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.