearly 248,000 people over an average of 12.5 years found that those who habitually slept 5 hours or 4 hours per night were more likely to develop T2DM (hazard ratios 1.16 and 1.41, respectively) than those who habitually slept 7-8Continue reading “Sleep and type 2 diabetes”

FOR PROVIDERS What is euglycemic DKA and why are patients on SGLT2-inhibitors susceptible? What does this have to do with plant-based nutrition? Euglycemic diabetic ketoacidosis is a state of normal blood glucose in someone with diabetes who has elevated ketones and either low pH, low bicarbonate, and/or high anion gap. This condition can be deceivingContinue reading “Euglycemic DKA”

Longtime plantrician Dr. Klaper and I went on the YouTube show Chef AJ Live to discuss “Why Don’t Doctors Learn About Nutrition in Medical School?” This was the first of a monthly series named after the non-profit organization which serves to bring nutrition to doctors in training. Going forward we’ll delve into various medical conditionsContinue reading “Moving Medicine Forward”

“…We’ll discuss the SURMOUNT-1 trial, which honestly, if I had a crystal ball, I think we may look back on in 20 years as one of the most impactful trials in all of medicine over the early 21st century.” As heard on a medical podcast about weight loss drugs. Yes, obesity is a crisis that requiresContinue reading “Mounjaro”

I recently did an elective rotation at TrueNorth Health Center in Santa Rosa, CA to learn about water-only fasting for disease reversal. Could these recovery stories I’d been hearing be true? TrueNorth is a residential facility founded in the 1980’s where patients come for days to months to address a variety of chronic conditions. ThoseContinue reading “Therapeutic fasting”

You may have read that 10 prescription drugs are now subject to price negotiation between Medicare and the drug manufacturers. These 10 drugs alone cost the federal government over $50 billion last year. While this provision of the Inflation Reduction Act is historic, it is also wild that drug companies have blocked any negotiation untilContinue reading “Chronic disease benefits drug companies more than the converse”

Mostly I am terrified by AI, but there are also promising applications. Ever seen ‘Not Milk’ in the grocery store? Its maker NotCo is based in Chile and uses AI software called Guiseppe to model the biochemistry of animal muscle/ secretions, identify similar compounds in plants, and develop new recipes for meat/ dairy alternatives. AContinue reading “A.I. in alternative meat development”

Probably not, but there is interesting speculation. Viagra/ sildenafil is widely prescribed to treat erectile dysfunction. By inhibiting phosphodiesterase 5 (PDE-5), it increases cyclic guanosine monophosphate (cGMP) and promotes vasodilation. Normally an increase in cGMP would suppress nitric oxide (NO) by negative feedback. But sildenafil interrupts this mechanism so that NO remains available to stimulateContinue reading “Low-dose Viagra for Alzheimer dementia?”

What’s the difference between vitamin K1 and K2?  -K1 is phytonadione or phylloquinone  -it carboxylates factors 2, 7, 9, 10 as well as proteins S, C, and Z in order to activate them for clotting  -it is recycled in a neat mechanism inhibited by warfarin, hence anticoagulation -it is named for Koagulation since German researchersContinue reading “Vitamin K”

Increasingly I am noticing pharmaceutical influence on medical attitudes. The book Overdosed America by Dr. John Abramson exposes the tactics employed by drug companies to fund strategic trials, optimize outcomes, suppress unfavorable data, and market new medications to patients and physicians alike. Dr. Abramson’s newer book called Sickening is waiting on my night stand. Yes,Continue reading “Drug hype”

The 2023 American Academy of Pediatrics guidelines are crucial for: -highlighting the imperative to address childhood obesity, and legitimizing it as a chronic disease with comorbidities -emphasizing disparities, social determinants of health, and dangers of stigmatization – recommending comprehensive lifestyle therapy as first-line treatment -citing common obesogenic medications But the guidelines fail to: -prioritize preventionContinue reading “Mixed review of the new pediatric obesity guidelines”

Really? A 2018 study showed significantly decreased GERD symptoms with fiber supplementation, but no other dietary changes, in 30 people with low baseline fiber intake. Mechanisms may include increased gastric motility (less available to reflux), increased gastroesophageal sphincter pressure, and favorable changes to the gut microbiome. Over 90% of Americans do not consume adequate fiber.Continue reading “Fiber for heartburn”

The holidays are famous for classic re-runs and bad sequels, but I didn’t expect to find Type 3 Diabetes. This is the concept linking insulin resistance and Alzheimer dementia. Neurons have some insulin-dependent glucose receptors which become resistant in diabetes such that neurons are insidiously deprived of glucose, compromising their function. Meanwhile, dyslipidemia leads lipidsContinue reading “Type 3 diabetes”

Inflammation is what food can either promote or prevent. Adipose tissue is an active endocrine organ that releases adipokines, triggering immune cells to release inflammatory cytokines. In the musculoskeletal system, this tips joints into a catabolic state of degeneration. So in obesity there is increased loading on joints AND intrinsic breakdown. This is why whole-foodContinue reading “Arthritis and diet”

This is a helpful review of the literature on nutrition and inflammatory bowel disease: https://www.tandfonline.com/doi/pdf/10.1080/17474124.2020.1733413?needAccess=true While there is much research yet to be done, ample observational and some experimental data has associated plant-based eating patterns with prevention of / remission from IBD. These aren’t always exclusively plant-based diets, but the more diverse plant compounds consumed andContinue reading “Inflammatory bowel disease and diet”

A recent review provides the basis for updated USPSTF guidelines on statins for primary prevention of cardiovascular disease (CVD). The bottom line is that in adults at increased CVD risk but without a prior event, statins were associated with reduced risk of clinical outcomes based on 22 randomized trials with 6 months to 6 yearsContinue reading “Statinertia”

A note on the magical molecules deemed short-chain fatty acids, like butyrate. They’re made as metabolites of beneficial gut flora like bifidobacteria, which spawn to digest the varied fibers in a plant-based food stream. Short chain fatty acids are shown to improve lipid metabolism, insulin sensitivity, and food satiety thereby alleviating metabolic syndrome. They alsoContinue reading “Magical molecules”

…is the mutual benefit for individual and public health. 80% of antibiotics (abx) in this country go to animals who are not sick. The abx prevent illness in abominable living conditions and also expedite weight gain. Meanwhile we face an antibiotic resistance crisis with 2 million cases of resistant infections resulting in around 25K deathsContinue reading “One of my favorite things about this movement”

Since 2015, processed meat has been deemed by the International Agency for Research on Cancer a group 1 carcinogen (same level of evidence as cigarettes) and red meat a group 2a carcinogen (same level of evidence as diesel exhaust and formaldehyde). When epidemiologists study processed, red, and total meat consumption and outcomes like cancer, all-causeContinue reading “Should hospitals still serve bacon and sausage?”

The American Medical Association passed a resolution to increase plant-based meals and eliminate processed meat in hospitals. (Duh, but important).  https://www.pcrm.org/news/news-releases/ama-passes-resolution-hospitals-should-provide-plant-based-meals-and-remove#:~:text=WASHINGTON%E2%80%94The%20American%20Medical%20Association’s,remove%20processed%20meats%20from%20menus.&text=The%20hospital%20provides%20patients%20with,options%20on%20its%20patient%20menu.

The chemistry overlaps with why it’s healthy. Polyphenols are the beneficial antioxidants, free radical scavengers, and vascular endothelium protectors in plant foods. Here’s a summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835915/It’s helpful when pitching patients on plants to be able to cite some details. For example, quercetin in apples and catechins in tea inhibit atherosclerotic plaque; or isoflavones in soymilkContinue reading “Why is produce colorful?”

Big things:-best plant sources are beans, lentils, leafy greens, dried fruit and nuts-heme iron is in meat and is better absorbed-but there is controversy about deleterious effects of heme iron-Impossible burgers use heme iron grown in the lab for taste/appearance, but we don’t have longitudinal data on its risk -enhance non-heme iron absorption with concurrentContinue reading “Dietary iron”

Evidence abounds not only for primary prevention but also secondary prevention of prostate cancer (pCA) via plant-based eating. First note that up to 40% of cancer in general is attributable to diet. Other hefty percentages come from smoking, alcohol, and human papilloma virus which leave only 5-10% from genetic etiologies alone. Helping patients understand thisContinue reading “The mischievous prostate”

There is growing literature on diet and COVID. This is a well designed prospective cohort study that shows an inverse association between COVID incidence/severity and quality of diet (as measured by an index of plant-based foods). Those in the top quartile for diet had way lower risk for severe COVID than those in the bottomContinue reading “Diet, socioeconomics, and COVID-19”

Encouraging to see this from The Economist. https://www.economist.com/graphic-detail/2022/01/28/if-everyone-were-vegan-only-a-quarter-of-current-farmland-would-be-needed

After some nutritional counseling on my cardiology rotation, the attending smiled at the patient and said, “He’ll put me out of business.” Later he said none of his longtime vegetarian or vegan patients have any semblance of atherosclerosis. That anecdote is supported by gargantuan population studies. Here is a solid review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315380/

Recent crossover study comparing Mediterranean and vegan diets among 62 ethnically diverse people with BMI 28-40. No meals provided but participants had weekly education about maintaining their respective diets. 16 weeks of one diet followed by a 4-week washout period and then 16 weeks of the other diet. This was a key comparison because thereContinue reading “Mediterranean vs. vegan eating patterns”

Interacting dysfunction in the setting of the standard Western diet. In the article below, we see how a high-fat diet causes insulin resistance, the metabolic disturbance behind many pathologies from type 2 diabetes to fatty liver disease to polycystic ovarian syndrome. Hyperinsulinemia from negative feedback actually decreases hepatic production of sex hormone binding globulin. LessContinue reading “What do the liver and ovaries have in common?”

Remember to pitch patients on plants. Not everyone will act on it but for a subset of people you talk to it will change their lives. Most patients have never been told but deserve to know that a minimally processed plant-based lifestyle will arrest and usually reverse the most common and dismal disease processes. IContinue reading “Dear colleagues”

Most patients have never heard this since we were taught all we can do is manage hyperglycemia to prevent chronic kidney disease, amputations and retinopathy. We add more meds at higher doses while patients continue with fluctuations in blood glucose, gain weight and can become helpless. Whole-food plant-based nutrition has been repeatedly shown to normalizeContinue reading “Type 2 diabetes is a reversible disease”

A recent study associates small amounts of fish consumption with increased risk of malignant melanoma, citing ocean pollutants like mercury and polychlorinated biphenyls (PCB’s) from plastic. No causality since it’s a prospective cohort study, but the N was just short of half a million people. The carcinogenicity of PBC’s is not new and elevated serumContinue reading “Plastic fish”

What’s a kidney’s favorite food? Turns out there is vast observational and some experimental data on this. For context, 1 in 7 adults in the US have chronic kidney disease, costing Medicare alone $87 billion every year.  Plant-based diets are highly associated with decreased incidence and delayed progression of CKD. Not only can plant foodsContinue reading “What’s a kidney’s favorite food?”