Is it really organic?

Had a discussion with a cousin of mine who happens to be an Ex New York Chef and the topic was, what is organic. Tom carries the persona of a New Yorker with blunt force grace and respect. He is also a great chef. In the typical new york accent, he came out with, "even if a product says Organic, who is to enforce the delicate cultivation of the organic produce or livestock?" Good point right? Well, I alway choose to trust in a higher consiousness and take the high road to feeling that most of mankind will have a good heart and do the right thing. I dont doubt the possiblities of people cutting corners and doing what they think is necessary to survive even if it means mislabeling. (To me, in the end, we attract what we are- live life with bad intention and bad will come to you...)

The Organic Foods Production Act was passed in 1990 as part of the Farm Bill. It has morphed into the National Organic Programs definition and rules published by the USDA in 2000. In order to label as organic, farmers and producers go through a lengthy and detailed process. On the contrary, to label as natural, there is no verification process except for meat and poultry (regulated by the Food and Safety and Inspection Services. All organic foods must be produced without antibiotics, synthetic hormones and genetic engineering. If you ask why antibiotics and hormones......imagine 100 people living in one single family home-in the basement. These 100 people are asked to eat 3-4 times a day to get fat, the women are asked to pretend they just gave birth and start lactating, they are asked to stay like this for a few years and not get sick, poop in one place and listen to the sound of other humans before them getting killed in another part of the house. Stress makes us not want to eat or lactate so we would get hormones. Close quarter living produces infection thus the need for antibiotics (several times a year depending on the season even if the basement is warm). Poor dieting on corn meal makes us have heart disease and arthritis so more medicine so we survive until slaughter time. Of course the weak get killed early and chopped up to be placed into the feed for the 99 remaining people in the basement. (I am getting grossed out writing this)

The organic eqivalent would be 100 people walking around outside, getting better food, regular check ups, and in the case of "Kobe Beef" brushed and given beer daily on a green pasture. See the difference? Less stress, less sickness, true bonding with children (cow calf) to produce milk, more exercise on open plain.....The value of you are what you eat can be extrapolated down to the stress free life of the product you are eating and that goes for fruits and veggies too. In India, China and some Native American lands, before the herb is harvested for medicinal use, the farmer will say a prayer of thanks to the earth.

Now comes the breakdown. 100% organic means the item is composed entirely of certified organic products. Organic means at least 95% of the item is composed of organic. Made with Organic ingredients means it is made of around 70-94% certified organic products. Ingredient panel only means the food has less than 70% organic ingredients.

USDA

Organic products are more expensive, 15-60% more depending on where you buy. I like Whole Foods Market and this is probably the most expensive around my area. I may pick and choose the most important items to come from WF (the food I need to taste the best for my kids) and the not so important one I pick up from Jewel/Osco or Dominics. Some of the things I feel don't have a high organic value would be my oranges and bananas. The peels keep most toxins out. I also use in season coupons (don't tell my uncle, he says real men don't shop with coupons...but then again, he had a heart attack)

Ashleigh Eisbrener put together a nice list of what to buy and not to buy organic. Here it is:

Buy:

Apples
Celery
Cherries
Grapes
Ketchup
Lettuce
Spinach
Strawberries
Tomatoes
Nectarines
Peaches
Pears
Peppers
Milk (although I really suggest almond milk)

Not necessary Organic:
Asparagus
Avocados
Bananas
Brocholi
Cabbage
Corn
Kiwi
Mangos
Onions
Pineapple
Peas

To cut or not to cut.....that is the question.

Now that I finished the marathon, I am back to blogging. Didn't relaize it has been the whole summer but good to be inspired again. On the phone with my local law enforcement friends today and just happened to hear a sliver of an illness. Of course for those who have met me, I had to start my "interrogation". (the kids will attest to the fact that if I hear anything medical come up in conversation.....there I go...blablablablabla). So "lady T" had a very common ailment of right upper quadrant pain. With traditional western medicine, we think of the body part and not the person so I already had a diagnosis and treatment for her. (And all I heard was 4 words..pain, abdomen, right side....western medicine has programmed me to be so uncaring that if I was rushed in an office.....I would stop the conversation and write a script!) Of course being the compassionate doc that I am, I listened more to "lady T the person". I knew from her voice she had patience, experienced with the stress of triage, hestitant on going to the doctor. (I don't blam her....I dont trust doctors....especially ones who force me to take swine flu vaccinations so I dont infect others with an illness I don't have from a vaccination that has been fasttracked!) Don't have to get into the details of the complaints but it brought me to this point. During holidays, especially in this economy, stress is high, exercise is low, sunshine is gone and hot foods and coffee are a-plenty. In considering all of the above, people with gastritis/ulcers/stomach irritability will start to blossom about now, full bloom will come in the days between xmas and new years. We as a society are putting nasty things in our mouths that were never meant to be created. Foods are genetically engineered to taste soooo great and make you feel soooo great for a short time. Then there is the remorse of "I can't believe I ate the whole thing", or "I should have stopped at 2", or "I am going to have to fast for a week now" or "now I will have to spend 500 hours on the bike". Well, the ramifications to bad behavior are: stomach upset. The body knows what is healthy for it and will let your brain know...."this much coffee is not good for you so I am going to gnaw at your right side for a couple of minutes every hour". Stress of winter season also brings sickness to the community, people missing work and staying home, having to fill in for extra shifts, fielding complaints from others who also feel lousy, more anger on the highways causing accidents and traffic jams, leading to being late for work, eating lunch too fast, having more indigestion and side pain,not being able to concentrate at work leading to poor sleep and getting sick....etc.
Without coming up with an exact diagnosis, the first thing I would try to get people to embrace the comforting things of the season. Nature has built so many things that help us through the dark months. Think warm fire, soft blanket, comfortable slippers, roasted nuts, warm cocoa, cuddling with a love one to stay warm, seasonal holidays with family. There are great answers to stress that we kinda just save for snow days but should be taking advantage of now. At Harvard, Herb Benson taught me that meditation and the relaxation response will take care of the majority of stress related illness without even prescribing one medicine. No doubt, this is difficult to learn and doesnt happen overnight. I now put on my western doctor hat and tell most folks, I have the power to make things go away in seconds with chemicals that may kill you, but if you are in a hurry and have prescription drug coverage, I am there for you! (Such an american answer to treat the symptoms fast and not worry about the cause) And while on the topic, you should always see a doctor for other possibilities....gallstones, kidney stones, liver disease, cancer. In fact, most docs due to the emminent threat of being sued, will initiate the treatment plan saying, it may be these other diseases but I will treat for the most common one first so don't think about cancer or surgical extraction of a gallstone. Like saying, "you can drive my Porsche, and it has alot of horsepower with a difficult to control midengine oversteer that will cause you to lose control and hit the median and die but that probalby wont happen so enjoy!" As Wayne Dyer says, don't let the negative meme (thought) enter your mind to begin with.
So back to belly pain, the fast answer is stress equals poor digestion and stomach erosion from increased acid production. Chronic over production of acid by the stomach will digest food but will also digest itself. Yes, if the stomach has an imbalance between the mucous lining it makes to protect itself and the amount of acid it makes to digest the food it carries, ulcers happen. These start as erosions/scratches/rough spots on its lining. With continued acid production, poor mucous production, high ingestion of damaging foods-coffee, caffeine, tomatoe, chocolate, advil, alcohol. The erosion/scratch/rough spot will grow and become louder. Symptoms will go from a gnawing to the solar plexus to radiating pain from the right side to pain to the right low back. Food will soon become irritating to the pain loose bowel movements occur, sleep gets interrupted early am.....Fast treatments would be avoid the foods mentioned, pepcid or zantac twice a day for 2 weeks, smaller meals more frequently to avoid overstretching of the irritated stomach. Some docs go straight to the "proton pump inhibitor meds like prilosec, prevacid, nexium. These are very powerful and shut off all acid to help heal the lining. Problem I see is that docs prescribe but don't advise diet change. So bad habits continue and patients get placed on strong meds for years. I tell all my patients, the ppi's(proton pump inhibitors) were release with a warning not to use past 3 weeks. No acid means poor digestion, bad bacteria overgrowth, poor mineral, vitamin and antioxidant absorption, poor healing and poor health. Food products like fennel, peppermint, ginger and anise have always been used to "calm" the stomach and act as "carminitives". I have acutally picked up a tea blend from Teavana in the Woodfield Mall containing: peppermint, chamomile and green tea-great for coffee substitute and warm with the antioxidant EGCG. Avoidance of very difficult to digest meat and dairy products for about 2 weeks also important. If no response, I have several treatments in acupuncture that would help in the healing process in addition to digestive enzymes until healed. There are also very good practitioners in reflexology, reiki, and some chiropractors who can help initiate the healing process with hands on healing.
I always welcome radiology studies like ct scans of the abdomen, ultrasounds of the gallbladder (especially with a family history) and maybe even kidney tests. One caveat is if there happens to be a stone in the gallbladder that was incidental and the pain is present, a surgeon will always say, when do you want to schedule for surgery? One may or may not need to be cut but the squeeky wheel always gets the most oil. "If you complain, he will cut it out".
A final note is during this time of year, meditation for 10-20 minutes twice a day will alway help your reaction to daily stressors. Depak Chopra suggests deep and quiet meditation at least 20 min/twice a day. Herb Benson suggests do it when you can "mini's". I like to include breathing 4-7-8 with yoga twice a day and it helps me smile for an entire 8 hours of working in a busy emergency room during peak H1N1 season (which will be another blog!)

What is Integrative Medicine

Some of my best friends will ask the question. Without getting too boring, I could tell them the life and times of Andrew Weil. That usually is the long winded approach. I find myself trying to justify my endeavors by speaking of the mans credentials. Harvard College, Harvard Medicine, NIH, Botanist, Author and world cultural traveler, founder of the University of Arizona's Program of Integrative Medicine and Fellowship with graduating classes since 1994. By this time, most time efficient doctors will be answering other questions. Most lay-people will have tuned out after the Harvard names. If I say, he's the founder of a branch of medicine that gets people off perscription drugs, then ears perk up. Most people envision and doctor that will say "ok, the data is out there that medicines dont help so stop everything and go about your normal routine". Little do folks know, the concept he sticks to is to add the physical, mental, spiritual aspects of medicine in addition to special attention to nutrition. Using food as medicine is a old concept but with all the RCT's (randomized controlled trials) that are being quoted, referenced and repeated in medical circles and magazines, basic nutrition really doesn't make the trillion dollar profits for small organizations so it's not spoken of. Doctors don't have the time for nutrition counseling and in many cases, one's medical insurance will not cover a referal to a "dietician" unless the disease is already being manifested. I uses to always refer my patients to the dietician in my building back in the 90's and I distinctly remember when Sandy Gifford had to turn away petients due to poor coverage. (she would still see my patients and educate as best as possible on her own time because of our relationship) ......in fact, doing things on personal time seemed to be what I always had to result in for getting around the limitations of insurance. Up until the time I stepped away from a 10 year practice with retirement just to send a message to the hospital that the patient is the bottom line not the dollar.
I know I was right mostly because of the feedback I still receive from old patients...even until now and I left my practice in 05. Patients are still feeling short changed from the time constraints of conventional insurance based medicine. Patients are also being given bigger and stronger drugs and several of them. I was aware of "laundry lists of medical problems and perscriptions for the elderly in nursing homes in the early 90's but now I am seeing it in 40-50 year olds(hypertension, diabetes, cholesterol). I am also seeing it in 10-20 year olds (adhd, diabetes, asthma). Now within the first year of life (reflux!).
As usual, there has to be a coexistence, modern medicine is great and very powerful. Trauma, rapid reversal of heart disease, cancer, kidney failure, premature birth, having 8 babies. But I think we are forgetting about nutrition, exercise and stress relief. This is how I see what I do is correct. To integrate old fashion health care with modern disease care is a must. Health care has to be individualized. Humans are so dynamic that everyone can't be labeled as a hypertensive or diabetic. I like what Chopra says regarding a new paradigm in medicine. The last few decades, medicine was so boastful to think if we knew the pathophysiologic pathway to a disease, then we could fix the disease by treating the pathway. Obviously this was the wrong thinking and now there are small fixes for every symptom in the world without fixing the mindset of the indiviual coming to us for the ailment/symptom. When I used to hear the term holistic medicine, I would think of someone who had little training in healing that people were going to in desperation of a better answer than what the doctor would tell them. Now I understand more about the best approach to healthcare and through the efforts of Dr Weil and others, the volume of people (healthcare and non medical) are "buying" into treating more than just a symptom or test result. Thus the idea of "integrating" mind, body, spiritual, environmental and nutritional thinking into the treatment plan. Hippocrates, the father of medicine said to use food as medicine, funny that its getting back to this!

What are growing pains?

I remember in residency, when seeing a child for a knee pain or limp and the evaluation was normal, I would usually say "growing pains". The moms and dads would already have heard about the diagnosis but would be at ease when I would agree. I would compare this to seeing a 40 year old male that comes in for left sided chest pain and I clear him of heart disease then say its just "stress". To throw all the potential diagnosis under one obscure title of stress is not acceptable to an intelligent educated american. Same thing with the diagnosis of growing pains. In the case of my nephew who is 6, his doctor said the limping he was suffering from is probably just that. This is probably true but I think an educated parent would like to know a more specific diagnosis. When the knees are painful, we worry about the patella. Sometimes worry about Osgood Schlatter Disease where the thigh muscles (quads) stay tight and the thigh bone (femur) gets longer. This would make the muscle pull at it's insertion points on the knee with more force causing a lump to form.




In some cases, knee pain and a limp at my nephews age could be something worse like Perthes Disease (or at a later age, a SCFE). Both of these are not common but since the results are bad, they have to be considered if limping doesn't go away or gets worse. Little James just started baseball 6 weeks ago which makes me feel better that we have a reason for the pain but I will probably be getting an xrays later. (Don't like the radiation exposure but I'll watch him closely and did ask my cousin to video tape his training next time.)

As my patients know, history is 80% of the diagnosis and I think baseball will be the reason for the pain (overtraining). The Saguil Approach is to start with a working diagnosis, evaluate for abnormality, watch the training pattern, surface and shoe type, consider an xray, rule out groin issues and consider 1-2 weeks off to see the results. I suggested that if it is due to baseball practice, try childrens motrin/advil three times a day the day of and the day after practice. Pain that breaks through that conservative treatment will mean we have a bigger issue to be investigated faster.

To note, if there is no limp and just complaints, may consider "secondary issues" like he doesn't like the sport or the coach, or worse, there's a bully around.

Does a normal Cholesterol level mean I have no problems with my heart?

Usually in the ER, patients will come in with a high blood pressure reading, slightly overweight and a history of smoking. After I comment about please rechecking this with the primary care doctor, the defensive answer is I just had a normal physical and normal cholesterol level. Ooohhh my gosh! I think it is the fault of the medical community in giving false hope that chasing a number keeps people healthy. I admit, with the short time we have to discuss, evaluate and treat symptoms in my exam room, it is easier to give a temporary "bandaid" to an effect of the disease and not the cause of it. Perhaps in the next decade, we can have doctors that fix things fast but medical advisors that guide people to make life changes.

Focusing on heart health, cholesterol is a good parameter to check in blood testing at the office once or twice a year but healthy lifestyles and habits will make permanent changes so that you may not have to ever check another blood test ever! (My doc friends are going to hunt me) This is what I believe and I walk the walk, I am a protector of life; family, friends and patients. If people are giving out poor medical or dental advise, I work to educate the patient on other options, natural healing and healthier living. I believe we doctors are giving a false sense of security to people when just controlling cholesterol levels and not making suggestions for life change. The reasons for bad health are multifactorial; can't change the world with one visit. Sometimes it just takes proper planning over the course of time. Building a practice from scratch seemed harder than moving a mountain. Now that I have utilized those around me who have the same passion for helping others, the task at hand seems so easy. (We could have opened a clinic right down the street from the old place, with less overhead and more life breath coming from the physical location never seen before!) This reflects one of my beliefs that when the world is viewed with reservation and contempt, a "black and white" picture will be seen. When viewed with love, faith and energy the colors will be infinite.

Just don't believe maintaining a normal cholesterol level will keep you free of disease. Strive to improve your health, diet and mind even with normal tests. Push the envelope with what you can perform with your body and mind, find a good doctor, dentist, trainer, therapist and life partner. Together we can change the world! There will always be bad economies, bad debt, bad medicine and bad people around but when we all lock elbows together, our concepts and faith are indestructible.

Check out this blog for other things to do in getting that heart healthy;
http://saguilapproach.blogspot.com/

Bioidentical hormones

At the Whole foods lecture someone brought up the question about what can I do with wt loss and other symptoms of menopause? The question was more of a hormone issue. (If the "menopausal" symptoms where controlled, good possibility that the weight wouldn't be as much an issue).
We are taught in medical school that all women go through a phase when the ovaries will stop working. Their role in life is to make ovum (eggs) once a month from 16 to about 45 years old. Once they have reached 45, usually the organ will slow down and stop making eggs and the hormones. When hormone cycles that have been in balance for 30 years between the brain, the ovary and the uterus stop, other organs that have had the pleasure of being bathed with hormone will cry out and say....wheres my estrogen!...wheres my progesterone! Brain goes through problems with function- memory, emotional lability, sadness anger temperature lability, muscles go through atrophy, fat depots go through accumulation, adrenals go through fatigue, sex organs ....well later on that one. As docs we are taught if the symtoms are there, check a blood test and if the hormone is missing or low, replace it! In theory, having what you where lacking should make the symptoms all go away (until you get tired of the pill or get a side effect -cancer) Many women did well as far as we know but then society as front loaded the majority of women's attitudes to say what you are feeling is normal, you have to go through it and your only choice is to take the hormone.

Here is the reveal: you can't "cookie cutter" humans! Different people have different presentations and although the blood levels will be fixed, the person that was suffering slightly before menopause hit will still be suffering after the hormones are taken, and some of those closet symptoms will not go back in the closet. If the doc doesnt take 10 minutes to listen to what you are truly suffering from, it will be missed so get a new doc!

Diets can be changed, exercise can be changed or introduced, lifestyles can be dropped or started, supplements can be taken. Even the hormones can still be used but perhaps a bioidentical can be tried before the standard pills are tried. Everyone has probalby heard about how "prem____" the progesterone substitute comes from purified horse urine. I say leave it to the horses! By contacting a local pharmacy that compounds, you can get a chemically derived hormone look alike. Investigating these guys would be what I suggest.....

-while in Florida I used Pharmacy Specialists 393 Maitland Avenue. Altamonte Springs, FL 32701 (407) 260-7002.
-here in Illinois, Martin Ave Pharmacy, 1247 Rickert Drive, Naperville Il 60540 (630) 355-6400

...and both places will ship, just need a script from the doc.


Anyway...the lady at the lecture mentioned she tried bioidenticals but have a hearing issue. (That would easily be fixed with acupuncture) but this should be brought up to the doc and the pharmacist. I think she was in the right direction but just needed a little guidance on what else to be looking for. I forgot to ask her that even through the hearing issue, how were the symptoms of menopause with the bioidentical? Bottom line, checkwith the insurance and if covered try them out....like having a custom made suit versus an off the rack.