Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Policy News 

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People across the political spectrum continue to debate the merits of Brett Kavanaugh for the Supreme Court. Since we now know that the political and judicial systems play such a large role in the health care of women, we’d all best pay close attention to this debate. 

Drug Shortages. We did not used to have them. Now it is common place on routine drugs, even IV fluids. No slight to third world countries, but sometimes it feels like we are in a third world country. The FDA is forming a new task for to more critically and quickly investigate and solve this problem. 

Companies that make formula are multinational. The Trump administration is avowedly pro business and this is particularly evident in the international sphere where of late, this had unsavory consequences. In its zeal to unfetter corporate interests, The Trump administration has taken an anti breastfeeding stance. At present advertisements of formula is limited regionally in areas where it could be misused or hazardous. The Trump administration has desired to “ reopen” these markets, under the auspices of free trade, seemingly oblivious to the perils of selling formula  in places where literacy (ability to mix correctly) and clean water is unavailable . The entire medical and public health establishment has reacted, concerned that breastfeeding continue to be encouraged as the safe and superior method that it is. Many are pointing out that formula manufacturers have no place at the health policy table. This baby feeding battle resurfaced last year when Ecuador proposed a resolution to the WHO (World health organization)  to support breastfeeding. The Trump administration through the US delegation at the World Health Assembly, tried to water down the resolution. When this did not work they threatened Ecuador with a trade war. Can you say “evil empire” ? ACOG (American College of Obstetricians and Gynecologists) and AAP (American Academy of Pediatricians) have responded formally. 

Did you know as little as two months of breastfeeding reduces risk of SIDS ? 

Did you know breastfeeding reduces mom’s risk of breast and ovary cancer, heat disease, and endometriosis ? 

Did you know the US ranks 26th among industrialized countries in breastfeeding ? 

The Trump administration seems to want people off the ACA. They have reduced the “navigators” fund from 36 to 10 million per year. Navigators are those who help people enroll in the ACA. The Trump administration says private health insurance agent and brokers do a better job. Do private brokers and agents get a fee for this ? 


Medical News 

Abortion facts were highlighted by NBC this last week: 

Death by childbirth is 14 times greater than death by abortion. 

Banning abortion does not reduce its incidence. 

Free birth control reduces abortion rates. 

Before legal abortion, 5000 women per died through complications of illegal abortion. 

Depression is not the only feature of postpartum depression. A new review has highlighted the fact that anger is often a big component of post partum depression. 

Your microbiome is the population of microorganisms that you have on your body and in your gut. This is affected greatly by what you eat. In pregnant women this microbiome is passed to the baby. Thus, what pregnant women eat can influence the microbiome of their child, for better or for worse. Newer research in multiple fields are beginning to describe the role of a healthy microbiome to overall health. 

The US birth rate is at an all time low for the second year running. Some site child care expense, wanting to spend time with existing children and concerns about the economy as chief reasons to wait. Germany and Japan have addressed their falling birth rates by putting better child care policies in place. Falling birth rates are not necessarily a bad thing, as they are associated with greater savings and higher levels of educational attainment. It is certainly an oversimplified falsehood to think that a larger population means a better economy. 


Stay tuned for more interesting news from the world of Obstetrics and Gynecology this time next week on Medical Monday. 


Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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Efforts continue around the country to prevent changes to Title X funding. Title X funding is meant to supply federal funds for family planning and preventive health services. However, since those services have historically included birth control and abortion, the current administration is seeking to redirect these funds. In particular, the Trump administration would like to see those funds go to programs that promote abstinence only, which is not an evidenced based measure. Opponents of the changes including Planned Parenthood are arguiing that such charge are unconstitutional since they have not gone through a federal rule making process. 

The House has passed a bill allowing Medicaid to pay for inpatient drug treatment in case of cocaine and opioid addiction. The bill is contested on both sides, with some Democrats saying its focus it too narrow. 

The House has also passed more bills pertaining to the opioid crisis, mot notably by extending access to mental health and substance abuse disorder services to children and pregnancy women under CHIP, the Children’s Health Insurance Program. 

“Association Health Plans” are potentially bare bones health insurance plans which may be obtained by groups of small businesses even across state lines. The idea there is that lower cost can be achieved by forgoing benefits like birth control or pregnancy care, things which have been mandated under the affordable care act (ACA). Many feel the omission of what are now defined as “essential services” is short sighted and will contribute to the weakening of health care markets overall. 

A US District Judge has ruled in favor of two Christian Colleges to bar the enforcement of the contraceptive mandate as it applies to their University sponsored insurance. I understand that many Christians are opposed to abortion, and that many are also opposed to sex before marriage. However, what is the problem with contraception ? 

Many people are not aware of the Pregnancy Discrimination Act. It is a clause to Title VII of the Civil Rights Act of 1964 and is for the purpose of prohibiting “sex discrimination on the basis of pregnancy”. Pregnancy is a temporary disability in the eyes of the law. Violating employment law pertaining to pregnancy wold be treated like violating employment law pertaining to disability. The Act protects women not only during pregnancy, but also during “pregnancy, childbirth and related medical conditions”. 

Medical News

In England there is a public health program. In 2008, an HPV vaccination program was instituted. Ten years later, we cannot see that this has resulted in infections with the most serious HPV viruses, types 16 and 18 fell 86%. Experts speculate that the vaccine could lea to the eradication of HPV related diseases such as genital warts or cervical cancer. 

Focus on the American Maternal Mortality Crisis continues. New data continue to confirm what many have already observed, that black women die at three times the rate of white women from pregnancy related causes. May have suggested hypertension and racism are playing roles, as well as lesser access to quality care. 

New and sobering data are coming in about the common disorder we call “PCOS” or polycystic ovarian syndrome. PCO is complex of hormonal problems leading to problems with ovulation, ovarian cysts, and trouble with androgens, insulin and the processing of fats and carbohydrates. We used to think of PCO  as pertaining mainly to infertility, but PCO related infertility is quite treatable. However, now, more physicians like me are even more concerned about the downstream metabolic effects of this syndrome. The carbohydrate intolerance leads to obesity and the obesity leads to more carbohydrate intolerance. All of this leads tot higher BP and abnormal lipids, setting the patient up fro diabetes and heart disease later in life. In fact, we now know that about half of patients with untreated PCO will have diabetes before age 40. If you think you have PCO, please contact your doctor and ask to be referred for appropriate medical and lifestyle management. 

Obesity in pregnancy is known to be associated with an increased rate of a number of pregnancy and brith complications. However, it now appears, that offspring of obese mothers are considered a high risk population for endothelial cell dysfunction, meaning cardiovascular problems. In fact, either maternal smoking or obesity predisposes daughters with PCOS. When will the nation and the medical profession come to terms with the obesity epidemic ? 

Stay tuned for more news from the fascinating world of Obstetrics and Gynecology, here, next week on Medical Monday. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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It is no secret by now that the Trump administration is systematically enacting policies to ban abortion and limit access to contraception. Medical experts have indicated their concern all along, saying these policies are likely to backfire, increasing unplanned pregnancies and abortions overall. 

Legal challenges to Trump administration policies are now coming from many quarters. Mississippi and Louisiana have pending legislation to ban abortion after 15 weeks. Both laws will now go to Federal court to be tested. Meanwhile, New Jersey is suing the Federal government against the exemption which permits corporations to purchase insurance without contraception coverage if they object to it on “moral” grounds. Since when can a corporation have morality ? People, owners, and board members can have morality or the lack of it.

The Federal Courts are going to have a big role in determining how much of this Trump era law stands. For example, a federal judge in Washington struck down the decision by the HHS (Department of Health and Human Services) to withhold funds for the teen pregnancy prevention program. The judge called the cancellation of funds “capricious”.  HHS actions have been struck down by federal courts four times to date. 

A survey of various health care groups has shown the 95% have strongly criticized the Trump administrations efforts to weaken the ACA (Affordable Care Act). The American College of Physicians has published a paper calling for recognition and addressing of the discrimination against women in health care. Health care disparities include those pertaining to reproduction, family and medical leave, domestic and sexual abuse and inclusion in clinical trials. 

Elsewhere in the world, Ireland has voted to repeal the countries ban on abortion. The popular vote passed by a margin of 2 to 1. To put things in perspective in this historically Catholic country, divorce was only legalized in 1995. Gay marriage has also been ratified in Ireland, and an openly gay man has served as Prime Minister. 

Medical News

We all know that genes influence our physical health. But they also influence our mental health. They are a number of genes which are associated with the development of Schizophrenia. However, even if they are present, the odds of actually developing schizophrenia are low. New research has indicated that pregnancy complications such as gestational diabetes and preeclampsia increase the risk of schizophrenia in susceptible individuals, as can smoking. This is all thought to take place via epigenetics and the placenta. More research is needed. 

A new study indicates what we have often observed; that those women who introduce a bottle in the hospital are much more likely to give up breastfeeding. Breastfeeding is recommended as the sole food source for babies for six months. 

The Nurses Health Study has produced data about nutrition and healing loss. Turns out those who had a diet most closely resembling a Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diet were 30% less likely to experience moderate or severe hearing loss later in life. 

You will hear all kinds of unscientific reasons from patients about why they will not get a certain vaccine. We all know vaccines stimulate the immune systems and we all know they can make you feel a bit flu like in the process- no fun. New research has now proven that HPV ( human papilloma virus) vaccine does not cause increased autoimmune activity in girls. This confirms two prior large cohort studies. Despite all this, there is still a lot of push back against vaccines. It is hard for a caregiver to persist when a patient or a parent declines a needed vaccine. However new research indicates that physician persistent leads to 94% of children being vaccinated against HPV. 

Many times I hear talk to the affect that obesity alone is not a problem. There must be other factors such as diabetes or hypertension for obesity to be a threat to health. FALSE.. Newer date now tells us that having obesity ALONE makes you 39% more likely to have heart disease. 

We have been finding a lot of vitamin deficiency up here in the North Country. This has been true in pregnancy. We have undertaken supplementation regimens with the input of Endocrinology and are tailoring better maintenance regimens for both diet and supplements. New research has now show some good news : that those who take vitamin D in pregnancy are 28 % less likely to have low birth weight babies or stillbirth. 

In other vitamin D related news, new research also indicated that women with sufficient levels of vitamin D are 10% more like to get pregnant after a miscarriage, and 15% more likely to have a live birth after a miscarriage. 

Folic acid is also important in pregnancy and is known to prevent birth defects such as spina bifida. New research indicates that poorer women rarely takeout before it during pregnancy. This is something that should have a really easy fix. 


Stay tuned for more news from the fascinating world of Obstetrics and Gynecology, here, next week on Medical Monday. 

Medical Monday : Two Week Catch Up


Happy Easter and Happy Passover. We have two weeks to cover. Thanks for reading ! 


Policy News

Much of the National Health Policy News this week deals with contraception and reproductive health. Can anyone remember any time in this or any other country when these private matters were ever so much on the national stage ? The politically conservative aspects of my nature questions why this degree of government intervention in private lives is necessary. My medical qualifications and medico-legal experience cause me to classify some of this meddling as practicing medicine without a license. 

Title X is a federal grant program whose purpose it is to promote positive birth outcomes and healthy families. It provides grants for family planning and health services. So here’s my first question: Why is it not run by health care professionals ? Trump administration officials are now contemplating new wording which would add additional criteria for clinics to receive Title X funding, namely the provision of primary preventive services. Sounds good right ? Well many clinics offer only reproductive health services. These clinics would have to expand or close. This measure seems like just another way of closing family planning clinics.  Now whether pap smears would qualify as preventive health is unclear, or whether paps would be classified as reproductive health, I don’t know. 

Texas is challenging the federal government’s withholding of funds for its family planning programs. They were withheld several years ago based on the fact that these providers, many of them through Planned Parenthood, also provided abortions.

Planned Parenthood itself is challenging the Federal Government on its withdraws of funds from the teen pregnancy program. Between this and two other plaintiffs, the Department of Health and Human Services has partially and temporarily restored some of the funding until litigation can be completed. 

Idaho has failed to solve the problem of insurance for those whose income falls between Medicaid and the Affordable Care Act coverage criteria. A proposal called Plan First Idaho would have funded family planing services for women in the gap. My question is, what rocket scientist designed the State’s the two programs such that their income qualifying criteria do not meet seamlessly ? This is a problem of their own making and it needs solving. Republicans in the Idaho House stalled this measure. 

Idaho Governor “ Butch” Otter has approved a measure by which prospective abortion patients must a told about “ abortion reversal” a procedure that does not exist. Additionally, he has signed legislation which will require abortion providers to collect personal and demographic information which, in de-identified form they intend to make public. I don't know what they think this will accomplish, but I have a feeling it may backfire, since they will be able to see how many and how diverse a group of women utilize the procedure.

The Supreme Court is hearing a case between the State of California and a group of "crisis pregnancy centers”, an actual chain of 130 outlets run by “ The National Institute of Family and Life Advocates”. These centers are anti-abortion counseling facilities, however they are licensed as family planning providers. California has a law requiring that all licensed family planning facilities to post notices of the availability of free or low cost birth control and abortion services and they are challenging it. They are arguing that this posting requirement violates their free speech.  So far the Court has expressed concern that these clinics not be singled out from other clinics. California has argued that their staff, many of whom are not medically qualified, present medical misinformation as truth, all to the end of dissuading patients from abortion. Apparently theses non-credentialed counselors actually wear white coats. 

Along with the opioid epidemic has come a hepatitis C epidemic. Kentucky, having seen a surge of the disease, has passed a law now requiring all pregnant women to be tested for it. Hepatitis C used to be very hard to treat. However, patients have much more hope nowadays due to the availability of effective therapy. 

Missouri has expanded Medicaid for pregnant women in drug abuse treatment. Their continued coverage will be contingent upon them staying in treatment, and could under those conditions, be continued up to 12 months.  

And now for more of a purple to blue state review:

Florida is considering a bill requiring HPV (human papilloma virus) vaccination to be required as part of the vaccinations required of children attending public school. Human papilloma virus causes multiple illnesses most notably cervical cancer and genital warts, and the vaccine has not demonstrated any conclusive evidence of harm.

It is interesting to note that physicians are not prescribing HPV vaccine equally for female and male children. Doctors recommend the vaccine twice as often for girls as they do for boys. This puts the boys at increased risk for HPV disease, and puts all their future partners at increased risk too. 

Mississippi passed a law banning abortion after 15 weeks Of course this is unconstitutional based on Roe V. Wade which is still on the books. A Federal Judge over turned Idaho's ban. 

New Hampshire has passed a bill which will allow pharmacist to prescribe birth control. No doctors visit will be necessary. The medical establishment has concluded that vast majority of the birth control methods are safe for the vast majority of women. They certainly are when compared to pregnancy for those same women. Authorities believe this will eliminate yet one more barrier to contraception. Utah signed a similar law into place earlier in the week. 

On the other coastline, the state of Washington now has a bill that will require insurance to cover contraception, abortion and maternity care. Additionally, after the first of the year, all contraception has to be co-pay and deductible free. This includes voluntary sterilization. 

The new budget has failed to shore up the ACA ( Affordable care Act) marketplaces. States will have to tighten their belts and work on their budgets one by one. 

ProPublica has reported that the “US is the most dangerous country in which to give birth”. States all over the US are creating programs to quantify and address the problem of maternal morbidity and mortality, even as the Federal government under Trump is dismantling reproductive and maternal health care piece by piece. 

Do you ever get the feeling that the various States in America are becoming like the countries of the European Union with different values, cultures budgets and laws ? 


Medical News: 



Striking research findings presented at Lancet Global Health conference have shown that the death risk is double among pregnant women who are anemic compared with those who are not. The lead study author also found the correcting anemia is not a sufficiently high enough priority among physicians. 

Research presented at Diabetes UK conference has shown that excess weight gain incurred during pregnancy by  gestational diabetics is associated with greater risk of cesarean section.

Women who exercise in pregnancy have shorter labors. This interesting news was published in the May issue of European Journal of Obstetrics and Gynecology and Reproductive Biology. The study group attended a professionally led session of moderate exercise three days per week. Labor was shortened about one hour, mostly in the first stage, or dilating phase. ACTIONABLE ! 

Children who were breastfed exclusively for at least 6 mores were less likely to become overweight to obese than their counterparts. The conclusions were drawn by analyzing over 38,000 records from children South Korea. The finding were presented at the Endocrine Society Annual Meeting. 

Gynecology/General Medical News: 

There may be a male birth control pill on the horizon. Research at the Endocrine Society's annual conference has presented information on a new male birth control pill called DMAU. It contains androgen and progestin,  which is analogous to the contents of the female birth control pill, estrogen and progestin. Once daily tablets appear to be safe and effective. No period required. 

Menopause and aging in general is characterized by a loss of muscle mass and bone density as well as the deposition of fat. As suspected, the Mediterranean diet may have a positive impact on bone mineral density and muscle mass in postmenopausal women. The Mediterranean diet emphasizes the eating of high quality protein, large volumes of fruit and vegetables, healthy fats such as olive oil and a modest amount of complex carbohydrates such as whole grains. As a whole, the diet is lower in simple carbohydrates than the typical American diet and is also higher in protein and antioxidants.

There are now over 400 cases of a rare lymphoma which are linked, epidemiologically, to breast implants. Breast implants are not new. Lymphoma is not new. However our ability to collect and parse data is better than it has ever been. The FDA it's taken this ability and created a meaningful database for this type of information. While an association between breast implants and this rare lymphoma is being established through data collection, a causality between the two is not necessary implied. That said, nothing is more likely to lead us to understand the causes of this problem than amassing quality data about it. 

Federal funding support for cancers is disproportionately low for gynecologic cancers if you rank them by lethality. Cancer of the ovary and the uterus ranked near the bottom of the funding list. Contact your elected officials ! 

A new modification of the current device used for pap smears can identify cells from endometrial (uterine lining) and ovarian cancer. The investigational PapSEEK uses an analysis of 18 genes and analysis similar to that used in prenatal screening for Down’s syndrome to identical the genetically abnormal cancer cells. THIS IS SO COOL ! 

A new study on postmenopausal hormone therapy has shown that it does help maintain thinking and memory skills. This is the case IF it is initiated shortly after the onset of natural menopause. This study was presented in the Journal Neurology and was a high quality randomized controlled trial of 75 women between the ages of  42 and 56. 

In my mountain state, there is not a great deal of sunlight or seafood. As a result we have a high prevalence of vitamin D deficiency. New research indicates that vitamin D deficiency increases a post menopausal women’s risk of metabolic syndrome. Metabolic syndrome includes the unholy triad of diabetes, high blood pressure, and abnormal serum lipids ( cholesterol and triglycerides) which together increase cardiovascular risk. Vitamin D levels are checked by a simple blood test. Ask your doctor about this ! 


Stay tuned for more news from the exciting world of Obstetrics an Gynecology, next week, here on Medical Monday ! 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology


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Good Monday. The media continues to focus on the Trump administration’s Department of Health and Human Services (DHHS) Policy of promoting “ abstinence only” to reduce teen pregnancy rates. Physicians like me deplore this scientifically disproven strategy. My governing body, ACOG, the American College of Obstetrics and Gynecology espouses and promotes access to evidence based contraception as fundamental to women’s health care. 

However there is more to the story. There is nothing wrong with the choice of abstinence. There is no problem if a patient choses abstinence as her birth control method. But to offer abstinence “only” in the context of a health care or teen pregnancy prevention setting, is folly. Similarly, there is no problem with discussing the “ benefits of avoiding sex” as the administration proposes. Furthermore, health care providers in particular would be happy to support the DHHS in avoiding the normalization of “ sexual risk behaviors”. I am assuming that they mean high risk sexual behaviors. All of this would be fine if it were not for the deal breaker clause “ abstinence only”, and, oh yes, defunding those who do not march in step with it. The NY Times has published an editorial exposing the shift to Title X funding priorities to abstinence only programs under the direction of Valerie Huber, a longtime advocate of abstinence only birth control. 

There’s more. The latest healthcare budget proposal not only seeks to redirect Title X funds, it also seeks to defund Planned Parenthood and other family planning programs altogether, as well as scrap, not just reduce, the budget for the Teen Pregnancy Prevention Program. Democrats plan to block this budget proposal. ACOG has stated that half of all pregnancies are unintended and this is a major public health problem.  41% of teens have had sex in high school. 

Scrutiny of drug prices is increasing in this administration. FDA administrator Scott Gottlieb as criticized drug pricing constructs used by the big drug companies which result in large OOP ( out of pocket expenditures) for patients. He was quoted as saying “ sick people aren’t supposed to be subsidizing the healthy”. Of course this sounds very pro-patient, but the bottom line is that the government current insures a great many people through Medicare, Medicaid and the Affordable Care Act, and it wants to pay less for drugs. 

Many of you know that I believe data should be free. Accordingly, I believe patients should have access to all their medical information and it should be complete, digital and portable to other providers. The Trump administration has indicated an interest is facilitating this trend. While access to complete digital medical records has many patient and caregiver advantages, it also makes it easier for insurers and regulators to determine eligibility and reimbursement, or lack thereof. For the time being, I think I’d trust Amazon, Google or Apple with my data more than I would trust a government medical database. Although theoretically, de-identified data would make it possible to do a lot of helpful population based research like they do in the Scandinavian Countries which have Universal Health Care. 

Work requirements for Medicaid recipients sounds like a good idea. However, Medicaid recipients are often pregnant single mothers. Arkansas has approved such regulations. Alabama is examining the idea. Children’s advocates are concerned that work requirements will take these parents away from children, while providing no daycare to supplant them. Single unemployed people on Medicaid rarely can afford daycare or even transportation to and from a job. Why is this not obvious ? My idea: Given these people a computer with internet access and require them to take an online class toward a certification. Make passing required and grades count. This could be done from home and the need for a car or daycare would go away. Maybe I will write my elected officials. 

The Trump administration wants to test work requirements to see if they improve patient care or reduce costs. ( Who decided those endpoints ? ) However the GAO (General Accounting Office) has asserted that such analyses in the past have not been rigorously conducted, and their results have-not been published, limiting their utility.

I thought Republicans wanted less government intrusion into our lives. Senate Bill 1394 in Arizona would require hospitals or clinics to report if a woman had an abortion and to report the REASON she had it. Seriously ? As if these reasons weren’t personal and complicated and no business of our elected officials ? It would also require that hospitals require reporting to the State in the event of any abortion complications, though this is not the case for complications of any other procedures. Arizona ACOG has come out in force against this. 


Preterm birth has been an unmitigated scourge in the US. It is twice as much so for women soldiers recently returned from duty. Preterm birth is poorly understood, but its many associations point to various forms of stress, such as socioeconomic deprivation, racism and abuse. I interpret this to mean anything that makes the women’s body a hostile environment for the fetus. It makes sense that a military environment would meet this criteria. 

On the other hand, exercise is an entirely different kind of stress, a good stress. Recent research has confirmed not only that pregnancy women may exercise, but that they may safely exercise in warm weather. They may also take hot baths and short saunas. That said, it is critical that patients considering these activities check with their doctor first as there may be caveats. 

Nurx. My new company crush. Go to This is a San Francisco startup offering doctor prescribed brith control online, with or without insurance. It currently operates in 18 States and they are looking to hire more docs in more states. Teens are welcome. 

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In the “ olden days”,  male medical students generally entered surgical specialties and female medical students entered non-surgical specialties. The crossover came with Ob/Gyn which is surgical. Women had a natural affinity for the field, and patients almost always prefer them. When I entered the field, it had already become half and half. However, now, 25 some years later, only 17% of Ob/Gyns are men. Male doctors are worried about getting into the field, and women in the field are worried about the demonstrated historical monetary devaluation of a field once it is predominantly filled by women. The big picture is this: Ob/Gyns are in short supply and the supply is growing smaller by the year. We should welcome and properly reimburse any docs of any gender willing to take on the vicissitudes of the profession. New data suggests bolstering the ranks of Certified Nurse Midwives could also help to address the shortage of skilled Obstetrics care providers, and together improve our deplorable maternal morbidity and mortality statistics.  

Good news ! A new study has indicated that probiotics and fish oil in pregnancy are associated with reduced allergies and eczema children. The study is of very high quality since it is a meta-analysis, a compilation of 19 other high quality studies onto same subject. That may warrant a policy change in the office. 


Stay tuned more more news from the world of Obstetrics and Gynecology, here next week, on Medical Monday. 

Medical Mondays: Breaking News from the World of Obstetrics and Gynecology

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Greetings on this Cyber Monday. I am happy to report that we had a great Thanksgiving Break and that I did not even go into town for Black Friday, the official start of the Christmas season. I may however, patronize Cyber Monday. Accordingly, politics has taken a bit of a back seat to commerce and the holiday, and I rather like it. Nonetheless there are a few things to report. 

Massachusetts is bringing good cheer as Governor Charlie Baker, Republican (!) signs a law protecting free birth control without copay. The Baker administration has declared that women of Massachusetts right to contraception will be protected regardless of what goes on in Washington. All the while, the Trump administration is trying any way it can to demand the contraceptive protections set in place through the Affordable Care Act (ACA). 

Contraception again made the news in that a group of states Attorney's General are filing suit against the Federal government over their weakening of the contraceptive mandate for corporations which hold religious or moral objections to it. I still think it is ridiculous to confer beliefs to corporations. 

Meanwhile enrollment in the ACA is up for this stage compared to last year, despite the enrollment time being cut in half. 

The funding of the proposed Trump tax cuts is really no mystery. They are to be funded by repealing the individual mandate, the insurance subsidies and the contraceptive mandate,  saving the federal government money that would have been spent on health care. The Fed can then garner support from those people who need deductions, i.e. those who have taxable income. The greater the income, the greater the benefit. So yes, the tax plan is a case of robbing Peter to pay Paul where Peter is health care and Paul is people with substantial income. Again, I have have emphasized this so much: Investment into health care pays itself of many times over, in both human and economic terms. The trump Administrations simply does not seem to know or care about this. They are interested in keeping their campaign promise of cutting taxes. However there is no free lunch, and those that elected him should have realized the money for the tax cut would have to come from somewhere. Perhaps Trump supporters value the short term gain of lower taxes more than they value the long term gain brought by comprehensive, universal and affordable health care. 

Math: The Trump administration quietly cut $200 million from Teen Pregnancy Prevention Programs only to greatly promote a $10 million dollar program of their own that they have recently unveiled. Their philosophy: abstinence only. 

On the medical news. In the Fun and Clever Obstetrics category, there is a new study reporting on work by a Canadian charity to foster early prenatal care in African women. Bridge to Health Medical and Dental is bringing early Ultrasound to women of Africa, but more importantly they are bringing women to Ultrasound. How ? By advertising that “ you will see your baby”. They have shown that women are 9 times more likely to show up for early US if they hear this message. 

More Zika data is filtering in. We know that Zika virus infection in pregnancy is associated with a high rate of fetal malformations. However, we now know it is also associated with a very high rate of miscarriage compared to controls. Among those who survive and are assessed at one year, 94 % appear grossly normal. 

In the news that may impact you department, we have the revision in the definition of normal blood pressure. Formerly normal Bp was defined as anything less than 140/90. Now it is anything less than 130/80. What’s your blood pressure ? The best thing to do to answer this question is to get a BP cuff for home, ideally one that is smartphone connected. Take lots of readings under different circumstances, and see where you really live. Share your data with your doctor. 

We used to recommend having a normal period or two before reattempting pregnancy after a miscarriage. However newer data suggests this may not be necessary. 

New data suggests that Advanced Maternal Age patients 35 or older should be induced by 40 weeks. In the past we waited until 41-42 weeks, but this has proven to be associated with increased rate of complications. 

Kratom. This is the newest herbal supplement to a.) become popular b.) cause serious health problems and even 36 deaths. It is Southeast Asian plant used to treat pain anxiety and depression. It produces euphoria. People in opioid withdrawal use it on the street to treat their symptoms. It is clearly dangerous and the word is not yet out. 

In an interesting twist of research fate, a new study has identified risk associated with the discontinuation of hormone therapy. In particular, women under 60 who discontinue hormone treatment had a higher risk for cardiac death and stroke during the first year of discontinuation. The same was not true in those after 60. Clearly more research is needed to understand the reasons behind this. 

Periodically, research comes out noting the association of lower rates of C sections and episiotomies in those who see midwives. Every time I look at this type of research I find it to be disingenuous to some degree. This means, it does not account for the factor of self selection to midwife care or provider veto of midwife care. I am the principal Obstetric backup for our local midwife practice. We work very closely with one another to see that midwife patients are low risk, and that those who become high risk transfer appropriately to a higher level of care. Additionally, Should point out the patients are generally insightful and understand when low risk care is appropriate, and risk themselves out of midwife care when they feel they are likely to have complications. See how all this would skew these studies ? 

We know that obesity has many adverse health effects. Here is a new one: Breast cancers in obese women are larger at the time of diagnosis. They are harder to feel, and harder to image as a result of obesity. Another reason to attain a healthy weight. 

We have a great entry for the we-already-knew -this-deparment. Americans are not eating enough fruit and vegetables ! Only 12% of Americans ate the recommended amount of fruit while only 9 % at the recommended amount of vegetables. Compliance with recommendations tracked with income but even the highest bracket did a poor job. 

Finally, also in the we-already-knew -this-deparment, 71 % of American women would prefer an annual mammogram rather than every two years. Many groups, including ACOG and the American Cancer Society had to publicly disagree with the US Preventive Services Task Force over a controversial interpretation of data in 2009 saying annual mammograms conferred to benefit. Confusion still reigns in the media. In 2016 the USPTF still reaffirmed hat the harms of screening outweigh benefits. Benefits are early detection of cancer, but that is not addressed by their data. Harms they define include pain of mammograms, fear of mammograms, and indicated breast biopsies whose results return benign. I’d say this last one in particular is actually a blessing. 

Stay tuned next week more more news from the world of Obstetrics and Gynecology. 

Food Friday: The Impromptu Dinner Party

Oh yes I did just throw an impromptu dinner party for 15 ! Truth is, this is not uncommon in my house. So, I thought I would share some strategies on how to manage this seemingly impossible feat. 

Who were these people ? These were nine guests from France who we were expecting. We were to house them for perhaps a week. So tonight, in what we thought was the first night of their visit, we thought they could simply settle in. However, it turns out they decided to stay only one night, so this would be our only chance to visit with them. Dinner was served. 

My family totals 6, not counting the baby granddaughter, so we had plenty of hands. This is the first tip.

1. You must train your children (and partner) from an early age to clean up after themselves in the kitchen, so the kitchen is not a fright when you go to use it. You must teach them basic cooking skills so they can effectively sous-chef (assist) you in a pinch. 

2. The next tip is similar: Keep the house reasonably tidy on a regular basis. Ensure your house is curated (meaning get rid of what you don’t need), clean and organized every week. Pick a day and keep to it. Then when opportunity strikes, you will be ready. 

3. Keep some basic decorations handy. I use candles and nice napkins. Guests seem reluctant to use our cloth napkins, so I keep some paper ones on hand. My candles are oversized white tea lights available at both Costco and Ikea. I place them in glass candle holders for ambiance. They come in little metal holders which prevent wax mess and get recycled. 

4. Have a set of dishes you can make quickly from things on hand, from the freezer and the pantry. Have ingredients for these recipes on hand most all the time. Have a ready-to-go festive drink as well. Mine is Pellegrino which I keep stocked in the pantry. 

In our case tonight, we made Paleo chili with all the trimmings, green salad and fruit salad. ( Always have those last two side dishes !) 

Here’s the rough recipe for Paleo Chili : 

  • In a large soup pot, saute a tablespoon of green chilis, canned or fresh, in a couple tablespoons olive oil. You may also include minced garlic.  
  • Brown about three pounds lean red meat in this flavored oil. Season with lemon pepper, cumin and chipotle chile powder, coating the surface of the meat lightly with each spice all across the area of the pan. ( This could be done with ground turkey too.) 
  • Saute some Mirepoix (roughly chopped carrots, onion and celery at a 2:1:1 ratio) and add that to the meat. 
  • Add a cup of frozen or fresh corn. 
  • Sitr and get mixture dry, caramelizing, and very hot. 
  • Add 1-2 cans full flavored beer (not paleo) or just water. Keep your face out of the steam. The alcohol cooks right off. 
  • Then add a can each of tomato sauce, stewed tomatoes, and diced tomatoes. 
  • Bean eaters (not Paleo) can add two cans here. I kept ours on the side since you never know the dietary constraints of guests. 
  • Simmer and adjust all seasonings, salt last. 
  • Serve with corn tortilla chips, chopped scallions, (lactose free) sour cream or substitute, salsa, and guacamole. Cheese eaters may add grated cheese. These garnishes are all set out for people to add at their discretion. 


Here is my Gluten free but too-sweet-to-be Paleo Quick Berry Cobbler: 

Spread a 2-3 berry-deep layer of red fruits on the bottom of a 13X 9 "ish" baking pan. These could be frozen or fresh raspberries, strawberries, cherries, or even blueberries, or better yet, a random combo of these. Pour off any dilute water from melting fruit. 

Make the topping. Mix the following until crumbly: 

  • 1c gluten free flour 
  • 1c sugar
  • 1egg
  • 1 teaspoon baking powder
  • 1 tea spoon salt

Spread over berries. 

Melt one stick of butter or 1/2 cup coconut oil and pour evenly over crumbs.

Bake at 350 degree until crust is golden brown and berries are not watery. Pro tip: bake on an edged pan lined with parchment. Start watching the cobbler at about 25 minutes. 

Keep conversation going by offering herbal or decaffeinated tea after dinner. 

Let guests help if they arrive too soon and clean up afterward. It is better to be doing things together than to have people idle and awkward.  Don’t think that everything has to be perfect. It is more important that you are warm and inviting.

Now you are all set to throw an impromptu New Year’s Eve party. Happy New Year ! 





Belated Food Friday: Paleo Party Shots

This year we joined our sister offices of Family Born Midwifery for our office Holiday Party. We decided to go Paleo, and every one gave it a go. 

It was a fantastic spread of roast turkey, root vegetables, as well as green salads and fruit salads. We had a selection of paleo cookies and a very easy berry cobbler. Unfortunately, the cobbler got eaten before it could be photographed. However, I would like to enclose the recipe for you since it is easy, quick, tasty, paleo, and colorful. 


And here are some other shots from our dinner just for fun. 

Food Friday: More on Edible Gifts

There are 23 days until Christmas ! There is still time to assemble some economical, healthful and delicious food gifts ! 

Traditionally, holiday food gifts are sweets and baked goods, and this is great for special occasions. If however, you’d like to focus on more healthful choices, here are some suggestions. Think savory, and think beyond food, per se. 


Recipes for all these are easily found on the internet and especially on Pinterest. Please feel free to follow me and check out my boards on Paleo Nutrition and Gifts.

When you prepare a holiday food gift, make the containers part of the gift. Baskets, jars and decorative boxes are widely available at craft, sewing, or even hardware stores. 

To make your gift really nice, include an artful hand lettered card or tag about how to use the gift. Perhaps include it's recipe if it is prepared. To make the gift really deluxe, include a book. For example, A spice oriented gift could be a selection of jarred and labelled spices in a nice basket, complete with a book on spice mixes. 

Be sure to make a list of all the people you wish to acknowledge, thank, or regale with gifts. Start now if you haven’t already. Have a plan and keep it simple. Doing so will reduce stress during the busy holiday. More importantly, it will give you more joy during the process. 

Food Friday: Comfort Food

I think we could all use a little comfort food after this week. 

We turn to comfort foods when we are stressed, sad or lonely. I know lots of people felt this way after this week’s presidential election, especially women. So I am here with some ideas for healthy comfort food. 

Comfort foods are traditionally loaded with simple or refined carbohydrates. Classics include baked goods like muffins and pie, heavy savory food like french fries, mashed potatoes and spaghetti and meatballs. They are filling, warm and associated with good memories. How can you make some of your own without going into a carbohydrate coma and feeling worse after you’re done ? 

I suggest starting with some hot tea, dressed nicely with lemon and and a little agave. This might be all you need. A savory alternative is a hot chicken broth, made easily from jarred organic broth mix which is readily available in standard grocery stores these days. 

If you need more, and you need it quickly, consider homemade popcorn with olive oil, salt, herbs, lemon pepper, or nutritional yeast. (The nutritional yeast is something you’ll have to get at your local organic foods store.)

If you can take the time to prepare something, be strategic. We will go with the traditional items, just tweaked for the cause of health. 



Try my fruit muffins 2.0 HERE  and use gluten free flour or whole wheat flour, depending on your tolerances. Try cutting the sugar. 



Try a Paleo nut crust with a fruit that doesn't need much sweetening. Plums come to mind. When I thaw frozen pie fruit out of season, I do so in a large nonstick frying pan, and pretty much get the water poured or boiled off, and the filling made. How about Paleo pumpkin pie made with coconut cream ? 

Here’s some recipes:

These recipes are for YOU. Don’t expect to serve a huge room of extended family these healthy alternative recipes and not get some comments about how they are different. They are different in that the crust is not the same and the fillings are less sweet. But they are treats you can feel good about. A brief search on Pinterest will yield dozens of Paleo pumpkin pie recipes. 


French Fries: 

This is easy: Crispy baked or broiled sweet potato fries made with coconut or olive oil. The key is in the cut. Sharpen your knife. Make them uniform. If you are brushing them with olive oil, make them thin, so high heat is not required. I recommend a large cookie pan lined with parchment. Lay the fries in a single layer brushed with oil and salted with kosher salt. The add pepper or herbs as desired. Bake at 375 in the upper half of oven until they are beginning to crisp. Dip in paleo or home made olive oil mayonnaise instead of sugary ketchup. Aioli sauce would also be nice. You may cook them in a hotter oven if you use coconut oil, but watch them carefully. 


Mashed "potatoes": 


Here you can try the now famous FAUX potatoes which are made with cauliflower. Wash and cut a whole head of cauliflower, cook until fork tender. You may steam, boil, or roast it. Then blend with a tablespoon of healthy fat like olive oil or a little butter, add salt or pepper to taste. Some people add a little garlic puree, but that is optional. Garnish with turkey bacon bits, and maybe chives. 


"Spaghetti" and meatballs: 


This gives you the chance to try Zoodles, or zucchini noodles. Use a peeler, or a special tool widely available in the kitchen gadget section of major stores. They cook quickly, so beware and do them last. Make the marinara sauce and meatballs of your dreams, the simply have them over the well drained Zoodles. 


I hope you have a nice comforting weekend. 

Food Friday: Autumn Squash

Like comfort food ? Squash is a healthy choice. 

When made correctly, squash is rich, velvety and filling. it can be sweet or savory. It is low glycemic and nutrient rich. Squash keep well. I keep mine right on the stone floor of my kitchen. I think they look pretty. 

It takes some doing to safely open squash. After all, they are made to withstand winter to deliver their seeds into the spring. When you are opening harder squash, be careful. Use a sharp knife, perhaps a mallet, a stable surface and good technique. A good idea is to carefully “set" your knife into the skin, then use the mallet, perhaps over a towel, to tap the knife into hard thick rind. Oftentimes if it opens a little you can crack it the rest of the way with a little leverage. 

Squash can be baked, roasted or steamed. It depends on your constitution and your taste. 

If you have time and little motivation, simply scoop out the seeds and bake the halves as is. This would be in a medium oven ( 350 degrees F) until soft. 

If you have less time and more patience, cut the squash into smaller pieces and perhaps get rid of the skin by either carving it off or scooping the meat out. Then roast on a pan at about 425 until carmelized. 

When you bake or roast, use olive oil, coconut oil, or butter onto squash before you cook. You may also salt and pepper in the beginning. If you want to add a little brown sugar, do it after the squash is mainly cooked and turn down the temp to at least 350 or lower since sugar burns easily. Watch it carefully until the sugar is melted but not burned. I line all pans with parchment paper to make for easy clean up. 

Roasted or baked squash can then be eaten as is, or blended with toasted nuts, craisins, or other dried fruit, diced fresh fruit like apples, and then rebaked slowly. It can be made into soup or blended into a dish like mashed potatoes. 

If you have little time, cube the squash into 1-2 inch pieces and steam it until tender. It will cook quickly, but have a less roasted earthy flavor. You may then use it any way. 

All squash, regardless or size or coloration, are members of the same family, curcurbitae. This is remarkable when you consider all the different flavors. Some of the meat is bright yellow, and makes “ spaghetti squash” fit for a marinara sauce. Some is deep red and full of vitamin A, and other flesh is sweet, orange and suitable for making pie: pumpkin pie ! My favorite is the humble butternut, simply because of it’s wonderful taste. And since I have neither time nor patience, I pick the longest thinnest ones I can find and slice them into big “coins”  about 3/4 inch think. I then roast them with bittern a pan with parchment and let people peel of the skins themselves. 

Enjoy the hearty food of fall ! 


Food Friday: Grocery Store Reverie

I am back in Palo Alto, California for reunion and I hardly have time to think about food. But, in the course of my travels, I have come across some of the most beautiful grocery stores ever. 

I have never been to Italy. But I have been to France. In these places, people care deeply about food in a way most Americans don't seem to. However, here in Palo Alto, these are my people. I watched in the stores how twenty something men would converse over the quality of fruit. Or how professorial types moved about with one meal's carefully chosen foods in a basket. I saw others asking questions about cheese, and the butcher explaining a fine point or two to some prospective buyers. I saw bakers, hatted in white,  displaying desserts for the evening's customers. Even the checkers would comment on the items in my basket, like a Sommelier complementing my choice of wines. 

I enjoyed this throng of like minded people. The beautiful displays of foods engendered conversations all around the store. Many people had phones to their ears, checking with companions elsewhere about what to purchase. These were not just grocery lists. They were menus that were being executed. Several were doing what I had been doing earlier in the day, holding a phone out in front sending a live video to another who would look over the wares and voice their preferences. 

There were thoughtful conversations here and there, but at the same time, the group had a bit of hustle and bustle as if they all had somewhere to get to. People were expecting them. Within the hour, so many well considered tables would be set. 

This would be my wish for every one on this evening of travel. The food you buy and the place you buy it should mean something. Moreover your dinners should be special in some way.  Finally, do what you can to have special dinners with special people, in a special place.  

Food Friday: Kombucha

Dr. Gina here covering the trends for you. Kombucha is the latest probiotic to hit the shelves big time. Should you drink it ? What is it ? 

Kombucha is a fermented drink make from tea, sugar, and cultures of both bacteria and yeast. It retains live probiotics in its finished form, which is part of the purported benefit. 

I think it is tasty. It can be carbonated, and a little fruit juice can be added. It has a tangy taste of vinegar, since fermentation produces vinegar. Commercial kombucha has small amounts of caffeine such as you would expect with tea, and trace amounts of alcohol which, by law, cannot exceed 0.3%. Most brands are low in sugar and calories and it does hydrate. You’d be wise to read the label just in case. 

You might be interested to hear all of the dramatic health claims about kombucha. In my search, I unearthed numerous animal and in vitro ( test tube) studies which seemed to suggest benefits in various circumstances, as with regards to liver function, lipid metabolism, oxidative stress and even cancer. However, none of these lab studies were conducted in such as way as to apply to humans. 

The Mayo clinic site

states there are no proven benefits to drinking kombucha. This may be more of a statement about the lack of evidence than it is a statement about an absolute lack of benefits. 

A 2014 study published in Journal of Medicinal Food suggests that kombucha " is suitable for the prevention against broad spectrum metabolic and infective disorders.” This study is a literature review and as such is subject to all the biases and potentially flawed methodologies of each of the individual studies reviewed. 

It is measurably true that kombucha contains probiotics and antioxidants from green tea. The health benefits of green tea, from which kombucha is made, are well documented. Therefore it is not unreasonable to ask whether there are any benefits from kombucha as well. 

WebMD’s presentation of the subject is the best and, I think the most balanced.

They highlight the composition, the claims, and the lack of clinical trials on kombucha. They also mention possible health problems with home made kombucha. They also caution against pregnant or lactating women, and the immunocompromised, from drinking kombucha. They do go on to highlight the big picture which is that for healthy people, most of the time, kombucha is a safe and potentially beneficial drink. As with many things, the claims are greater than the science. Also as with many things, more research is needed.  

Would you like to know more about superfoods, dietary supplements and nutraceuticals ? Did you know the National Institute of Health has a division just for you. Check out the National Center for Complementary and Integrative Health,

a division of the National Institute for Health, paid for by your tax dollars. 

Stay tuned for more food news on next week’s Food Friday.  

Food Friday: My Strategic Foods

I am a 54 year old woman with Systemic Lupus. Sounds dismal, huh ? Actually, I am healthy, working, and recreating full time. I hate to say it, but my lupus may have caused me to take better care of my health than I would have otherwise.

I am one of those people who pursues optimal health. I feel I have to, since I am obliged to set a good example for my patients, and because I have a family who relies on me. 

I can’t afford to do anything but eat optimally. I can’t afford to do anything but workout regularly. At my age, with my condition, going backwards is really hard to make up. Going forwards is extra slow, since I also cannot overdo it, so I have to make gains really gradually. 

I love good food and cooking, and I love working out and how it makes me feel and look. So these things are not hard sells for me. I try very hard to convey to my patients and readers the joys of these things, but you may certainly relate when I tell you that most people are not where they would like to be on their fitness and nutrition. So instead of me just sharing how I feel, I would like to tell you a few simple things that I do that help me keep my nutrition in line easily. This is Food Friday, and we are going to talk about my strategic foods. 

With my lifestyle, workout, goals and medical condition, I need more protein that the average 54 year old woman. To help me get that conveniently, I start every morning with about 16 ounces of skim organic lactose free milk mixed with about 2 scoops of whey protein powder. That gets me nearly 30 grams of protein, a reasonable start to the 80 grams per day that I shoot for.

At about 10 am, I make some oat bran cereal, one of my strategic carbohydrates. I include this for the fiber it provides. I take a page from the Giada DiLaurentis' playbook and dress it with about a Tablespoon of olive oil and some kosher salt. It is reminiscent of buttered popcorn. I usually have a bowl of decaf green tea matcha which is full of antioxidants. 

At lunch I usually have fish, chicken or red meat with veggies, which are usually leftovers brought from home. I try to eat lunch with water, either cold or hot. I may also have fruit. I favor blueberries and strawberries, which is good because they are nutrient dense, and low on the FODMAP scale. ( More information on FODMAPS HERE)  I bring them in a little tupperware. These generally leave home frozen and thus by lunch they are just right. 

Mid afternoon I try for some more protein with some kefir ( cultured probiotic milk) or a meat stick. Additionally, in the afternoon, I have taken to drinking a Kombucha which is a fizzy  probiotic drink. 

When I get home from work I need a little something before dinner, and it is usually a little fruit and drink. This sets me up to work out, which I do before dinner. Sometimes I or someone else starts dinner, and I work out while it is cooking. I drink sips of water all though my workout. 

Dinner is, not surprisingly, meat, fish, chicken or eggs, with vegetables and fruit. And here I use another strategic carbohydrate, brown rice. Between the fiber in that and the oatmeal, things “ go well”. Again, I drink water with the meal to aid digestion and keep me hydrated. When I am cleaning up dinner, I fix my lunch and two snacks to take to work, since I am not a morning person. I also fix my protein drink in a “ shaky” bottle so it is ready to grab in the morning. 

And though it is so trendy it is outdated, I am still crushing on kale. I eat it dried, and I eat it chopped and sautéed either in olive oil or coconut oil. I like to toss in tomatoes for color and a bright flavor. I have learned to salt and season after it is finished since it shrinks down so much. You have to start with a heaping pan full to get a couple servings. I use lemon pepper very liberally, as well as Mirin, rice wine, or rice vinegar. Balsamic vinegar also works nicely on kale. 

At bedtime I usually get a little dark chocolate. My recent favorite is a raw Mexican chocolate from Taza. It is spendy, but you only need a little bit. I also get something more to drink. 

Yes, it’s a lot of time spent, and a fair amount of preparation, but it makes me feel good and I like it. Try these strategic foods or develop your own favorites. Remember, small healthy habits, done over long periods of time, make health. 

Food Friday: The Travel Food Tour

Food always factors greatly in my traveling. First, I am concerned about healthy snacks that are allowed on the plane. It ends up being nuts, chocolate, and dried meats like jerky. I buy fruit, veggies and drink as soon as I get past security. 

On the plane I either get a club soda with a splash of cranberry juice, or a bloody mary mix with no alcohol: a Virgin Mary. 

For layovers, I like to keep it light but ethnic. My favorite in Salt Lake is the Greek place, since I seldom get this kind of food. In Seattle, it is Asian of some kind, usually Japanese or Chinese. 

 Once to my destination, I had the good fortune to be hosted some lovely people who came originally from the south of India. She, a Biology professor at Stanford, and he an engineer with a company, they were both a bit older, and had freedom in their schedule. They used this time in some part to putter around in a lovely cottage garden that they both maintained. Big sweet oranges were falling off the trees, while diverse peppers, tomatoes and strawberries decorated their respective bushes. 

We shared similar sensibilities in everyday foods, which took my worries away. Additionally we went out a couple times, once to a traditional Indian restaurant and ate family style. It was so much fun since each new dish was a discovery. The second time we went to a old style steakhouse with clients. The dinner was spiced with political conversation. 

The most amazing use of food was at the conference itself. I laughed when I saw the schedule. As there were not one, but two or three breaks between breakfast and lunch. Tables were set all over the place amidst and some times in auditoriums. The food at morning break might be poached pears, or filled croissants. Lunch was often salmon with several vegetables. Mid afternoon, tea with something on the sweet side was served, from strawberry shortcake to cups of fresh fruit. Fruited ice water was everywhere. 

All of this abundance encouraged a relaxed attitude. People sat with each other ate short frequent meals or servings. Before long another session would be called, and then another break, so it kept people mixing in a very genial fashion. The food was entertaining as well as delicious, so it was an instant conversation starter, fostering very positive feelings.

Finally my travels usually include some exotic purchases. This time I headed to an Indian grocery store which we lack, and picked up some very fresh spices. Small and light, they were easy to bring home. 

I have long advocated that my patients pay more attention to their food. If you do, you will enjoy it more and it will be of a better quality. This fits my vision that enjoyment of good food, good social life and good health go together. 






Food Friday: Feeding the Recovering 

Last week on Food Friday we looked at "Feeding the Unwell". We talked about patients who were quite ill or in the early post op phases. This week we will go on to pleasanter things and talk about the time frame when patients are feeling better, but still are unable to cook healthy attractive food for themselves. 

Nutritional requirements are increased while recovering. In particular, nutrients and protein needs are particularly increased, similar to that for pregnancy. There are other special needs. For example, the need to avoid constipation is key. Those recovering from surgery or whose mobility has been limited are prone to constipation, and this can be a significant source of discomfort. Strategic food choices can help avoid this. 

Those who are recovering may have had antibiotics. They may benefit from probiotics such as yoghurt, kefir, sauerkraut, and kombucha. 

Appetite is often diminished in the recovery period. Foods need to be especially appealing and tailored to the patient’s preferences. It also is best to foster a small frequent meals type schedule. 

Between all this, you as the caregiver or helpful friend have several options: 

  • Bring freshly made food which can be portioned out over time.
  • Bring frozen food which can be heated up.
  • Bring ziplock freezer bag “ Kits” of food for use in slow cookers or fast cookers ( pressure cookers like InstantPot) which the patient might have. 
  • Make sure the patient has enough healthy handy beverages. Consider herb tea, probiotic Kombucha, milk if tolerated and lightly sweetened drinks. 
  • Bring frozen “smoothie kits” containing yogurt or kefir, fruits, and veggies. 
  • Use the secret weapon of some wholesome sweets, .i.e. dark chocolate, or a slice of fruit pie to kickstart a recovering person’s appetite. 
  • Use the secret weapon of salty foods like pickles, salsa or sauerkraut to induce someone to drink more water. 


Here are some of my Pinterest Boards with recipes which may inspire you. 

Instant Pot Tips and Recipes

Paleo Nutrition


Pick dishes with ample protein, fruit, veggies, and fiber. Include healthy fat such as avocado, nuts, olive or coconut oil. For specific information on these, see below: 



Healthy Fat



Here are some tips to make your culinary caregiving experience more manageable and satisfying. 

  • Visit your patient first to see how she really is doing. 
  • Make sure you know her allergies, intolerances, preferences and level of hunger. 
  • Check in regarding who else will be helping, and whether someone else has organized a meal schedule. 
  • Organize a meal schedule yourself using Google Docs or another method of your choice. 


Your patient will not just be well fed; She will have the pleasure of seeing you and the knowledge that you care.  

Food Friday: A More Complete View of Workout Nutrition

Last week we talked about the basics of targeted workout nutrition. This week we will get specific. And we will not talk about all the glossy prepackaged products on the shelves of stores. It turns out that some simple inexpensive choices which anyone can get at an ordinary grocery store make ideal workout supplements. 

It turns out to be good to divide workout nutrition into three categories: pre work-out, during the work out, and post workout. It is also useful to differentiate between nutrition for mostly weight workouts from that for mostly cardio workouts. 

Many of these differences are summarized nicely in an infographic on, which they have encouraged people to repost. I have included it here since I think it is clever, useful and attractive. 

Get health and fitness tips at

Food Friday: Pre and Post Work Out Food and Drink 

Young attractive woman doing exercises for the triceps.jpg

This is actually called nutrient timing in the hallowed halls of medicine. When I initially started looking into this, I found a number of sources calling it bunk, and just as many others touting it earnestly. I wanted to get to the truth of the matter. 

To understand the rationale for pre and post workout food and drinks, one must understand the concepts of catabolism and anabolism. These are the two basic metabolic modes that the body can be in. 

Catabolism is the state of breaking down.

Make no mistake, all exercise is, by design, a teardown or at least a strain, on body parts. What makes exercise more than just trauma is that it is done in such a way to be just enough strain to stimulate new growth, or anabolism. Moreover, it is balanced between upper and lower body, as well as between flexor and extensor muscle systems of the body. Exercise is a well designed program of strategic strains on the body so as to stimulate a growth and strengthening of the systems. 

Anabolism is a state of building up that one will hopefully achieve in the aftermath of exercise. 

Clearly this state of anabolism is resource requiring, even resource intensive. We need certain amounts of water, carbohydrates and fats for energy, and protein to build body parts. 

Review of the literature reveals a shortage of good studies on the effectiveness of pre and post exercise supplements. However a number of general insights can be gained. 

  • Gains after exercise are greater when exercise is in initiated in a non fasting state. 
  • A meal should not be closer than 1.5 to 2 hours before a workout. 
  • The so called post exercise window when one can benefit from this supplementation is not as small nor as soon as was previously believed.
  • To maximize anabolic effect, pre and post meals should be separated by no more than 4 hours. 
  • Good nutrition spread throughout the day also supports continued anabolism. 
  • The post exercise interval is more important than the pre-exercise interval, but supplements at both times appears to confer some benefit in optimal anabolic gain and have little risk. 
  • Carbohydrate is needed as well in the post exercise interval in order to replace glycogen, but the carbohydrate need is met by meeting the normal daily requirement for carbohydrate distributed throughout the day. 
  • Protein supplementation pre and post workout should be about 0.5 g/kg of Lean body mass (LBM) For example, a 50 kg person would consume 25g of protein a couple hours before a workout and a couple of hours after a workout. 
  • Pre and post exercise supplements seem to confer a greater percentage gain in the untrained versus the already trained. 
  • Pre and post workout supplements need not be expensive or prepackaged. Protein powder in milk will do nicely. 

Good for you if you are interested in both fitness and nutrition. Now you can leverage them both for some serious gains. Ladies, remember, muscles do not make you look big. They make you look toned and sleek. And they burn more calories than fat. Best yet, they let you do fun things like carry backpacks, ride horses and play sports.