Zeke Emanuel, Are You Serious?

The following is a letter to the editor I sent to the Westport News, which appeared on October 3, 2014.

Dr. Hezekiel Emanuel recently published a strong and lengthy, but controversial, article in The Atlantic, entitled Why I Hope to Die at 75,  an argument that society and families-and you-will be better off if nature takes its course swiftly and promptly.

Just a reminder: Dr. Emanuel, one of the architects of the Affordable Care Act (AKA Obamacare), holds many awards and respectable positions (including  Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania). His writings have many listening ears.

In the article, and interviews that followed, Dr. Emanuel further extends his opinion why life after 75 is not only for him, but also NOT for you.

Needless to say, the article generated a lot of criticism which justified in my opinion. This is concisely presented in a Forbes article of 9/24/2014, Should We Take Zeke Emanuel’s  Advice And Be Ready To Die At 75?

I’m not going through the back-and-forth arguments here, but suffice it to say that I strongly disagree with Dr. Emanuel. May be it’s OK for him to count down to the day of his death at 75, but it is not so for many others. The percentage of people over 75 who are independent, active and productive is impressively high, and increasing on a regular basis.

 Warren Buffet is 84, I guess he is now 9 years “overdue.” Winston Churchill was prime minister of the UK until the age of 80. Ben Gurion was prime minister of Israel until the age of 77 (and very active for years after that), President Reagan was in office until the age of 78 (“Mr. Gorbachev, tear down this wall” at age 77).

And the 75’s and over are important to their families!

Dr. Emanuel is 57 years old; it would be interesting to see what he has to say when he’s 74 and ready to “fold it in.”

So where does it leave me and others in this age group? Are we living on borrowed time? Are we wasting public resources just because we live?  I don’t think so!

I’m here to continue with my plans: Continue to foster relationships, family and friends, and continue – and expand – the effort to treat the under-served.

I am already treating many patients who have no insurance, or whose insurance does not meet their needs, regardless of their ability to pay, regardless of their age. I think that no one should be denied medical care, and I intend to continue with that cause.

An Apple (or more) a Day...

At Beardsley Cider Mill and Orchard today, our youngest grandchild. 

What a great day to be outdoors with your family!

More Health Pearls: Appetite control, Testosterone, Vitamin D

• Curb your appetite.  Almonds are a great snack, providing proteins, the right type of fats and, above all, a lot of antioxidants. Eating a few almonds as you become hungry between meals will help you curb your appetite and, in doing so, help you control your weight and provide excellent nutritional value. An ounce a day (or a little more) will help a lot.

• Men, are you taking testosterone? Beware of the low testosterone hype. Don’t take testosterone unless your need for it is evaluated, and then prescribed by a physician authorized to prescribe it (testosterone is a controlled drug). Taking testosterone unnecessarily, or taking too much of it, carries with it serious health risks such as premature heart attacks and prostate cancer.

• Vitamin D. Vitamn D, “the sunshine vitamin” plays an important role in a large variety of metabolic processes. It regulates the amount of calcium and phosphorous in the body, may improve balance and muscle strength in older adults. A low vitamin level is now considered a risk for increased heart disease and diabetes (especially in overweight people). It has a tendency to lower body inflammation, a desirable property. It’s important to make sure that your vitamin D level is not too low, even in the summer, when vitamin levels are higher. It’s a simple blood test; if your level is too low, it’s usually corrected with over-the-counter supplements.

Health Pearls: Back Pain, Aspirin, Best Fruits

• For common low back pain, Tylenol (acetaminophen), even in high doses, may not be any better than placebo (recent article in The Lancet). Over the counter NSAIDS, such as ibuprofen, or Aleve (Naproxen), or prescription meloxicam (Mobic) are generally effective. Better still, drug-free therapeutic massage therapy may be very effective. It works by relaxing the low back muscles, and by stimulating the brain to release pain-relieving dopamine and serotonin.
• If you take aspirin to lower your risk of a heart attack, you would want to make sure that the aspirin you're taking works for you. A simple urine test which measures Thromboxane A2 levels is available through our office to make sure you are not "aspirin resistant." Ask me about this at your next office visit!!!
• Summer time is fruit-eating time. Some of the best fruits are those that have a low Glycemic Load, namely they only minimally increase your blood sugar level. The best include: Strawberries (one half cup), cherries (12 cherries), and peaches (1 medium size). All have a Glycemic Load of 3 or less, which is very low and good.
  
  If you want a reliable list of the Glycemic Index of common foods, call the office or send me an email → istaw@drstaw.com.

Take a walk in the cooler hours of the day, and stay hydrated.

Omega-3, What’s the Real Story?

Omega-3 fatty acids are “essential fatty acids” that are required by the body in order to perform a variety of metabolic functions, but which our bodies can not produce. Our body must get them from the food we eat. They are classified as polyunsaturated fatty acids (PUFAs) and are considered to be “the good fats.”

There are three important omega-3s: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). EPA and DHA are found primarily in fish, krill, and calamari, and in algae (algal oil). They are present in the highest concentrations in fatty fish such as salmon, tuna, sardines and mackerel. ALA is commonly found in plant sources like flax seed, soy, walnuts and canola oil.

While the function of omega-3s is not fully understood, these fatty acids definitely play a definite role in our health. Their role is the subject of extensive ongoing research, and even controversy.

People at risk for heart disease and stroke, and those who already have one or both conditions, do better when they consume fatty fish several times a week. Eating the fish may be more effective than taking supplemental fish oil, perhaps because the fish contains other helpful substances, but the jury is still out on this one.

People with inflammatory diseases may benefit from an increased consumption of omega-3s. The list is long, and includes rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and Ulcerative colitis), lupus, and some forms of immune kidney diseases.

Fish oil may play a role in the prevention of a variety of cancers, age related eye disease, dry eye symptoms (keratoconjunctivitis sicca), anxiety, depression aggression, age-related cognitive function, and even Alzheimer’s.

Much of the beneficial effect of omega-3s is thought to be due to its ani-inflammatory function. The reasoning is that many diseases are either caused by or made worse by inflammatory processes in the body, and the less inflammation there is, the easier it is to bring the condition under control.

There is no agreement about how much omega-3 is enough, and how much is too much. Some authorities place the minimum daily requirement for healthy women and men at 1,000 mg and 1600 mg a day, respectively. A prescription drug, Lovaza (used to treat high triglycerides, a cardiac risk), provides more than 3,000 mg of omega-3s a day.

Recommended doses for different conditions vary throughout a wide range.

A reasonable-size portion of salmon, approximately 6 ounces, contains a little more than 800 mg of EPA and more than 1,100 mg of DHA.

So what’s the bottom line?

Two to three portions a week of salmon or another fatty fish a week, plus a variety of ALA-foods (walnuts, soy, and flax seed) should suffice for most healthy people.

If you are not a fish or ALA-food eater, you may want to take a fish oil and flax seed oil supplement.

If you feel that you have a condition that can be treated, at least in part, with fish oil, don’t do it on your own. The subject is very complicated and in a state of flux. It may involve consideration of other supplements, dietary changes and prescriptions. Above all, it requires a thorough understanding of your condition and the potential benefits of omega-3s, and knowledge of its limitations. Discuss it with your doctor!