Big news this week is that President Obama had his first physical exam since assuming office.  The press pounced on the fact that the POTUS had slightly high cholesterol, 209, up from 173 on his previous physical.  Mainstream media proffered headlines like “Barack Obama’s Health Troubled by Cheeseburgers.”  White House doctors urged Obama to eat a low cholesterol diet. That’s not the solution.  A major study (actually a meta-analysis of 21 previous studies) in this month’s issue of the prestigious American Journal of Clinical Nutrition looked at thousands of patients and concluded that there was absolutely no connection between dietary intake of saturated fat and heart disease, stroke, or cardiovascular disease in general.  That’s right, folks, fat—even the saturated kind—is not the problem. What is?  It’s refined carbohydrates in the form of sodas, candy, flour products, even excess “fruit drinks.”  But why the obsession with obsolete cholesterol guidelines in Obama’s case?  He has robust HDL cholesterol of 62, his blood pressure is great, he’s lean, and he’s an avid basketball player and jogger. Of interest is that his doctors opted to perform an EBT heart scan, confirming that he had zero plaque in his coronary arteries.  If you listen to Health Talk, or if you’ve been a patient of mine, you know that I’m a big fan of that test for determining whether patients have heart disease risk.  The irony is that Medicare and most insurance companies won’t pay for this excellent test. If it’s good enough for the Prez, why can’t we get it?  Oh, and that virtual colonoscopy he got?  That just got disallowed by Medicare, too.  Government rationing, anyone?Don’t even get me started about Obama’s continued flirtation with tobacco.  My interpretation is that he thinks he’s exempt from rules that apply to ordinary mortals.  If he had real character, he would pledge to stop smoking and make it a national event, spotlighting the harmful effects it has on Americans’ health and on spiraling health care costs.  Mr. President, use your bully pulpit for the sake especially of the millions of American youth who consider you a role model.  Your purported efforts to curb health care costs with colossal new government programs would seem less disingenuous.

On the mountain at Canyon Ranch

Just returned from Canyon Ranch in Tucson after a week’s respite from NYC winter blahs.  The weather was fantastic; we managed a perfect insertion with six cloudless days in the 70s and cool nights in the 40s between two El Nino rainstorms.  This was fortuitous, as temperature dips and flooding would have played havoc with our hiking/biking plans. For those of you unfamiliar with Canyon Ranch, it’s sort of the perfect conception of heaven for the health-conscious:  whereas suicide bombers envision 40 virgins, evangelicals lean toward angels playing harps on clouds, Vikings prefer a raucus Valhalla banquet hall, and Romans pine for the Elysian Fields, Canyon Ranch offers a full menu of healthy pleasures:  nutritious gourmet food, interesting classes (I took star-gazing and photography), golf and tennis clinics, hiking, biking, great lap pools, and a fantastic spa with an incredible array of massage and body treatments. But beware:  there are no cell phones in public, no booze, and no cigarettes, and no junk food—this might be some people’s idea of Purgatory. One of the new things I learned about this time was Yamuna body and foot treatments, which involve use of special balls and rollers to stretch and stimulate muscles.  This is something I’ll be sure to incorporate alongside my stretching routine to overcome pain and overuse injuries. We took some great hikes, and I cycled up Mt. Lemmon to an altitude over 5000 feet (It’s 7400 feet up, and pros like Lance Armstrong bound up to nearly the top, ride the team van down, and do it over again before lunch).  But I still felt good putting in a hard climb on the challenging steep grades. I’m pleased to see that Canyon Ranch is “getting with the program” on gluten-free options.  With no difficulty, I obtained delicious rice pasta with meatballs (I earned it after my daily exertions!), and gluten-free muffins and even pancakes.  Maybe next year there’ll even be a Paleo menu option!  Dr. H to Canyon Ranch:  Need a menu-consultant?? At the end of the trip we swung by the Sonora Desert Museum which is the world’s premier museum dedicated to desert habit.  It’s picturesquely situated in Saguaro West National Park, which offers spectacular vistas of mountains and vast stands of majestic Saguaro cacti.  Got some great pictures, which I’ll post on my Facebook profile page.  Come check them out.

With Valentines’ Day around the corner, I thought it might be apropos to offer a run-down of the biochemical changes that occur when we’re in love.  Or, stated otherwise, what’s the formula for Love Potion Number Nine?

First of all, let’s not confuse love with fluid hydraulics.  That’s what Viagra’s for, and it can help to overcome erectile dysfunction by promoting circulation, but it doesn’t recreate the sublime feeling of infatuation.  In fact, while erectile dysfunction drugs may help men have sex, they seem to do little or nothing when given to women in clinical trials.

This may have given rise to the saying, popular among sex researchers, that a woman’s most important sex organ is  . . . her brain.

Not to be confused with sexual arousal, the term “Limerance” refers to that state somewhere between agony and ecstasy where the heart goes pitter-patter for one’s love object.

The brain neurotransmitter serotonin clearly has something to do with it.  The ultimate serotonin-releasing drug is MDMA, better-known by its street-name Ecstasy.  It produces feelings of rapturous love, and users report transcendent interpersonal encounters, or even getting stoned contemplating ordinary objects.  Interestingly, it impedes sexual performance, so it’s more about Platonic love.  And users of lesser serotonin-releasing anti-depressants like Prozac (an SSRI or serotonin reuptake inhibitor) often report sexual dysfunction.

Then, of course, there are the sex hormones estrogen, progesterone, testosterone and DHEA.  Higher levels of estrogen promote female sexual behaviors, while progesterone doesn’t do much, and testosterone and DHEA promote libido in both men and women.  In fact, low levels of DHEA in women are predictive of loss of libido.  Testosterone unreliably promotes sex drive in women, suggesting true love is not about testosterone.

Phenylethylamine, or PEA, has been getting lots of press lately because it activates brain centers responsible for loving feelings.  It has an amphetamine-like effect, and therefore has addiction potential.  Chocolate has a high PEA content, hence the hypothesis that a Valentine’s Day box of chocolate may be an aphrodisiac, or alternatively, a consolation prize for the real thing. 

But scientists now report that PEA is broken down during the process of digestion and may be poorly absorbed.  So the “buzz” people get from chocolate may be just from the good taste, the sugar, rich fat, and caffeine.

Pheromones may play a stealth role in attraction.  These molecules are part of a primitive signaling system that involves the very ancient olfactory system that is a direct pipeline to the emotional center of the brain, the hypothalamus.  Sometimes pheromones can be detected as attractive “funk”, but often they are undetected and hit us “under the radar”, subliminally influencing bonding behaviors.

Clearly endorphins, our body’s own homemade opiates, are part of the “high” that’s associated with love.  Again, as with OTC pain meds and heroin, think strong addiction potential:  Robert Palmer had it right in his memorable rock lyric “You know you’re gonna have to face it, you’re addicted to love.”

Then there’s oxytocin, an interesting hormone that gets released when there’s physical contact.  A slow dance or a hug can bathe you in this affinity-reinforcing hormone that may be the key to pair-bonding in mammals.  Touch deprivation takes a toll on health, because oxytocin triggers a profound relaxation response.

No discussion of the chemistry of love would be complete without mention of dopamine, the neurotransmitter responsible for motivation and reward.  Hooked gamblers banging away at the slots in Vegas or Atlantic City are stoking brain levels of dopamine with every lever pull.  Dopamine is also profoundly associated with risk-taking behavior like extreme sports—or illicit affairs.

So profound is the effect of dopamine on behavior that users of drugs that rev dopamine—commonly used for restless leg syndrome or Parkinson’s Disease—sometimes depart from their staid ways and embark on serial affairs.  Malpractice suits commonly award aggrieved plaintiffs big sums when marital breakups are triggered.

Bottom line, love is sublime, but akin to madness and intoxication.  It’s a force of nature to be reckoned with.  Maybe we should just study the brain chemistry of Tiger Woods for an inside peak at the chemistry of love.  And he just got out of rehab!

This last weekend, the potential to do some real serious damage to the arteries was there:  it was lousy weather, there were FOUR NFL playoff games, the season premiere of “24″ and the Golden Globes! 

I had company over to my house the whole weekend, and decided to head things off at the pass:  I got the Nintendo Wii Sports and Wii Fit Plus and installed them in the flat screen home theater.

My verdict: I think it’s a great way to get the whole family involved in fitness activities.  There’s something for everyone here: serious strength training and aerobics for dedicated jocks, games for all ages (I particularly enjoyed bowling and tennis), and even balance exercises for the older crowd.

Regular aerobic and strength training still comes off as the surest way to stave off mental decline, trumping crossword puzzles and Sudoku; also, insidious declines in balance are as important as loss of bone density in predicting osteoporotic fractures, not to mention the anti-diabetes and cardiovascular benefits.

The system is well-designed and helps motivate you with cute “Miis” that you can create as avatars to participate in the activities.  You hold the controls and move your avatars.  Boxing was a hoot–I stood there flailing away with my controls against a 31 year old trained boxer who repeatedly sent my Mii to the canvas.  I managed to knock him down once or twice, but pretty soon, I was out for the count, and we were all laughing hysterically, but seriously out of breath, no concussions!

An 80-plus guest looked a little unsure as we showed her the controls for bowling, but quickly got the hang of it.  You should have seen her face after she bowled two consecutive strikes–talk about a rejuvenation program!

There’s a new reason to stay fit in 2010. Normally, it’s anticipation of resort season that creates the impetus for dieting and weight loss in mid-winter. But this year, it’s different. New urgency has been imparted with the initiation of body-scanning, coming to an airport near you.

Happy New Year!

Bob, one of my patients, just contacted me with a worthwhile query: Bob writes

“As the beneficiary of good health outcomes via natural therapy, I would like an opportunity to express my appreciation. Dr. Hoffman, at this holiday time, is there a worthwhile philanthropy that you endorse to further the goals of nutritional medicine?”

The answer is yes, there are several (and thanks, Bob, for asking!).

One of my favorites is Vitamin Angels (www.vitaminangels.org).

The mission of Vitamin Angels is “to mobilize and deploy private sector resources to advance availability, access and use of micronutrients, especially vitamin A, by newborns, infants and children in need. Vitamin Angels reduces child mortality worldwide by connecting essential micronutrients, especially vitamin A, with infants and children under five. Essential micronutrients enable young immune systems to fight infectious diseases, helping children attain good health and the opportunity to lead meaningful and productive lives.”

Or, if you’re more into the politics of complementary medicine, the Alliance for Natural Health (www.anh-usa.org) is a good organization to support.

The stated goal of the ANH is “promoting sustainable health and freedom of choice in healthcare through good science and good law. We protect the right of natural-health practitioners to practice and the right of consumers to choose the healthcare options they prefer. Since 1992, we have worked to shift the medical paradigm from an exclusive focus on surgery, drugs and other conventional techniques to an ‘integrative’ approach incorporating food, dietary supplements and lifestyle changes. This is the way to improve health and extend lives while reducing the costs of healthcare back to a sustainable level.”

One of my favorite philanthropies is the American College for the Advancement of Medicine’s Education Foundation (ACAMef). I am a former president of ACAM, and it’s a great training resource for physicians; they also provide a useful directory for patients seeking scientifically-trained complementary physicians. Twice yearly, I go to ACAM conferences to learn what’s new in alternative medicine. Their website is

http://www.acamnet.org/site/c.ltJWJ4MPIwE/b.2073059/k.29EF/Foundation.htm

The stated goal of ACAMef is “to educate and empower physicians, patients and the general public about complementary, alternative and integrative medicine (CAIM). To accomplish this mission, we have a three prong approach; funding medical research for treatments that will support and enhance complementary modalities and integrative therapies, providing assistance for public programs and group forums that champion patient rights through education, information and access to CAIM therapies and providing educational scholarship for medical students from accredited medical schools seeking to enhance their scope of study with programs and seminars in complementary, alternative and integrative medicine.”

So this holiday season, if you’ve benefited from the advice we’ve provided you on Health Talk in 2009, consider showing your appreciation by giving a little something back to keep this field alive and vibrant. Remember, altruism has proven health benefits–charitable acts can actually extend your life!

Happy Holidays and best wishes in the coming New Year!

Dr. Hoffman

One of my holiday traditions is to see Handel’s Messiah.  And my favorite place to see it is St. Thomas Church in midtown Manhattan.  This year, the performance, by the men and boys’ choir of St. Thomas Church and visiting soloists, was spectacular. In the seventeenth century, Handel revolutionized music by composing an oratorio based on sacred texts.  Controversial at the time, some critics lambasted it as a profanation of the story of Jesus, because it was performed in a secular context. It wasn’t even in Latin—it’s in English!  But the public of Dublin, then London embraced it, and King James the Second was so moved that he inaugurated the tradition of standing during the Halleluiah Chorus. The orchestration is by Mozart, so you have a sense of an amazing historical tradition where biblical texts depicting ancient events are interpreted first by Handel, then passed along to us via one of the world’s most celebrated composers, and then preserved for posterity. The voices of the men and boys of St. Thomas’ choir harmonize beautifully to create a moving sound collage.  The soloists offered moving renditions of the sacred texts, including an eerily soprano-like male counter –tenor.  There is no more lovely musical experience at holiday time.

This weekend, I hit the nostalgia trail to see Finian’s Rainbow on Broadway.  Nostalgic because Finian’s Rainbow was my high school senior play (I didn’t participate in it because I had stage fright in those days and couldn’t dance or sing).  I’ve since overcome my stage fright (but don’t ever expect me to dance or sing). I was pleasantly surprised, because I thought of Finian’s Rainbow as kind of a square “heritage” musical.  Actually, it’s breakthrough, profound, and wonderfully witty.  The lyrics are astoundingly good, and every song is a classic hit. For 1947, it’s incredibly hip.  It lambastes racism, featuring a racist Southern politician who gets transformed into a black minstrel singer, and regains his “soul”.  Here’s an example of the “Begat” song:

They begat the daughters

of the DAR

They begat the Babbits

of the bourgeoisie,

Who begat the misbegotten G.O.P. The musical can also be seen as a clever parable about capitalism, pretty trenchant in light of the recent global financial meltdown.  Finian steals a pot of gold from a leprechaun, and then buries the gold in the ground in an impoverished valley inhabited by sharecroppers.  Rumors about the presence of gold leak out, and soon the inhabitants are deluged with offers of credit lines.  “We’ve got money!” exclaims one of the chorus.  The hero answers:  “What we’ve got is better than money—we’ve got credit!”  Prescient words, indeed!  The gold eventually turns to dross, but its transformative magic leads to love and racial harmony—not a bad message.  It was nice that our high school steeped our young minds in this ethos—back in 1969! Then, more nostalgia: I saw Pirate Radio, a movie about the Rock ‘n Roll revolution in Britain circa 1966.  The official BBC wouldn’t play rock in those days, so off-shore pirate radio stations aboard ships broadcast songs 24/7, attracting 20 million listeners.  Pirate Radio captures the spirit of an era when music launched a social revolution. Although the plot was a little contrived, the portrayal of the idiosyncratic DJ’s is a hoot, and how could you go wrong with archival cuts from the Kinks, the Rolling Stones, Donovan, the Beatles, the Who, and Jimi Hendrix? It  brought back the days when turning on the radio was almost a subversive act—we felt like we were part of something big, the birth of rock ‘n roll and the advent of a drastically altered social landscape.  People try to put us d-down (Talkin’ ’bout my generation)
Just because we get around (Talkin’ ’bout my generation)
Things they do look awful c-c-cold (Talkin’ ’bout my generation)
I hope I die before I get old (Talkin’ ’bout my generation)

This is my generation
This is my generation, baby

People have been asking me for my gluten-free stuffing recipe. We served it this Thanksgiving for family and guests, including two invitees from Spain who were having their first American Turkey Day feast. It was a great success.

Just saw Memphis this week.  I started out a little skeptical.  After all, this story-line vein has been well-mined in such B’way productions as John Waters’ Hairspray (white girl discovers black music, overcomes racism) and movies like Cadillac Records  (white boy discovers black music, overcomes racism). But I was won over by the fun musical score, and the great characters that transcended a slightly sappy story line.  Chad Kimball and Montego Glover are great as the inter-racial lovers, and they are well-supported by dancers and vocalists. Memphis is Broadway at its best, in the tradition of Porgy and Bess, but updated with modern production values and hip arrangements of R & B music.  It’s a polished ensemble, and it offers quality, uplifting entertainment—after all, isn’t that what going to a show is all about?

Memphis Commerical