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.

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.

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.