Wednesday, October 15, 2014


 Well that was quite a bit of fun.  Shooting the breeze with Dr. Kathleen Kozak of Hawaii Public Radio's "The Body Show."  October is breast cancer awareness month, and we discussed everything from timely breast cancer screening to the surgical treatment of breast cancer, to oncoplastic breast surgery and to the post surgery treatment of breast cancer.   Also, plant based diet champion and author of "The China Study" T. Colin Campbell joins us in the beginning of the show.  What a pleasure!  Listening link below...

http://hpr2.org/post/body-show-breast-cancer-awareness-0



Friday, June 13, 2014

Vitamin D intake and All-Cause Mortality: a No-Brainer...

Aloha!

Having recently relocated to a more tropical locale, I got to thinking: is all the buzz about Vitamin D true? And, if so, what can I do to ensure that I obtain enough vitamin D daily?

A recent meta-analysis review paper (published in December 2013) provides decent background on the subject.  Having a certain range of Vitamin D levels in your blood lowers your chance of dying from any cause - it lowers your All-Cause-Mortality.  Here are some more specifics:

Cancer
Adequate Vitamin D levels have been shown to slow cancer growth in cancers or the skin, colon, breast and prostate.

Diabetes:
Being deficient in Vitamin D has been shown to influence the development of type one and type two Diabetes.

High Blood Pressure and Heart Disease:
Inadequate levels of Vitamin D have been linked to high blood pressure and development of atherosclerotic plaque.

Endocrine:
Adequate levels of vitamin D are essential to proper bone health and preventing osteoporosis.
Vitamin D deficiency has been linked to infections and several auto-immune conditions such as multiple sclerosis.

In summary, inadequate Vitamin D levels have been regarded my many as a marker for premature death. 
The picture below shows this in graph form: (feel free to compliment my artistic abilities later)

Displaying photo.JPG
basically, on the x axis (bottom line)are vitamin D levels, on the y axis relative risk of all cause mortality. This U-shaped curve demonstrates that risk of dying is decreased with vitamin D levels of 27.5 ng/mL on.  Curiously though, the risk increases as vitamin D levels get too high. 

So, what is the magic number of vitamin D needed in the bloodstream? 
If you want to know your blood levels of vitamin D any friendly doctor can order the test to measure it for you.  Most experts agree that over 20ng/mL is enough - but newer research tells us that levels of over 30ng/mL are better.  In my expert opinion I think somewhere between 30 and 70ng/mL is best.

 How do I ensure that I am getting enough vitamin D daily?
Vitamin D's main source is us: we produce it in the skin after we are exposed to sunlight (UV-B radiation).  Ideally we would need to sit naked in the sunlight for about 20 minutes daily. But not all of us are able to sit in the sun for 20 minutes daily, let alone naked in the sun.  Or, we live at a latitude where it would be very difficult or impossible to obtain enough sunlight.  Also, as we age our ability to convert this sunlight to vitamin D diminishes (we become less efficient at it).  So for many of us sunlight may not be the only way we can get enough vitamin D.
What about diet?  Can we get enough vitamin D3 from eating plants and vegetables?  The truth is this is a difficult vitamin to get from plant based food sources - mushrooms exposed to ultraviolet light are the best option.  For the carniverous folks reading this salmon, mackerel and tuna are ok sources but it would still be difficult to obtain adequate levels.  Besides this, the next best thing would be to take a supplement.  I am usually not a person that recommends popping a pill - I don't even recommend a multivitamin.  But, Vitamin D in my opinion is so important we need to make sure we obtain enough of it.  As for me I will continue to plan on surfing, sailing and hiking to obtain adequate vitamin D levels with occasional supplementation to back this up.

Bonus question: Is there is a difference between Vitamin D2 and Vitamin D3?
The jury is out on this. There are two types of supplements available: vitamin D2 and D3.  Does it make a difference which one I take?  Recent studies have shown that vitamin D3 (mainly from sunlight, and certain supplements) has been linked to the lower all-cause-mortality.  So if you end up taking a supplement vitamin D3 is recommended.

So, in conclusion,
Adequate Vitamin D levels reduce all cause mortality.
Try to get it from sunlight.  If that is not possible, try some supplements.
It is a good idea to get your vitamin D level checked to get a good idea where you stand on this.

Displaying photo.JPG

Aloha - Peace, love and scalpels

____________________________________________________________________
References and useful links:
- http://nutritionfacts.org/video/vitamin-d-and-mortality-may-be-a-u-shaped-curve/
- http://ac.els-cdn.com/S1568163712000177/1-s2.0-S1568163712000177-main.pdf?_tid=14696d02-f38f-11e3-8f09-00000aab0f6c&acdnat=1402728340_ff5cba0f9b13bde4ab9d6173f0424894
- http://ajcn.nutrition.org/content/97/4/782.long
- http://ajcn.nutrition.org/content/95/1/91.long

Monday, March 31, 2014

Google Glass in Surgery

Google Glass, the darling of google.  Available now to Glass Explorers for a nominal fee of $1500.  On the general market later this year.  The Glass is full of new applications, but the one I am most interested in is surgery.  Imagine: the ability to superimpose a CT scan on your patient during surgery demonstrating the precise location of a tumor and major surrounding blood vessels.  Imagine: the ability to stream your surgery, exactly what you are seeing as a surgeon, to an expert miles and miles away for advice. Sign me up!

Then, I start thinking about the downsides of such technology.  My first concern would be that I would become what is known as a Glasshole.  Second and more important, would I become reliant?  Would surgeons as a whole become weaker because they are able to easily look up facts they should know, ask for help before they really need it because the technology is there?  In short, would google glass become a security blanket, a safety net for the previously independent surgeon?


After pondering this for quite a while I have come to the conclusion that Glass is a lot like the smartphones of today.  I already call my smartphone my "peripheral brain" as I refer to it frequently to research information, take photos etc.  Glass would be an extension of this.  Using my peripheral brain does not make me a weaker surgeon, just a more resourceful surgeon.  Finally, any opportunity we as surgeons have to advance technology is exciting.  Who knows, maybe I will come up with a new application for it and sell the idea to google ;)

Now, to the nutrition portion of the blog.  Just like google glass can give me a roadmap in surgery I will providing a roadmap for adopting a healthy, plant based diet.  The link is below.  This is a google document created by me, free to download at any time.  I will be updating it as needed.  All of the sources provided have been vetted and approved by me.  Enjoy.

Plant Based Links, Cookbooks and References

Peace, Love and Scalpels

Tuesday, March 25, 2014

My husband and I were featured in our local newspaper regarding our dietary habits...  click here to read the article...
Welcome to my blog.  I am new to this blogging thing but hopefully will pick it up fast.   Being a surgeon and all I am a capable and quick learner when it comes to technology.  I have decided to start this blog for multiple reasons.  I feel very passionate about obtaining and maintaining optimal health.  In my career I see so many diseases that are a direct result of poor dietary and lifestyle choices.  Yet many individuals (including healthcare professionals) fail to see or emphasize the connection between the two.   I strive to raise awareness of this connection and hopefully foster a change in mindsets.

For example, did you know that too much red meat intake increases colon cancer risk?  Low fiber diets predispose to diverticulitis and colon cancer?  Obesity has been directly linked to breast cancer?


So, for my first episode of discussion: a recent article published in the Annual Review of Public Health 2014 titled "Can we say what diet is best for health?"   Click on the link for a free pdf copy.  This article reviews many of today's popular healthy diets (including vegan, Mediterranean and paleo) searching for the optimal diet.  Pros and cons of each are discussed.  Did they find a best diet? The answer is no.  They came to this conclusion: "Eat food, not too much, and mainly plants."  Additionally they emphasized avoiding processed foods and supplements.

So all in all, follow the diet that is healthy and perfect for you.  Everything in moderation.  Avoid processed foods.  Incorporate color into your diet - eat the rainbow...

                                                                         ... until later....Peace, Love and Scalpels....