Dietary fiber is critical since the bowel organisms necessary for many aspects of health rely on it. Adequate fiber in the diet will also help prevent colon cancer by aiding removal of cancer inducing chemicals in food (meat, especially processed, is particularly a problem.)  Prevention of constipation by eating fiber is necessary to avoid diverticulitis, hemorrhoids, hernias.

My son John is a regular psyllium user since he’s found it’s the best way to guarantee no problems from his hemorrhoids.

Those of us who eat mainly or entirely plant-based diets usually don’t have an issue with getting enough fiber but since my diagnosis of celiac disease I can no longer eat many whole grains- wheat, rye or barley- which had been a major fiber source for me. When we travel getting enough fiber can be a problem and I’ve discovered that psyllium is an easy, inexpensive solution.

The popular commercial version of psyllium is Metamucil but there is no reason to buy this more expensive product when bulk organic psyllium is available in most pharmacies and online. 

Psyllium has little taste but an unpleasant consistency. Chugging a glass of water with psyllium before eating will help stool volume and consistency, improve blood sugar and cholesterol levels. Bloating and gas do increase but other side effects are rare. Dosage suggested is three teaspoons a day divided before each meal but John and I both do it all before breakfast for convenience. Starting with a small amount and increasing should allow better tolerance.

Below is a list of the best food sources of fiber. Enough of these should eliminate a need for psyllium.

• cooked navy beans (1/2 cup contains 9.5 g)
• 100 percent ready-to-eat bran (1/2 cup contains 8.8 g)
• canned kidney beans (1/2 cup contains 8.2 g)
• cooked split peas (1/2 cup contains 8.1 g)
• cooked lentils (1/2 cup contains 7.8 g)
• cooked pinto/black beans (1/2 cup contains 7.8/7.5 g)
• cooked artichoke (one whole artichoke contains 6.5 g)
• cooked white beans/chickpeas/great northern beans (1/2 cup contains 6.3-6.2 g)
• mature soybeans (1/2 cup cooked contains 5.2 g)
• plain rye wafers or crackers (2 crackers contain 5.0 g)
• baked sweet potato with the peel (1 medium potato contains 4.8 g)
• raw pear or Asian pear (1 small pear contains 4.3-4.4 g)
• cooked green peas (1/2 cup contains 4.4 g)
• whole wheat English muffin/bread (1 muffin or 2 slices contains 4.4 g)
• cooked bulgur wheat (1/2 cup contains 4.1 g)
• raw raspberries (1/2 cup contains 4.0 g)
• boiled sweet potato without the peel (1 medium potato contains 3.9 g)
• baked potato with the peel (1 medium potato contains 3.8 g)
• stewed prunes (1/2 cup contains 3.8 g)
• dried figs or dates (1/2 cup contains 3.7-3.8 g)
• raw oat bran (1/2 cup contains 3.6 g)
• canned pumpkin (1/2 cup contains 3.6 g)
• cooked spinach (1/2 cup contains 3.5 g)
• shredded ready-to-eat wheat cereals (1 ounce contains 2.8-3.4 g)
• raw almonds (1 oz. contains 3.3 g)
• raw apple with the skin (1 medium apple includes 3.3 g)
• cooked whole wheat spaghetti (1/2 cup contains 3.1 g)
• raw banana or orange (1 fruit contains 3.1 g)

I subscribe to several medical research summary websites. This week the prominent articles enraged me:

An article comparing left main coronary stenosis treatment by surgery (CABG) or percutaneous stenting. The conclusion- the two are approximately equal in value. What they don’t say is that they are both close to worthless (except for stents placed while having a heart attack which is not what they were evaluating.) Either can help short term with angina but long term value is not there since angina often comes back and those who have these procedures don’t live any longer. Only lifestyle change, primarily diet, will treat symptoms long term and increase lifespan. There’s no money in diet change but a lot of money for doctors, medical centers, equipment and drug companies with CABG or stenting.

The second article was a widely publicized review of the effect of reducing processed and red meat in the diet. The conclusion- little value to reducing processed and red meat. But what is the true story? Modest decrease in these two types of meat doesn’t matter much since they are so harmful that only drastic decrease or avoidance makes a big difference. Think two packs of cigarettes versus three. Any surprise that it didn’t matter much? AND guess where the lead author of this paper gets significant funding for his research? I don’t think I have to tell you.

As long as medical research is funded by those with money interests in the outcome and the journals live on ads from those groups this will be the medical “science” and information we get.

A few years ago I reviewed Mistreated, a book by Robert Pearl, which looked at, and found wanting, our current medical system. His focus was mainly on the quality of medical care, not its cost or inaccessibility to many Americans. The causes of our poor quality care he lists are the same ones that inflate costs and make care unavailable for many: the fee-for-service model which benefits insurance companies, the drug industry, large medical centers and specialty physicians by rewarding more tests and treatment, not doing things in the patients’ best interests. We pay a ton of money for bad care in order to enrich the powerful, wealthy groups listed above.

Our government enables this system through its Medicare policies because these groups are major contributors to politicians and many congressional districts profit from their large number of employees.

Only drastic change in federal policy will allow us better care, available to all, at a lower cost. That is why Deb and I are strong supporters of Elizabeth Warren’s candidacy for president. She has health care policy right. She also has the knowledge and experience to take on monied interests in medical care, finance, energy and other areas of abuse. She is the candidate big business fears the most.

Most upper middle class and wealthy people like the convenience and TLC that they now receive. Deb and I like it too, but we have a medical background and can weed out most unnecessary tests and procedures suggested to us. What would Warren’s Medicare for all be like for us and others in our position? It would be similar to what is now offered by Kaiser, Intermountain Health Care, the Mayo and Geisinger Cinics: large HMO’s, more impersonal and bureaucratic than we are used to or want, BUT with better care at lower cost, available to all. No more bankruptcies due to a bad luck medical condition; many fewer deaths and bad results due to unnecessary tests and procedures; many fewer poor people suffering because of lack of medical care. This is an trade off we are willing and eager to make. 

This new book by Dean and Anne Ornish announces on its cover: “How simple lifestyle changes can REVERSE most chronic diseases- eat well, move more, stress less, love more.”

Dean is one of the major figures in lifestyle medicine. Forty years ago as a medical student he published original research documenting reversal of coronary disease with lifestyle changes. His professional career has been devoted to research on and promotion of lifestyle medicine. His wife Anne, an expert in yoga and meditation, is active in Dean’s research institute and has created a digital platform to train healthcare professionals and others in lifestyle medicine.

UNDO IT! is an excellent primer of lifestyle medicine. The scientific basis and practical applications are well covered. Books on diet, exercise, meditation, stress reduction techniques, and relationships abound. This single volume has it all and, I believe, has no major errors or flaws in science or advice. I’ve covered most of the material in prior blogs but this would be excellent ‘one stop shopping’ for those who want an introduction or overview of the topic.

Last year I wrote about our friend Carlos changing to a mainly whole food plant based diet, his resultant weight loss and feeling good. He has graciously allowed me to publish his recent email to us.

Hi Debbie and Jack :
25 years ago I used to be a runner, I was young and handsome, not anymore. SInce  I changed my eating habits, I almost have lost 40 pounds,so I encouraged myself to go back to running.My younger sister Alicia has been running for the last 6 years and this year I started  running with her. Last month I signed up for the Rock and roll half Marathon, since I’ve been feeling great I decided to give it a try.Last sunday was the big run ! , It was great, lots of fun, wasn’t easy but wasn’t that hard either.I felt young and alive . Actually I did a better time than my sister. I hope to do it again next year.
I just wanted to share my joy with you. Here are a couple of pictures.
Aloha.  Carlos

Deb and I have been back on Kauai for over two weeks, catching up with neighbors and friends here and going to our many famers’ markets filled with the best local produce. Long early morning walks with Charlie, our five year old doggie prince, take us through local neighborhoods, golf course and down the hill to a mostly deserted beach. We’re tired at the end of every day.

Two neighbors brought us very good news. One, a middle aged woman, is a serious jock- hiking, running, cycling, sailing, competitive paddling, including open ocean to other islands. She was an omnivore eating lots of fruits and veggies but switched to an almost entirely whole food plant based diet since January when we last saw her. Twenty pounds lighter she looks like Wonder Woman now and feels great. The second is also a middle aged woman who exercised little, mainly due to achy knees. She switched from a SAD to one that was heavy on whole plant foods but not vegetarian. She lost 17 pounds since January, looks and feels terrific, and can take long walks without knee pain.

Food can change your life and bring great joy!

More people, computers, space = more costs for a medical home compared to a standard medical practice and these costs have to come from patients or taxpayers.

Quickly, visits to ERs plummet and hospitalizations decrease neutralizing much of the increased cost of the medical homes, but some big medical centers don’t want hospitalizations to decrease. Longer term patients are less sick thereby using fewer medical services and drugs, but drug companies and medical centers don’t want this to happen. As more medical homes emphasize lifestyle medicine, especially a whole food plant based diet, medical costs plummet, but drug companies, insurance companies, medical centers, specialty physicians (the legacy players of Pearl’s book Mistreated) are then taking a big hit.

Is the idea that lifestyle medicine can reduce total health costs an unproven hypothesis? No! McDougall and Ornish have both published well designed studies documenting large drops in the total cost of medical care in patients who are trained and monitored by lifestyle medical practices. And most patients will adhere to this program when it is well and logically presented.

The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. (Wikipedia)

As discussed in prior blogs the American medical care system is broken, controlled by big businesses (insurance, drug companies, large medical centers) who profit from an inefficient model and are permitted to take huge amounts of money designated for health care. A good way of observing this is by checking the stock prices for these companies over the last 30 years and the salaries of CEOs at these companies and large medical centers. Because of our giant national medical bill attempts to increase expenses by caring for the poor and those needing extensive, expensive services are often rejected by taxpayers. Our congresspeople and state legislators get so much money from big business that policies to limit drug prices and control by private insurers are rarely initiated and more rarely successful. A rebellious legislator knows that lots of money will be flowing to opponents’ campaign coffers if she supports change to the protection given health care businesses.

The medical home system has had limited acceptance primarily because it costs more. But it returns a much better level of care, especially for access, prevention and management of chronic illness, often emphasizing lifestyle medicine. A notable exception to the limitation of medical homes has been through the work of Phil Cass in Columbus, Ohio. His story is summarized in a long interview:

Anne Harrington is the Franklin L. Ford Professor of the History of Science and faculty dean of Pforzheimer House at Harvard University. Her recent book, Mind Fixers, traces the history of psychiatry as a medical specialty with an analysis of its successes and failures. It has received rave reviews.

For the past 150 years psychiatry has been a battleground between the biologists and advocates of interpersonal dialogues. Are psychiatric problems rooted in anatomy and/or chemicals or are they rooted in thoughts? The teachings of Freud and his onetime associate Jung dominated psychiatric practice until the 1950’s when chlorpromazine (Thorazine) initiated a revolution in thought and practice. Severely schizophrenic patients were now usually manageable; they did not have to sit around in straight jackets or a catatonic trance all day. Most could now function well enough to be discharged from the huge psychiatric hospitals which had served as warehouses for the seriously deranged.

Lithium had been used as a tonic for years: it was the basis for many elixirs including 7-Up, but it was regarded as quackery by the medical profession. In the 1940’s an Australian researcher discovered lithium’s effect on the mood of lab animals and then confirmed this in severely depressed patients, especially those with bi-polar disorder (euphoria alternating with severe depression), but his results were mostly ignored. He persisted and found a few Australian supporters but many years passed before a Dutch psychiatrist came across his work and re-confirmed the power of lithium in this condition.

Several radical non-pharmacological treatments for severe psychiatric problems were attempted. These included electric shocks; inducing coma with insulin; giving the patient malaria in the hope that high fevers would be curative; pre-frontal lobotomy (destroying a small part of the brain).

With the success of Thorazine Big Pharma started to take over psychiatry; Freudians, Jungians and other non-drug practitioners were increasingly marginalized. Drugs were developed for anxiety, milder forms of depression, and a wide variety of other psychological conditions. In the last third of the 20th century these drugs were the biggest money makers in the pharmaceutical industry and every year saw several new ones introduced, each with the support of prominent psychiatrists and big advertising budgets. For many professors of psychiatry drug company sponsored appearances multiplied their income several times. You could now be a rich professor without inheriting money or inventing something; few resisted the temptation to be a shill for Big Pharma.

This century has brought a re-assessment of the role of drugs in psychiatry; drug research and new products have almost ceased. Most of these drugs are addicting and have significant side effects; they don’t even work that well. Clinical trials were carefully designed to emphasize success, and studies which showed no positive drug effect were scraped and never published. The whole industry and their professor-shills were discredited. The FDA was shamed for their investigations and drug approvals.

What of value is left? Electro-shock therapy can now be done humanely and helps some people with the worst depression. Lithium is critical for those with bi-polar disorder and some with severe depression. Thorazine allows severe schizophrenics some respite. All of these treatments come at high cost in side effects and a loss of vibrancy to life. A typical comment by a treated patient is “I’ve lost my uniqueness, what it is to be me, and my joy of living. The world is flat and gray.”

Harrington asks: “Can psychiatry acknowledge and firmly turn away from its ethical lapses- and especially the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering?” Her recommendations for the future of psychiatry: psychiatrists should concentrate on the care of the psychotic, those with schizophrenia, bi-polar disease and severe depression. Leave the rest to psychologists, social workers, marriage and family counselors who are well trained in non-drug techniques. Unfortunately psychotics often have little money and the treatment of a large number of anxious and unhappy people who can hold a job will continue to be the major income source for psychiatrists unless we greatly increase community funding for severe mental illness.

Deb and I recently returned from a long trip to New Zealand and Australia where we enjoyed the scenery and various tourist attractions. Botanical gardens in Dunedin and Hobart are world class. The one in Hobart has an excellent cafe which had good gluten free options- lucky me. Aukland and Sydney both have extensive ferry routes allowing easy access to good hikes and interesting suburban communities.

New Zealand and Tasmania residents seemed active and out-doorsy. Obesity was rare; most locals were appropriate weight and vigorous. Sydney is a large metropolis of 5 million and the residents were heavier and less apparently fit, no surprise in a big city. In general I’d compare Sydney residents to southern Californians; Kiwis and Tasmanians to the clientele at REI, the outdoor sporting goods co-op.

Another delight was the scarcity of fast food outlets. There were some but much fewer than in the United States. However diets in both countries leave a lot to be desired, with meat and dairy dominating menus and in supermarkets. These are lands of sheep and cattle with heavy reliance on export and internal consumption of their products. Even fine dining restaurants which advertised local produce had meager veggie choices. The number of vegetarian and vegan restaurants and whole food plant options were similar to what we have in California.