Save Your Skin — Get Your Windows Tinted!!

About 8 years ago,  I noticed a small area just in front of my left ear that kept on crusting over and wouldn’t heal even with antibacterial ointment. I assumed that is was something called a pre-auricular sinus, which is very common, because I am an ENT doctor and I see them all the time.

I finally went to a dermatologist who diagnosed it as a skin cancer (a basal cell carcinoma), and it was successfully excised. I have been out in the sun a lot in my life, so I didn’t think anything else of it, but then I learned that the majority of skin cancers occur on the left side of the face, just like mine. Why? Because when you drive your car, the sun comes through the window and blasts the left side of the face causing damage to the skin, increasing the risk of developing a cancer.

It is important to understand that the ultraviolet spectrum contains two general categories, Ultraviolet A (UVA) and Ultraviolet B (UVB). UVB contains the wavelengths that cause an acute sunburn, but which are needed to make Vitamin D. So you need UVB, but not too much. If you expose large amounts of skin (chest, back, legs) to the sun (without sunscreen) mid-day for 20 minutes Spring-Summer-Fall, you will make about 5-10,000 units of Vitamin D.

UVA contains the wavelengths that penetrate deeper into the skin and are most responsible for photoaging (wrinkles). We now know that both UVA and UVB in excessive amounts cause skin cancer. The truck driver pictured below demonstrates the cumulative effects of UVA on the left side of his face after 30 years on the job:

The important thing to understand is that UVB cannot penetrate glass — so you cannot get a sunburn through glass. You also cannot make any vitamin D through glass. But UVA goes through glass with no problems. You absolutely should take steps to stop this!

The auto manufacturers treat windshields with special coatings that block both UVA and UVB, but the side windows allow a very large amount of UVA transmission. All the major tints block both UVA and UVB, protecting your face and neck. Why don’t the auto manufacturers do us the favor of applying a coating that blocks UVA? Because they don’t care.

Most states regulate the amount of tint you can have on your side windows, but most cops (at least in California) won’t hassle you unless it is really dark. Even if you put a clear plastic “tint” on the windows, you will prevent UVA from passing through. You just won’t get the additional infrared protection that a true tint provides, which helps keep the interior cool in hot weather.

Dermatologists don’t seem to ever mention this issue, and I don’t know why — but they absolutely should. I will never again own a car without aftermarket tint, and it is especially important for young people who haven’t accumulated wrinkles yet.

Now you know, so go out and put some tint on your windows, and protect your skin!!

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The Importance of Vitamin D

Vitamins are critical for our health, and there are 12 known essential vitamins. Vitamins can only be acquired from the diet or supplements and work by acting as “cofactors” (enablers) for some enzymes. These enzymes can’t work properly without their cofactors. Enzymes are proteins that are like little machines in our cellular factories that allow molecules to either be built up or broken down according to our bodies’ needs. There are thousands of enzymes.

Vitamin D was originally thought be a vitamin, but it turns out it is not. It never acts as an enzyme cofactor. It is a hormone. What’s the difference?

Hormones are molecules (made by enzymes, like everything else) which are secreted into the blood and carry messages to other cells, telling those cells to do things differently than if the hormone wasn’t present. A good example is epinephrine or adrenalin. It is secreted by the adrenal gland and goes to other areas of the body where it stimulates a fight-or-flight response – dilated pupils, increased breathing, increased heart rate and blood pressure, etc.

Vitamin D is a hormone which is manufactured in several different tissues. Initial synthesis starts in the skin where cells harness energy from the sun (ultraviolet B rays) to break a bond in the cholesterol molecule, which is the backbone for all steroid hormones. This is the only known instance of an energy source outside of your body being required to manufacture a molecule!

Once the skin starts the manufacturing process, it is finished in the liver, kidney, and other cells in the body until vitamin D is finally in its fully active form. What does this hormone do? Many things – it allows your intestine to absorb critical minerals such as calcium so that bones can be built and maintained. It also plays a critical function in your immune system. Your immunity is weak when vitamin D is low, which is likely why people tend to get sick more often in the winter – less sun, less vitamin D, less immune function, more illness.

Vitamin D appears to influence about 20% of all the genes in your body. That is a massive impact compared to many other hormones!

One of the more important vitamin D functions we have found recently relates to mood. Your body cannot make adequate amounts of serotonin without vitamin D. Serotonin is needed for a good mood, and serotonin deficiency causes depression. Serotonin is also necessary for the synthesis of melatonin, which is needed for a good night’s sleep. So if you don’t have adequate amounts of vitamin D, you are more likely to be depressed and sleep poorly.

How much vitamin D is enough? Research suggests it is somewhere around a concentration of 40-60 (ng/dl). Very few people are anywhere near this, because we evolved in a much sunnier environment and we never used to be inside or wear so much clothing as we do now. The only people who have enough vitamin D naturally are those who live in the southern US or closer to the equator and expose large amounts of skin to the midday sun at least 1-2 total hours per week.

If you live north of Atlanta, you cannot make any vitamin D during the winter months no matter how often you expose your skin to the sun.

To achieve a healthy level of vitamin D in the serum, you should take approximately 1,000 units orally per 35 pounds of body weight – and double that if you are obese. That means a normal 175 pound man should be on approximately 5000 units per day. If you are deficient, and take this amount daily for 6 weeks, you should arrive in the healthy range by that time. Vitamin D is very cheap and it can be purchased everywhere.

I take 5000 units per day and my levels are in the 50-60 range. Since I started supplementing a few years ago, I am very rarely ill, even though I am around sick people all the time.

Give it a try, and after 6-12 months, do a look-back and see if you feel better and have been sick less often than before. This time of year is a great time to start since you are likely near your nadir of serum levels.

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Get a Dog

As impairments to good health go, I have slowly learned that excessive psychological stress is probably the second largest issue that people have to deal with. It is outmatched only by addiction – the most important one being to carbohydrates, particularly sugar.

Excessive stress is rampant in our society. I think it is mainly because we are 24/7 task saturated. We didn’t evolve to be hunched over computer screens 10 hours a day after sitting in traffic for two hours a day, with our text message, Facebook, and Twitter feed alerting us every five minutes the entire time. Many of us are simply out of bandwidth and it seems to be getting worse.

Combine that with rampant malnourishment (not of calories but of micronutrients – vitamins and minerals) and the toxic effects of processed food, and you have a perfect storm of ill health.

This type of lifestyle kills time for the important stuff – exercise, fresh air, and the silence needed for reflection. Caring for a dog tends to force this time into a person’s life.

Below: my dog Claire (and as a puppy above).


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Understanding Drugs

I recently congratulated a patient on getting off of all drugs after I surgically cured her chronic sinusitis and she was able to stop her asthma inhaler. She remarked that she wasn’t off all drugs — she was still on thyroid hormone. She wasn’t aware that drugs and hormones are two different things.

Hormones are a native part of the human body. Your body manufactures them. If it didn’t, you would die. It is often useful to supplement them when production is suboptimal. This happens commonly as we age.

Drugs are foreign to the body. Antimicrobials target invading bacteria and viruses, but other drugs alter the body’s functioning in some way to achieve a specific result, such as lower cholesterol or blood pressure, a slower heart rate, decreased inflammation, etc. They usually do this by either blocking the action of a specific enzyme or by altering the receptor for a hormone or other cellular messenger, although in many cases we have no idea how a drug works. In order for drugs to produce any benefit, the underlying process that they alter should be defective or maladaptive in some way.

Americans are taking more drugs than ever, and it is important as an educated consumer to understand them. I read in a prominent journal that the average senior citizen is on 7 different drugs. That’s a lot. Aside from each drug taken individually, there are numerous interactions possible, most of which haven’t been tested.

I like to think of the human body as a biologic machine.  Like any other machine, it has discrete components that allow it to work, like gears and springs inside of a watch. Anyone with a mechanical background understands that machines are made up of component parts that have been designed to work together to perform a specific function.

Biologic machines obviously differ from non-living machines in the sense that they are far more complex than anything man-made, and that in being alive, they are self-repairing and also internally create most of the components that are used to make the machine run. These components include the structures that make up the organism, as well as special proteins called enzymes that are required to manufacture other components. There are many other components as well, such as hormones mentioned above, which function as messages from one organ to another – similar to “snail mail” but carried through the bloodstream. If all these components are properly assembled, then they will work well, and generally we ought not to interfere with them for any significant amount of time.

That leads into the question, how well engineered are we? We all are born with slightly different DNA sequences, and we are discovering that each of us has small DNA areas that are suboptimal because of what are called SNPs – single nucleotide polymorphisms. You can find out what SNP DNA defects you might have by getting an inexpensive analysis, which I recommend. These DNA defects affect how a particular component is manufactured, which can increase your risk of certain diseases as you age, and you can take steps to mitigate these risks.

Problematic SNPs notwithstanding, over two million years of evolutionary pressure has slowly resulted in the human physiology that you currently own. That’s a lot of time to correct deficiencies and make adjustments. With so much time, we and other animals should have become very well engineered, to say the least.

Placing any well-designed machine into its optimal environment should result in that machine’s optimal functioning. This is the same as matching a machine to its “design spec.” Just like flying an airplane within its “envelope.”

What is the optimal environment for the functioning of a human being? What is our “spec”?

Most likely, it is what we were exposed to for the majority of the time we evolved. There is a huge debate about what this is precisely, but in my opinion it would include a hunter-gatherer diet with zero processed foods, little artificial light and modern stress, lots of exercise and at least moderate sun exposure. Not coincidentally, this type of lifestyle often results in a dramatic reversal of poor health in many patients who are willing and able to try it — patients who traditionally are given a laundry list of drugs to take with little attention paid to what they eat and how they live.

Unless there is a specific physiologic or genetic defect identified in an individual which a drug can rectify, it is unlikely that drug therapy is the best choice to improve your health. This is the reason that the evidence for the efficacy/utility for the vast majority of drugs that are meant to “extend/improve” our lives is very poor. Not to mention the inevitable “blow-back” side effects all drugs can have that affect your quality of life.

If you are on a long-term drug, look at your lifestyle and diet – and do your best to fix them. Americans are not as chronically ill as we are because we need more and better drugs. We are sick because we live in a toxic environment.

If you are sick or depressed, it’s probably not because you have a Lipitor, Metformin, or Prozac deficiency. Changes you can make to to bring your lifestyle more in line with the environment to which you are genetically adapted is a far better bet to optimize your health than taking a drug, and you should focus on this first.

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Walk Again After Severing The Spinal Cord?

Advances in medicine have almost always been adopted very slowly — in my opinion, mainly because of the phenomenon of group think, and a reluctance to entertain the idea that what we have previously thought was best for patients could be wrong. Probably the most widespread current example of this in my opinion is the idea that cholesterol is bad and that it should be lowered with statins.

Some of the most famous instances of misguided medicine include the rejection of Ignaz Semmelweis’ idea that washing one’s hands before delivering a baby would reduce the incidence of post-partum infection of the uterus, which killed untold numbers of women; he was mocked and viciously attacked, despite proving that the infection rate among his patients was drastically lower than that of  his peers. It wasn’t until long after his death that his ideas were accepted, despite clear evidence he was right for years before.

More recently, Barry Marshall was an Australian gastroenterologist who was ridiculed in the 1980s for suggesting that H. Pylori, a bacteria, could be responsible for peptic ulcer disease. No one believed that a bacteria could survive in the acidic environment of the stomach. It was only after he deliberately infected himself by swallowing a solution of the bacteria that his ideas were accepted, and he was awarded the Nobel Prize for medicine in 2005.

The list goes on and on.

I came across this article Surgeon Repairs Spinal Cord With Omentum recently and it reminded me of this phenomenon. Per the article, no one appears to have any interest in trying this technique, even though animal studies suggest very significant healing of the cord in animals who have fresh injuries.

If you know anyone who has suffered a spinal cord injury, you may want to pass this along.

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Fraud at Mass. General

Interesting article in a recent Medscape

At Mass. General, Attending Physicians —  fully trained surgeons who are supposed to be supervising doctors in training – often intentionally leave the trainee alone to do surgery and only come in to the operating room if the trainee calls for help, and the “supervising” surgeon is actually available to come (article points out that commonly, the attending surgeon is supervising surgeries at two different hospitals at the same time, obviously making the ability to respond to a time-critical emergency somewhat difficult).

Mass General

Mass. General Hospital

The practice, which has been going on for decades, was uncovered by the Boston Globe in a Spotlight series. The orthopedic surgeon who cooperated with the Globe to publicize the practice was stripped of his clinical privileges. Now, because of pressure from the public, supervising surgeons are allowed to “supervise” multiple surgeries simultaneously only if the the operating rooms are no more than a quarter of a mile away from each other!!!

This “double booking” practice is widespread throughout the US, and not uncommonly has devastating results. For example, recently a surgeon who was supposed to be supervising an orthopedic procedure on a child in Florida was not present, and the trainee operated on the wrong leg.

Can you imagine getting on an airplane where both of the pilots were trainees and a fully qualified pilot was only available after a delay of at least several minutes to help them after an emergency situation occurred? Would you get on that airplane?

This situation is one of many reasons I recommend you should NEVER be admitted to a training hospital unless absolutely necessary, and as I suggested in a previous post, you should endeavor to avoid hospitals entirely. If you are admitted, you and your attending doctor should discuss who will be caring for you and how any trainees will be supervised.

Why is this happening? It’s all about the money. The attending surgeon bills for the procedure, even if he never stepped in the room. The resident pulls a low fixed salary until he too graduates and starts making a large salary by billing for stuff he never actually does….

It’s fraud, in my opinion.

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Don’t Eat Unhealthy Animals

I commonly tell my patients that whether it is a plant or an animal, your health is directly proportional to the health of the plant or animal that you are taking into your body — which is why I strongly recommend the restriction of industrial beef from your diet, as well as non-organic poultry/eggs and farmed fish, and non-organic vegetables.

This video is an excellent introduction to this idea and follow up to my last post and is well worth the 10 minutes out of your day.

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The Perils of Industrial Beef

Merry Christmas! — It is a very busy time of the year, but if you eat beef and have the time to read this interview with Michael Pollan about industrial/feedlot beef production in America, you should.


Typical Feedlot. No, that is not mud they are standing in….

I’ve read many excellent books and other resources on this subject, but that interview captures almost all of the important information you should be aware of.

In case you don’t have the time to read it, the salient points are as follows:

  • Cows are given growth-promoting hormones and knowingly made sick, obese, and diabetic in the process of getting them to maximum weight quickly so they can be slaughtered and render the marbled steak which consumers have become accustomed to eating.
  • Cows are fed grains (mainly corn), to which they are not genetically adapted, which triggers their accumulation of body fat.
  • The “diabesity” (diabetes and obesity) which these animals experience destroys their immune system, while the grain-based diet wreaks havoc with their intestinal health and gut flora, often leading to severe bacterial infections.
  • Risks of illness are worsened by the crowded nature of the feedlot as well as the fact that these animals spend all their time standing and laying in their own excrement.
  • Because these animals’ resistance to infection is ruined, they are given antibiotics to survive. Much of this antibiotic can end up in the meat you consume, potentially causing major problems in your body. Much also ends up in the environment after the animal has excreted it.
  • Antibiotics given to animals constitutes 80% (!!) of all antibiotic use in America, and this misuse is the main reason for the high prevalence of bacterial antibiotic resistance we see today — which is a direct threat to your health, if you ever need antibiotics to overcome an infection.
  • The incidence of bacterially contaminated meat (for example, with E. coli) is directly related to the manner in which these animals are raised, and consumption of contaminated meat is often lethal.
  • The nutritional content of industrial beef is terrible compared to that from animals fed a diet they are genetically adapted to (i.e., grass).
  • The costs of intervening so drastically in the normal physiology and ecology of these animals are manifold and include tremendous damage to the environment (the interview goes into the details of this).


    Cows eating grains, not grass….

As usual, there is a governmental component to this. The subsidies for corn are such that it is an incredibly cheap source of “food” for cattle, and accordingly these subsidies facilitate this entire destructive process. (The subsidization of corn as a source for ethanol as an environmentally harmful additive for gasoline, as well as a means for producing high-fructose corn syrup which is toxic for human beings, are other examples of the blowback from government intervention, but that’s for another blog post).

There is a website maintained by the USDA in which meat randomly sampled and found to have high levels of hormones and antibiotics is made public, but it is very difficult to find, and as best I can tell, there are rarely significant  consequences for the offending purveyors. Moreover, the cut-offs for what is considered “contaminated” are fairly high for many antibiotics, so just because someone isn’t tagged as a violator doesn’t mean that their meat is free of drugs.

The bottom line is that beef can be a very healthy food, but as with every other animal or plant, the environment in which that animal or plant was raised is the primary determinant of how healthy it will be to eat. I strongly advise that if you consume industrial meat, you do so to the minimum extent possible.

If you have the option of buying grass-fed, non-feedlot beef, I believe you should. It is more expensive but worth it in my opinion. We can do that at one store in Coronado and I am very thankful for it.

We don’t yet have any restaurants serving grass-fed steak here, but as awareness increases, there are many popping up around the nation. If you want to enjoy healthy beef when eating out, you may want to find one of these restaurants. Otherwise, I recommend you cook your steaks at home most of the time.


Posted in Coronado Preventive Medicine, Diet, Drugs, General Preventive Medicine, M.D., Mark M. Scheurer | 1 Comment

Staying Out Of The Hospital

A retired surgeon wrote an interesting essay in the New York Times about how he decided to intervene on his hospitalized daughter’s behalf when she became unstable. The story is sobering. Leaving aside the fact that what this doctor did would get you kicked out of almost any hospital in the U.S., the fact is that hospitals are a dangerous place to be. Your objective should be to avoid them at all costs.

This past summer, someone close to me was admitted to a hospital in Northern San Diego because of complications from a surgical procedure. After he was admitted, he spent almost all of his time in bed trying to rest. Why? Because every hour on the hour all night, the nursing staff came in to his room, turned on the overhead fluorescent lights, and started charting data on a white board adjacent to his bed. He was unable to sleep and rapidly lost strength to get up and walk or recover from his problems. This is what we do to terrorists to break them down – sleep deprivation!91a5c42d47adecdaf8556ebd66719b26

When I visited him two days into his stay, I put a stop to that. I also found an incentive spirometer, still in its wrapper, on his bed stand. This is a breathing device to help bed-bound people avoid pneumonia. His nurse was unable to explain why he had not been instructed in its use. I fixed that issue as well, but sure enough, and quite possibly because of the delay, he developed pneumonia on the third day. Pneumonia one acquires in the hospital is so dangerous, it actually is regarded as separate diagnosis than the pneumonia you might get outside of the hospital. He was lucky. He could have died. Many do – but he recovered.

Every doctor who has gone through the clinical years of training as a medical student, and then through residency, has seen numerous problems whereby the system breaks down. Orders may be written or executed improperly, leading to potential patient harm. There are also diagnostic errors in the form of misdiagnoses and in failures to make timely diagnoses.

A recent study suggested that preventable medical errors, most of which occur in hospitals, are now the third leading cause of death of Americans behind heart disease and cancer. In my opinion, the causes for this are many, but the primary ones are the understaffing and undertraining of care givers.

The large hospital systems are pressured to cut costs to create profits for shareholders and pay for administrators in the face of ever sicker Americans filling the beds. Administrative costs are huge. Many of the CEOs of these systems are being paid in excess of 20 million dollars per year. These pressures lead to the staffing issues contributing to medical errors.

HMOs “capitate” costs, meaning that each person (patient) within the HMO system essentially has an annual dollar amount assigned to him or her, and the profit of the system as a whole depends on spending substantially less than that amount (on average). Accordingly, the incentive is especially strong to reduce healthcare costs spent on HMO patients because that is a direct impact on their bottom line. The less spent on patients, the more that is left over at the end of the year as profits and bonuses.

The last time I worked for an HMO was 17 years ago when I was an ER doctor in Mississippi. In the ER and the ICUs (which I covered alone overnight as the only physician in the hospital), I would often need to intubate (place a breathing tube in) patients for various reasons. This can be very difficult in time-critical emergency situations, for example in trauma patients due to blood obscuring the airway. The HMO which owned the hospital decided to cut costs by eliminating the colorimetric device that is used to confirm that the breathing tube is in the correct position. They argued that its use was not standard of care in Mississippi, even though they had provided it up to that point and the other two hospitals in town still stocked it. I quit working at that hospital the following day.

A Preventive Approach including following an anti-inflammatory diet, maintaining your bone and muscle mass through proper exercise and nutrition, correcting your sleep quality and body fat percentage if needed, and ensuring that your endocrine system is optimized will give you the best chance of staying out of hospitals and away from the unpredictable danger that hospital admission represents.

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Eating Grains, Or Not

“Healthy Whole Grains…”

If something is repeated often enough, it can become an unquestioned truth. “Healthy whole grains” has been recommended for years as a staple of conventional medical advice. But are whole grains really healthy?

Let’s consider what grains are and what nutritional value they have — either in the “whole” form or not.

Grains are seeds. Specifically, grains are the seeds of grasses. These grasses include wheat, rye, barley, corn, rice, and many others. Why should we eat these seeds? To answer that question, it is necessary to understand basic seed anatomy. Since wheat is the predominant seed that Americans consume, let’s start there.

After removal of the hull/chaff or outer casing (the process is called threshing, whereby the wheat is separated from the chaff), wheat is comprised of three components: the outer husk/bran, the endosperm, and the germ. White flour is made from the endosperm and the germ only. Therefore, the only difference between “whole grain wheat” and non-whole grain is the presence of the husk, or bran.0713F3WholeGrainsGrainAnatomy

The husk/bran of the wheat seed contains fiber, B vitamins, and some trace minerals. It also contains phytic acid which binds to important minerals such as calcium and zinc and prevents the absorption of those minerals — not a good thing. Phytic acid is one example of what can be called an anti-nutrient. I strongly recommend that the consumption of foods with anti-nutrients be substantially restricted or eliminated in your diet. The favorable nutrients in the husk such as B vitamins can be easily obtained from foods without anti-nutrients. Strike one against wheat.

The majority of the wheat seed is comprised of the endosperm, which is almost entirely made of rapidly absorbed carbohydrate in the form of a highly branched starch called amylopectin. Consumption of amylopectin will spike your blood sugar (glucose) higher than virtually any other substance you can eat, including table sugar. This is extremely harmful to your health, particularly if you are overweight or have diabetes or pre-diabetes. The fact that the majority of physicians and the American Diabetes Association continues to advise those with diabetes to consume a diet which will wreak havoc with their blood sugar control is pretty crazy, in my opinion.

The last major component of the seed is the germ or “nucleus” in the middle where the genetic material for the plant is stored (the DNA). The germ contains two major anti-nutrients, wheat germ agglutinin and gluten. Wheat germ agglutinin is part of a class of molecules called lectins, which are a means of plant self-defense against animals who might eat them. Lectins make animals who are not adapted to eat that particular plant ill, which improves the plant’s chance of survival. Another lectin is called ricin; it is made by the castor bean. Ricin is a very effective poison which terrorists like to use. Wheat germ agglutinin won’t kill you like ricin will, but it will make you sick by causing irritation of your gut. It particularly can cause acid reflux in a large percentage of people. I have had numerous patients experience resolution of their reflux after eliminating wheat from their diet.

Gluten is actually a family of proteins, and includes the glutenins and the gliadins. Unlike other proteins which can be broken down completely into their component amino acids, gluten cannot be fully broken down in the human gut. Instead, it is broken up into relatively large fragments called polypeptides, which are very inflammatory in the gut and cause the gut’s barrier to become “leaky.” An impaired intestinal barrier can cause generalized inflammation throughout the body and result in migraines, joint pain, and many other inflammatory conditions. There is also good evidence that a leaky gut can predispose to many different autoimmune diseases. There is only one autoimmune disease with a mechanism that is well understood — celiac disease. It is caused by the presence of gluten in the diet, and it is cured by the removal of gluten.

My advice is that if you want to enjoy good health, every food you consume should be consciously evaluated with regard to its nutritional value, not whether it tastes good. Grains have no nutrients that cannot be easily obtained from other sources. I see no reason to put up with all the harmful components of wheat and other grains when the nutrients they offer are available in many other foods which do not have all of the harmful components of those grains.

Although it is difficult to avoid wheat because it is in almost everything Americans eat, try eliminating it from your diet for a month and see how you feel.

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