Monday, October 27, 2014


While I usually don't re-post other blogs on this blog, I do so today because author Tim Ferriss says what needs to be said so eloquently. Depriving certain cancer cells of sugar, through diet and medication, can literally starve them to death. Glucose is essential for anaerobic metabolism which is the preferred way for these cells to create energy. Ferriss and Dr. Peter Attia both highlight that the use of the blood sugar lowering agent metformin (Glucophage) has been shown to decrease cancers in Type II diabetics. As usual, contact your physician before starting any prescribed medications.
"Potential Tactics for Defeating Cancer - A Tool Kit in 1000 Words"

Ferriss is the author of The 4-Hour Body which is on my recommended reading list. Beware though: it is not for the squeamish.


Thursday, August 14, 2014

Through Early Morning Fog I See

On Facebook, someone wrote that Robin Williams' death this week felt like a "gut punch." That is how I would describe my reaction, too. It is like losing a good friend or relative. And a friend who could make me roll about on the floor laughing. Reactions to his suicide range from grief to judgement to outright mockery (think "fat radio personality"). Having dealt with depressed patients in clinical practice and with attempted suicides in the ER, I want to add something to the conversation. In addition, there is my own personal experience with depression to draw on.

In this country, we are so fiercely independent that even thinking of asking for help is considered a sign of weakness. If there is just one take-home message you get from me today it is this: depression is an illness. A person with pneumonia didn't ask to get sick. A person with Crohn's disease shouldn't be embarrassed about having the illness, asking for help, or taking medications. Yet we treat people with mental health issues like they are pariahs at best, criminals at worst. Stepping off my soapbox for a minute, I now want to get clinical with you.
Psychiatrists characterize depression as a Mood Disorder, meaning that it depends on the person's own internal state. In this case, it is an overwhelming state of sadness. Other internal feelings include worthlessness, hopelessness, and guilt. External signs and symptoms (you do know the difference, don't you?) include insomnia/hypersomnia, increase/decreased appetite, early morning awakenings, and anhedonia or the loss of pleasure in life. There may be other associated factors including problems with memory and increased anxiety. To sum it up, a person with depression is in emotional pain.
Suicide is the ultimate attempt to end the pain. As illogical as it seems to those of us on the outside looking in, this course of action is perfectly logical to the person contemplating it. Those internal feelings of worthlessness, hopelessness, and guilt seem overwhelming and permanent. If the person has had periods of severe depression in the past, he may not want to go down that path again so suicide is like taking the nearest exit ramp off that road. To those who have never experienced severe depression, suicide appears to be an act of the weak and cowardly. Trust me: the pain is so overbearing that suicide becomes a form of treatment for that person. A desperate treatment but desperate people do desperate things.
As usual, I like to end these posts describing what you can do to help people with depression and thoughts of suicide. First of all, the highest risk factor for suicide is a previous suicide attempt. So if  you know someone who has tried it before, be especially vigilant for any of the signs or symptoms I described before. For anyone, if you suspect suicidality ask them one simple question: "are you thinking of hurting or killing  yourself?" That question has saved thousands, if not millions of lives.If you get a "yes" answer, do what you can to get that person help. Immediately.

It's not a bad thing to lament anyone's death. People felt close to Robin Williams and grieve as if someone they knew had died as do the friends and families of anyone who has committed suicide. It's a sad tragedy no matter who you are.

Friday, June 27, 2014

A Calorie is Not Just a Calorie

Does this sound familiar? You want to lose weight so you buy into an established program like Weight Watchers or Jenny Craig. Or you buy yourself yet another dieting book, perhaps the latest craze everyone is talking about. Conventional diets have you counting calories: not only what you consume but how much you  presumably expend during exercise. You measure portion sizes according to some pictures, the size of your hand, or even pre-made plates they sell you. The stress rises from all the attention to detail and attempts at perfection.

You do lose weight initially. It seems all "diets" lead to some weight loss in the first few weeks. What happens then? You plateau. No matter how hard you exercise and how much attention you pay to your food portions and avoidance of fats, you can't seem to make the same inroads any longer. So you stop counting calories, maybe unconsciously  at first. Your metabolism has slowed on the calorie-restricted diet and now established eating patterns result in increased weight and fat deposition. Now you are heavier than when you started. What to do next? Of course: try the latest dieting fad. The cycle repeats itself.

What if I told you counting calories and fat-restricted diets are things of the past? That the added stress of counting calories consumed and expended increases cortisol levels which in turn increases fat deposition? That there are ways to lose fat and tone muscles that allow you to eat all you want of the correct, nutritious foods?

There are. I lived it myself.

In February of 2012, I weighed-in at a whopping 220 pounds, 45 pounds heavier than my college graduate weight. We had Dolphin Therapy for Jon coming up in March and I wanted to lose some of my rolly-polliness so I started practicing what I had been preaching to my patients for the last 2 years. I attacked the problem in two ways: jump-starting my weight loss with the 2 week "induction" phase of the Atkins Diet. I knew it would work since I made astounding progress on it when I was training for a body building contest in 1997. I then followed that with the Wheat Belly Diet, devised and written by my friend and cardiologist Dr. William Davis. I also monitored my body fat, cholesterol levels, and C-Reactive Protein (CRP) levels. CRP is a generalized measurement of acute inflammation. Chronically elevated levels of inflammation are associated with cardiovascular disease among other things:
                   "Recent research suggests that patients with elevated basal levels of CRP are at an increased risk of diabetes, hypertension and cardiovascular disease."

Six weeks into the program I had lost 30 pounds. My total cholesterol level had dropped from 220 to 187. My body fat had decreased from 30% to 22%. And I never went hungry. Admittedly, the Atkins part of the regime was rigorous. The Wheat Belly part is just fun. Discovering new ways to prepare wheat- and gluten-free meals appealed to my inner Chef.

This is the gist of the program that I advocate for all my clients, friends, and relatives. There are obviously more details that I will explore in later posts. But for now, please consider buying or borrowing these two books. Learn that "diet" refers to a lifestyle (not THE Lifestyle which I will talk about some time later) and that you can enjoy eating sanely and nutritionally.

And stop counting calories: it's not healthy.

Thursday, June 19, 2014

Where There Is No Doctor

Where There Is No Doctor is book published and sold by the wonderful people at Hesperian Health. I used the book myself while in Nicaragua. For a physician, the content can be a bit simplistic at times but I do acknowledge that the intended audience is for non-physician health care workers. Only 10 percent of pathologies and medical states constitute 90% of what any given provider will encounter. Workers can easily be trained to diagnose and treat those conditions. The remainder would need to be referred to specialists  (ideally over the internet) who will work with the providers to ensure adequate care and follow-up.

During my tenure in Nicaragua, I applied for a grant that addressed the need to bring quality health care to underserved areas of that country. My proposal was based on Mao Zedong's attempt to do the same thing in China. He called the program "Barefoot Doctors" and, in a real small nutshell, medical doctors would train motivated individuals picked by their respective villages in the essentials of medicine (like the 10% mentioned above) then send them back to the villages as primary care providers. My proposal did not receive the grant (I submitted it too late) but it served as the basis for my third book Barefoot Doctors (A Quiet Revolution).

The biggest and  best advantage my Barefoot Doctors idea has over Chairman Mao's is the internet. Surprisingly, internet access is available in the least expected places. Where it is not, there are many like-minded groups such as PATH trying to transform the face of medical access throughout the world. MY vision includes getting access to volunteer specialists 24 hours a day, 7 days a week. We CAN do this. It will just take time, money, innovation, and motivated people.

Hesperian Health is a wonderful endeavor created and run by people who have a real heart for serving. If you get the chance, head over to their website, browse around awhile, purchases the resources you are interested in, and donate to them if you feel the need. Their mission is similar to mine.

Saturday, June 14, 2014


This scenario was so common in my clinic that it is almost cliché: men refusing to acknowledge they have an illness until it is too late. I don’t know if this is a genetic thing, perhaps some DNA located on the hairy ear chromosome, or if it is cultural. I know, it is difficult for American males to admit weaknesses and ask for help. Even when we get to the point of crisis and ask for help, a common response in this country is “help yourself.” Been there; heard that.
Let’s talk prostate cancer. It is a touchy subject, one that men don’t want to discuss and many females find “yucky” for some reason. For example, when I found the supplement called “Man Gold” at the Vitamin Shoppe, one of my daughters originally “liked” it on facebook then retracted it when she read that it “supports prostate health.” I guess thinking about your father’s private parts is taboo.
Here are some prostate cancer facts taken from the American Cancer Society website:
            Other than skin cancer, prostate cancer is the most common cancer in American men. The American Cancer Society’s estimates for prostate cancer in the United States for 2014 are:
  • About 233,000 new cases of prostate cancer will be diagnosed
  • About 29,480 men will die of prostate cancer.
  • About 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
  • Prostate cancer occurs mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.
  • Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 man in 36 will die of prostate cancer.
This avoidance of men’s issues is evident on a national level, too. According to the New York Times:
            Among the big cancers, breast cancer receives the most funding per new case, $2,596 — and by far the most money relative to each death, $13,452. Notably, prostate cancer, the most common cancer, receives the least funding per new case at just $1,318. But on a per-death basis it ranks second, with $11,298 in N.C.I. funds.”
You can help change both scenarios: men’s seemingly natural tendency to address health issues and the avoidance/repulsiveness attitude about the prostate. Us TOO International Prostate Cancer Education & Support Network is “a grassroots, registered 501(c)(3) non-profit prostate cancer education and support network of 325 support group chapters worldwide, providing men and their families with free information, materials and peer-to-peer support so they can make informed choices on detection, treatment options and coping with ongoing survivorship. The organization was founded in 1990 by five men who had been treated for prostate cancer.” Go ahead, click on the link and give your support. The group gives good advice to family members who have a loved father, grandfather, or husband with the disease. Talk about it. If mom developed cervical cancer would you shun discussing it with her?

As a tribute to fathers everywhere, including my own dad Norbert Mangold who died way too young, I am offering my book How to Think Like a Doctor for free for two days starting June 15th. Please, download it, share it, and review it on whether you like it or not. I appreciate thoughtful reviews and have made modifications based on some of those comments. It really is a good read.
Learn and enjoy!
Dr. Mike

Thursday, June 12, 2014


As a lightweight camper and hiker, I always enjoy finding new multi-use gear (I sound like Alton Brown!). For over a year now I have been advocating the original, smaller BioLite wood stove which also generates electricity and now the company has generated a Kickstarter campaign for the same type of fuel efficient stove. This one is meant for groups but still maintains the same efficiency, making it ideal in crisis and underserved areas of the world where wood is scarce, such as in Haiti.

In fact, my first endeavor in this area is as co-creator of the Mangold Mamba in the aftermath of the earthquakes in that country. While wood is scarce there, alcohol is not. This is a great example of how the SCANCAPS concept works: good health, a safe environment, clean water, and nutritious food are all required everywhere we live. If you can, click on the Kickstarter link and make a difference in someone's quality of life.

Saturday, May 31, 2014

Dementia II

In the first part of this series I talked about how dementia is not only a decline in memory but also a decrease of other higher cognitive functions such as reasoning and judgment. While I was big on detection, especially subtle clues, I lacked in prevention. Always a proponent of eating correctly, exercising, and supplementation, I have found more specific guidelines published by The Amen Clinics here:

Note the standard recommendations for fish or krill oil and Vitamin D which all of us should be taking. Take a look at some of my previous posts for more detailed information, too.

Does following Dr. Amen's advice help someone already with dementia? Perhaps early on but a well-regulated regimen of supplements, physical and mental exercise, and medications is the best approach. While I hope family members can get involved in their parents' care, early intervention is critical to minimize damage and prolong a quality life. Getting mom or dad to admit she or he has a problem is also a challenge. My best advice: do not enable. Do not tell your parent that everything is fine. Do not allow  your siblings to enable either. Easier said than done. Trust me.

Wednesday, May 21, 2014


--Alexander Pope

            I have been doing a little research on the role forgiveness has on healing. Ironically, I found more material on the internet from secular sources such as the American Medical Student Association (AMSA), Mormons (Church of Latter Day Saints), and Eastern religions such as Buddhism and Hinduism than I did from mainline Christian groups (exception, Matthew West: see link to right). This struck me as peculiar since Jesus lived a life forgiving people, not only from sins they committed against God but also against himself: “Father, forgive them, for they do not know what they are doing” (Luke 23:34). From a medical standpoint, I will use sources such as the Luskin article in the AMSA link above.

There are several health benefits to true forgiveness. These include decreased anger and negative thoughts, decreased anxiety, decreased depression and grief, and decreased vulnerability to substance abuse. The latter includes alcohol and in some cases, nicotine abuse. Do a self-experiment: remember a time when someone said or did something to you that you consider a “sin” against you. It can be real or imagined: imagined sins, as NLP has taught us, feel real to us (as an important aside, I have coined a new word “mangole” which is the ability take what someone has said that was meant to be positive or at the best neutral, and twist it around until it becomes negative and destructive to that person’s peace of mind. As in “I told her to let him describe it for me but she mangoled it up until she convinced herself I told her to shut up”). Now remember it in detail: the sounds, pitch of the voice, visual cues, even the ambient temperature. Now note your heart and respiratory rates. Perhaps even the flush of your skin. See how long-term sins can affect you even now. I believe that if you truly forgive someone, you can recollect that moment and not experience that negative zone. How do we do that?
      My personal approach is a combination of scientific (secular) practices such as NLP, some Eastern influences such as mindfulness and meditation (although meditation has also been a Christian practice and value throughout 2 millennia), and supposedly Christian values such as loving your neighbor as yourself:
Find a place to relax that brings you peace. Close your eyes and concentrate on your breathing. I wish for Christianity’s sake that the word “mantra” wasn’t so scary but having a word or phrase to help you focus your concentration is a wonderful spiritual gift. Mine is “Shalom.” When my thoughts wonder or when my breathing rate increases, I repeat the word mentally. When you are relaxed and able to focus, bring to mind the person who sinned against you again, real or imagined. Ask God to help you forgive that person. With God’s help, forgive him or her. If there is any tension involved with remembering the incident, ask God for more help. Give thanks. Have peace in what you have done. You have done that not only for your health but for your spiritual evolution. And importantly, for that other person. It is a win-win situation.


Forgiveness: Overcoming the Impossible by Matthew West

Saturday, May 17, 2014

How to Think Like a Doctor Reviews

How to Think Like a Doctor describes how a physician thinks. Whether you are a Medical Assistant student, a nursing student, a pre-med student, a new medical student, or even going into health care administration, you will benefit from discovering the process of how an M.D. or D.O. views any particular patient encounter and arrives at a diagnosis. The Diagnosis is key and ties together all of the other elements of the encounter so that a Plan can be formed to make the patient better. Improvement in health is why doctors do what they do and now you can gain an insight into that thought process. 

Even if you are not a health care student or provider, How to Think Like a Doctor will make you a more knowledgeable patient. My best patients are those who become experts about their own bodies and their own medical and health issues. In addition to diseases, doctors address pain issues, mental health issues, dietary concerns, and even societal ills. Some physicians strive to make healthy people even better. So if you fall into any of these categories, you will benefit from this book.

From the Reviews:
1. 5.0 out of 5 stars
 Initial thoughts September 13, 2013
By MBell
Format:Kindle Edition|Verified Purchase
Just downloaded and I am already adding some words to my vocabulary "new favorite words list". Good stuff. I think that not only is this insightful information, but also a motivator for me personally. I don't know if anybody else feels this way, but the more knowledge I gain, the more excited and confident I feel myself becoming. I am in the beginning stages of obtaining a degree in Surgical Technology and this book is a great resource of information that otherwise would need to be obtained from years of on the job experiences. Highly recommended.

2. 5.0 out of 5 stars
 Excellent Resource May 15, 2014
Format:Kindle Edition|Verified Purchase
An excellent job of breaking down the "doctor speak" into terms that ordinary people can understand. Dr. Manhood also explains WHY doctors do a lot of the things they do, and some of the pressures put on them that have nothing to do with patient care. I highly recommend this book for all patients. The more the patient understands what the doctor needs to know, the better information they can give the doctor.

3. Well written, easily understtod September 15, 2013
Format:Kindle Edition|Verified Purchase
This is a great book for all healthcare consumers and those starting out in any healthcare field. As a registered nurse, I was impressed by the simplicity that the author brought to what many would perceive as a difficult process. It empowers the healthcare consumer by giving them insight into how a doctor moves through the process from meeting a patient to diagnosis. I have recommended this book to the many nursing students that I encounter and to patients who express an interest in taking control of their healthcare decisions. Highly recommended.

Here is one I don't understand. The reviewer would have given the book 5 stars if it had a different title maybe? I did respond to the review and challenged the reviewer to actually write an eBook that addresses the concerns expressed in the review. To give the book 1 star instead of 5 would be like giving The Wheat Belly Diet a low rating because Dr. Davis doesn't address the health concerns of cow's milk:
By Jan P
Format:Kindle Edition|Verified Purchase
This book, I think, does accurately reflect "How many doctors think" - but, I'm giving it just one star for exactly that reason.

The case study on Mrs G reveals she's 5'3" & 200# which is morbidly obese with elevated blood pressure (142/88), and arthritis and NOT one recommendation of addressing the inflammation of her arthritis, obesity or hypertension with diet. No recommendations for diet change, weight loss, aerobic exercise to help promote wt loss (sorry, yoga alone may not do it) or a referral to a dietitian/nutritionist. And, prescribing NSAIDs is likely to just screw up her gut eventually.

That's why I refer clients to integrative or functional physicians that would address the entire client with lifestyle change and refer to somebody that could help her, not just drugs and yoga, which may be unsafe in many positions with hypertension, such as downward dog.)

Sunday, May 11, 2014


I am in the age group where many of my friends are now dealing with aging parents. Many of the latter have some form of dementia which complicates not only their health issues but also our ability to help and support them. “Dementia” does not only refer to memory loss. It also includes defects in reasoning, decision making, judgment, and language. Keep all of those factors in mind since there is an interplay between them and the affected person’s own personality.
One difficulty we face is that our parents often refuse to acknowledge that they have a problem. They can be very good at covering-up memory lapses such as joking about them (“if my head wasn't screwed on I swear I’d forget where I put it”) or even denying they have a problem. Sometimes the problem can be evident to us and sometimes they’re good at covering up. This is where I want to take you in this series of blogs: how can you identify dementia using the other symptoms? What does early, untreated dementia mean to you and your relationship with your parent? And what can we do about it?
Dementia is not a disease per se but rather a set of symptoms that cause difficulties in any or all of the following mental capabilities:                                  
1.       Memory
2.       Reasoning
3.       Judgment
4.       Decision Making
5.       Language (not only expressive but importantly, receptive)
Developing these five areas is what growing up is all about. Becoming proficient in them is what being an adult is all about. We gain better judgment because of what we remember that works and does not work. Because of that judgment, based on our experiences, we become better at reasoning and decision making, and “decision making” is the active result of reasoning whether it is in what we say or what we do. In this first part of the series, I want to focus on language or what we say (“expressive”) and what we understand others say to us (“receptive”).
Perhaps a better word than language is communication because only a percentage of what we communicate is auditory while a large part is body language, voice pitch and rate, and facial expression.  For a more detailed explanation, check into Neuro-Linguistic Programming (see “Recommended Reading” at the bottom of this page). In a nutshell, what a person hears is not necessarily what we believe we speak. Older people automatically have a disadvantage since the sense of hearing naturally worsens as we get older. Secondly, people with dementia have poorer memories so what they REMEMBER hearing is often not what was said. Thirdly, there becomes a disconnect between the communication received and that person’s reasoning, judgment, and decision making.  As a result, how they respond (say or do) can be totally unexpected based on what we spoke to them.
Some people naturally have difficulties with this processing and it becomes worse with dementia. We have to be careful: is the unexpected result because of that personality defect, the dementia, or the dementia making the defect worse? One true example: I have a friend whose mother is naturally stubborn about going to seek medical attention. As she gets older, she also needs more help but refuses to believe she has any problems that warrant going to her physician. She also has early dementia and has become lost several times. Still refuses help. When he phoned me last he was actually in town from California and the stress in his voice was undeniable. After helping arrange his mother’s affairs he suggested that he take her to get medical help the next day. She understood this to mean that he considered her weak and unable to take care of herself. She blew up at him and kicked him out of the house.
I think about scenarios like this a lot. Does anyone have any suggestions on how to handle mom or dad in a situation like this? My own advice is if there is more than one sibling involved, that they all stick together and not encourage or enable the demented parent to act on irrational judgments, reasoning, and decision making. Gently correct, be supportive of reasonable actions and words, and try not to blame each other or the parent for bubbles in the road.

Early stage dementia is the best time for medicinal and nutritional intervention. Get the parent’s doc involved. Consider gingkobiloba, Omega-3’s, and Vitamin E, all of which have been shown to help dementia but not necessarily prevent it. Mind exercises are good, too as is exercise and sleep. Consider getting help with anxiety and depression which often accompany aging and dementia itself. 
Click here for more information about dementia: Dementia Pictures Slideshow.

Saturday, May 10, 2014


Anyone who has followed my dietary advice knows that my first recommendation is to ditch the wheat and all other products that contain gluten. When I talk about "diet" I don't mean losing weight necessarily (although that will follow) but rather your nutritional lifestyle. My revelation about going wheat-free came about with a talk one day at a Starbucks with the author of the book Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health, William Davis, MD (see my Recommended Reading list). In my own experience, I lost 30 pounds in six weeks when I first started the diet then another 10 after I incorporated a "cheat day" once a week. A cheat day is the one day a week (I chose Friday) when I would eat what I wanted and as much as I wanted. Despite the fact that I never got hungry following Dr. Davis' advice, my metabolism did eventually slow down and I revved it back up by pigging out one meal a week.
But the "diet" part is actually two-fold: avoid gluten AND avoid sugars and simple starches. While "Wheat Belly" measures the effects of carbohydrates on a person's insulin response, I found it easier to stick with the standard Glycemic Index, avoiding "fast carbs" and consuming only "slow carbs." Those phrases were popularized by Timothy Ferriss in his book The 4-Hour Body . Warning: not for the faint-hearted. He also gave me the idea of the cheat day. The thing I like best about Ferris is that he tries his ideas on himself first. This just supports Dr. Mangold's Rules for Good Living No. 2: Never Trust a Fat Dietitian.
Search for "Glycemic Index" and you will find no lack of sites that not only explain what the term means, but also give you lists of foods that are low and high GI. Sugars and simple starches are highest, while more complex veggies are low. Simply put, I did fine with cabbage, asparagus, kale, spinach, nuts, and legumes. Dr. Davis narrows the choices down even more but I still lost weight eating non-recommended foods. He also has a Wheat Belly Cookbook. As I said, I never went hungry nor should you.
Here's to your start of healthy eating!