A doctor of Chinese medicine, diagnosing me

Today if you get a degree in Traditional Chinese Medicine (TCM) in Beijing you will read from the original text of Li Shi Chen who first categorized the pharmacy of TCM 500 years ago. He put together various herbs and portions that are used by the Traditional Chinese Medicine (TCM) physicians even today. Using the “argument to antiquity” TCM will state that these have been used for 5000 years, and are still  of value for treating a variety of ailments.
Many of the medications prescribed in the United States today were not available when I graduated medical school in 1986. Cleaning out my desk I found samples of Viox, now off the market, a once highly touted pain medication. Vioxx came to the market in 1999, and was one of the most widely prescribed pain medicines until a few cases of cardiac deaths convinced the FDA to pull it from the market in 2004. Medications change in the modern world of medicine, we get more effective, better and less toxic alternatives. If a physician today only used medicine from 500 years ago  they would lose their medical license:

Mercury:
In China and Tibet it was thought to prolong life, help heal fractures. Mercury was so revered that the tomb of the first Emperor of China, Qin, has “rivers of mercury” so he would have a good after life. In the west it was used as a treatment for infections including syphilis.

Arsenic
Hippocrates (460-377 BCE) used arsenic as medicine. Galen (130-200 ACE) recommended arsenic to treat ulcers. In the 19th century arsenicals were used to treat acne. In the early 1900’s physicians were using arsenicals to treat pellagra and malaria, and was the mainstay treatment for syphilis until penicillin.

Morphine
A potent pain reliever was once bottled as Mrs. Winslow’s Soothing Syrup, used to keep babies quiet, and for teething. While it kept the children quiet during the Victorian Era, when children were to be seen and not heard, it may have led to  addiction at the least and some children died from overdosing.

Snake Oil
A liniment used for arthritis – and sold widely by “snake oil salesmen.” Once it was discovered that it didn’t work very well (has a bad odor also).

Old in medicine does not translate to effective, or tested, or non-toxic. Still people get the impression that TCM is not harmful, and can be used since it has been used for over 5000 years. But TCM is harmful in several ways:
Two British women who took a Chinese herbal remedy called Mu Tong have renal failure and need kidney transplants. They remedies were found to contain aristolochic acid, toxic to kidneys. Dr. Graham Lord, a consultant kidney specialist from the Hammersmith and Charing Cross Hospitals NHS Trust last year stated, “We have no idea how many people consumed this herb, but there are hundreds of Chinese herbal medicine clinics in Britain, so the number is probably substantial.”
A DNA analysis of some traditional Chinese medicines found that they contained DNA of endangered animal species. Researchers at Murdoch University in Australia found samples contained DNA from animals listed as “trade-restricted” according to the Convention on International Trade in Endangered Species Legislation. Animals clearly died for their use in TCM.

Many things are used in Chinese medicine, some endangered

The rhinoceros is nearly extinct because its horn, used in Traditional Chinese medicine, is highly prized. When the rhino horn is ground into a powder, the 16th century Chinese pharmacist Li Shi Chen said it could cure snakebites, typhoid, headaches, vomiting, and food poisoning.  Contrary to popular belief it is not prescribed as an aphrodisiac. Tested, high doses can lower fevers in rats, however, Tylenol is cheaper, works better, and does not endanger a species. The last rhinoceros of one species in South Africa was slaughtered – bled to death by removing the horn with a chain saw. There is still, in South Africa an abundance of white rhinoceros, although they are still killed for their horn.
The dose of the medication is unknown. Different plants, herbs, and species have different levels of active ingredients in them. Some ingredients, even if they have an effective dose, that dose cannot be determined without chemical analysis. You could get a dose that is ineffective, a dose that is effective, or a dose that is toxic.

TCM represents a group of medicines that have been classified in the 16th century, and have not been updated since that time. The argument to antiquity would not work with modern medicine here, as the Food and Drug Administration is keeping America safe.

A contrast TCM with modern medicine is seen in the Yew Tree. The Yew Tree is highly poisonous and was found to have an anti-cancer agent, now called Taxol, which is used to treat ovarian Cancer. Taxol was purified from the Yew tree initially and now is chemically synthesized without using the now endangered species of Yew Trees. However, TCM still uses extracts of Yew Trees for their medicines. From the synthesized taxol, and number of chemical modifications have been done to provide more effective anti-cancer agents, with lower toxicity to humans. Practitioners of TCM might point to this as a win, however, ground bark from the Yew tree to treat ovarian cancer would have only two results: either ineffective or toxic.

To diagnose a patient needing medications western medicine uses comprehensive physical examinations in combination with laboratory tests, perhaps x-ray tests such as the CAT scan. TCM physicians will look at the palms of your hands, as they prescribe herbs from Tibet, without having the foggiest notion of what the herbs/dried rhino horns/ bear gallbladders, or whatever potions, come from.

They diagnose based on the palm

Finally, the older something is does not mean that it is better. When it comes to medicine it often means it is worse. TCM fails with a part of their argument to antiquity when they cannot even substantiate how long the medicines have been used, nor can they point to any good trials of the medicines. If your doctor used a western medical text that is over 10 years old it would be considered out of date, as would the doctor. It is time that the world realize that TCM is out-of-date, ineffective, possibly toxic, and a threat to endangered plants and animals.

I look forward to the People’s Republic of China taking control of this group and forcing them to comply with standards of safety for their people and the people of the world.

The Huffington Post is at it again- by promoting a nutrition quiz from the Physicians Committee for Responsible Medicine (PCRM).  One would think that a group like PCRM would be a responsible group, with a website that would have credible information. However, PCRM is a vegan organization that promotes an anti-dairy, anti-meat, anti-seafood, anti-egg diet, and the purpose of their quiz was to help evoke those ideas.  They have also sent out news releases that are bias to  a vegetarian diet and argues for it with half-truths that do little to advance their position, and a lot to reduce their credibility.

Recent breaking news quoted a paper in that indicated that fish oil did not prevent recurrence of heart problems and “evidence fails to support their use.”  PCRM did not include the conclusion:

“However, a diet high in fatty fish (≥2 servings of marine fish per week) should continue to be recommended for the general population and for patients with existing CVD because fish not only provides omega-3 fatty acids but also may replace less healthy protein sources, such as red meat.”

PCRM is anti-fish, as well as anti-dairy, and they fail to note that the American Heart Association recommendations for two meals a day being replaced by fish.

Recently PCRM released another study showing E. Coli was in 48% of chicken bought in 10 cities by their group. What they failed to state was that the E.Coli was not the type that causes humans illness.  Further, the major outbreaks of food-borne illness have recently come from produce and peanuts – as they are grown in soil that contains E. Coli. and can be contaminated with salmonella.  There are many types of bacteria in the soil, and E. coli is a common soil bacteria, but it is not the same type as that which comes from feces.

If you were a Vegan this might be your view of food

Here is their quiz with Science and Evidence based medicine rebuttal:

(1) Skim milk has the same amount of calories as cola

Yes, they are anti-dairy, and this is suppose to scare people into thinking that dairy is bad. For those who can tolerate milk, those who are not lactose intolerant, milk is a great source of nutrients.  Cola, not so much. They say all you need is water, nothing else – and we agree, however,  milk can have plenty of nutrients in them and should not be over looked.

(2) Cheese and steak have the same amount of cholesterol.

The first question you should ask is- so what? Dietary cholesterol has a minimal effect on the blood level of  the body’s cholesterol, we have known this since I was in medical school ( 1980’s). You can see my last post about fats to see more. That different amounts of cheese as well as a porterhouse steak have the same amount of cholesterol means nothing.  Very few physicians look simply at the cholesterol level, unless it is either very high >250 – and then we look at the underlying lipid profiles.

(3) Cheese is 70% fat.

Some cheese is, but again, cheese in moderation is not a bad thing. Some cheese is not  70% fat. By the way, most nuts, which this group advocates, are also 70% fat. They go on to say that Americans are eating three times the cheese we did in the 1970′s – probably not the case for some. Cheese is something that should be used in moderation – as it is dense with calories

(4) Frequent consumption of hot dogs and bacon makes it more likely you will get colon cancer.

In the one study, that has many flaws, if you eat a diet rich in processed meats your risk of cancer is higher- by a small amount. But that is a correlation, and not necessarily a causation, and when you work out the statistics, your chance of eating that much (a lot ) is not much, and your chance of getting cancer from it is – well, we don’t know. We don’t advocate eating a lot of processed any food. They state that the recommended amount of processed meats would be “none” – we would disagree, as do bacon lovers everywhere.  The correlation is so small with this as to be stretched.

(5) Women who regularly eat soy have a lower cancer risk.

This is not necessarily so.   Comparison studies have been mixed- so the answer is, we don’t know.  PCRM based their information about population studies from Asia- but other factors these women have include (a) less obesity (b) more physically active (c) drink less alcohol (d) eat more fruits and vegetables. Until the issue becomes clearer, many doctors recommend that women who take hormonal therapy or who have estrogen-receptor-positive breast cancer avoid soy supplements because they contain high concentrations of isoflavones. But in general, it’s fine to eat moderate amounts of soy foods as part of a balanced diet. One to 3 servings of soy a day (a serving is about a half cup) is similar to an average Japanese woman’s daily soy intake. If you are taking hormonal therapy to fight off a hormone-receptor-positive breast cancer, and you are concerned about any phytoestrogen effects, ask your doctor or registered dietitian about how much soy you can eat.

(6) Salmon has cholesterol and fat

Ah yes it does, and to repeat- consuming cholesterol is not the issue. Salmon fat is high in omega-3 fatty acids and quite healthy. Eskimos and maritime Native Americans had a diet rich in salmon and the lowest rate of heart disease on earth.  There is not convincing evidence to advocate taking fish-oil capsules, there is still evidence that replacing two meals a week with fish is protective for the heart.

(7) An egg has more cholesterol than a Big Mac

Cholesterol is not an issue in diet but the 540 calories in a Big Mac compared to the 90 calories in a large egg is. The calories in a Big Mac come from 29 grams of fat, while only 5 grams of fat from an egg. While PCRM has an issue with dairy, as do some from the Paleo diet, eggs are a healthy source of protein.  If you get rid of the yolk you can get rid of a lot of the calories also. The amount of cholesterol is less important than the lower calories- and you could always use egg whites which have less fat, much less cholesterol, but a great source of protein.

(8) Milk, Beans, and broccoli are all high in calcium

This is true, and for those who need a good source of calcium but do not drink milk, there are some good alternatives. They point out that the calcium in the beans and broccoli is absorbed at a rate of  50-60%, while milk is just  32%. What they fail to point out is that 1/2 cup of broccoli contains 21 mg of calcium while 8 oz of nonfat milk contains 300 mg. That means from broccoli you get 11 mg of Calcium which is about 1 percent of the daily requirement. If you get non-calcium enriched milk you are still getting 100 mg of calcium or ten times the amount you would with broccoli.

Vegetarians may absorb less calcium than omnivores because they consume more plant products containing oxalic and phytic acids . Lacto-ovo vegetarians (who consume eggs and dairy) and non-vegetarians have similar calcium intakes. However, vegans, who eat no animal products and ovo-vegetarians (who eat eggs but no dairy products), might not obtain sufficient calcium because of their avoidance of dairy foods.

In the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition, bone fracture risk was similar in meat eaters, fish eaters and vegetarians, but higher in vegans, likely due to their lower mean calcium intake.  It is difficult to assess the impact of vegetarian diets on calcium status because of the wide variety of eating practices and thus should be considered on a case by case basis.

(9) Fish and Beef have no fiber

Quite true- there is no fiber in meats. This is why a balanced diet contains fruits and vegetables. However, fish and beef contain better sources of fat absorbable vitamins, calcium, B12, protein, and other nutrients than vegetables do.

(10)  A skinless roasted chicken breast has more calories per ounce than soda or white rice

This is quite true- and mainly because of the fat content of the chicken. But chicken has more nutrients than white rice and more than soda.

PCRM also was responsible for the comments that E. Coli was found in many of the chicken products.  What they didn’t say was that the E. Coli they found were not the same as responsible for food borne illness.  In fact, the E. Coli they found was the kind commonly found in the soil, where the very plants grow that they advocate consuming. The pro-Vegan group also neglected to mention that the majority of Salmonella infections that have caused major outbreaks have come from agricultural products, including peanuts, that they advocate for a healthy diet.

It appears that PCRM is more propaganda than science. If you are going to advocate for a position, your position is diminished when you don’t tell the full story. If cornered in press conferences they avoid the answers to the questions. This is not a place to get information at all.

In the case of diet and lifestyle, there is a lot we do not know- but PCRM as a source of nutritional information is less than adequate, in that often it does not tell the whole story.  As a website for health and information it is more like a political party than a resource for those looking for evidence based medicine or science based medicine.

One of the misleading advertisements from PCRM

When the Archives of Internal Medicine published the article “Red Meat Consumption and Mortality” all I could think of is “here we go again.”

First to go through this paper- which is a statistical population study from the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS). Of the 140,000 combined participants they tossed out 20,000 because of a history of the diseases reported or those who did not fill out the forms perfectly.

To start with – this is not a study where people were followed from baseline to death to see if what they ate contributed, and determining amounts along with following other variables as they progress (lifestyle issues with exercise, smoking, etc). This instead is a study based on food questionnaires, and statistical analysis. Correlation does not imply causation.

One has to be careful with epidemiological studies, as they are not  proof of a cause, rather they point to a number of variables that might be involved to form a hypothesis. It is these same types of statistical studies that told us that women should use hormone replacement therapy because it prevents heart attacks in 1991, only to be told 11 years later that it might cause heart attacks. It is a sampling bias of those individuals who choose to participate in the studies that led to the erroneous conclusions.

The second issue with these studies is the ability of the food questionnaire and its accuracy. This has been studied – that is, the ability of people to recall and fill out what they ate. We do this in our office all the time- ask people what they eat—and since we are involved in weight loss and healthy lifestyle here is what we can say: people have no ability to remember what they ate, how much they ate much beyond the last day. When studied by others, looking at the questionnaire (FFQ or Food Frequency Questionnaire) in the Nurses’ Health Study was found to be useless. As reported by others, the accuracy of the questionnaire compared to reality was unacceptable.

For example, 20 per cent of the nurses reported living on 1200 calories per day or less, and low intake of red meat, and 20 percent report over 2000 calories a day.

In the study the first table showed that the highest reported red meat consumption was associated with smoking, drinking more, obesity, and higher calories. Oh wait- have you ever heard that smoking, obesity, eating more calories, or drinking more might lead to an early death? Perhaps you have, in fact, there are some correlations (which don’t imply causation) for these, and there are some great prospective studies showing that obesity leads to early death.  Of course, in any statistical paper you can remove the confounding factors – and THEY DID NOT in this paper.

One other cute correlation- in the data, those who report eating the most red meat had the lowest cholesterol levels. Yes, that is odd isn’t it. Readers of this blog know that cholesterol and meat have less to do with one another – and that isn’t a statistical issue, that is just basic biology.  Eating more meat does not mean you will have a higher cholesterol – having bad genetics does.

Here is what three systematic reviews of prospective studies show in the relationship between saturated fat and heart disease- zip. There has been a consistent lack of an associated between saturated fat intake and heart disease. While this new study statistically makes the argument that changing diet would decrease events from heart disease and cancer, when looked at (references below) none of the pooled studies show a change in that risk relationship. And, when some studies have shown a change in risk, when the data was examined there was no difference in mortality. While some say red meat clearly is bad, the evidence is anything but clear. Proving again that population studies, without isolating the variables, without having a scientific basis, are worthless.

Finally, the science of red meat—what do we know? Red meat is a large category of meats includes everything from bacon (considered “processed” by some and delicious by others) to cows raised on grain, and cows raised on grass. Grass fed beef have higher levels of omega-3 fatty acids. Consuming different red meats mean you are consuming different levels of ingredients. Lumping them together is just sloppy science.

Nothing like great grill marks on a steak

Skeaff CM, Miller J. Dietary fat and coronary heart disease: summary of evidence from prospective cohort and randomised controlled trials. Ann Nutr Metab 2009;55:173–201.

Mente A. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 2009;169:659–69.

Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010;91:535–46.

Many people today are talking about diets that are “gluten-free.” Restaurants are offering “gluten-free” menus. There are websites, chiropractors, and others proclaiming that going on a gluten-free diet will provide improved health. But lets be clear- unless you have an allergy to gluten, removing gluten from your diet will not provide better health, weight loss, but eliminating gluten will dramatically limit what you can eat.

But there are some people who are “allergic” to gluten- and for them having a gluten free diet is the difference between health and illness – between a risk of some rare cancers for which we don’t have great treatment for. We call that condition celiac disease – for those who have celiac disease, being gluten free is critical. Other names for this disease include celiac sprue, gluten sensitive enteropathy, non-tropical sprue, and a few other names.

Gluten is a protein that is found in wheat, barley, rye, and oats. Gluten is a protein that allows wheat to have “elasticity” – meaning you can roll out the dough- or toss it in the air and make a great pizza crust. You can’t do that with non-gluten grains—no one can make a pizza or great bread from corn alone. Gluten is also used to thicken soups, ketchup, soy sauce, and is found in almost every processed food out there. Take gluten out of the American diet and you will be challenged to find good alternatives.

When a person is allergic to gluten their symptoms include malnutrition, anemia, osteoporosis, infertility, short stature, and inability to thrive. However, the “classic” symptoms are not necessarily common. There are a number of patients who have silent celiac disease, where they will be discovered to have atrophy of their absorptive surface of the small bowel without any symptoms, or just mild symptoms such as an iron deficiency anemia. There are a number of forms of celiac disease that respond well to a gluten free diet – and remain normal after introduction of gluten into the diet.

Celiac disease is best diagnosed with a biopsy of the small intestine. Most often the biopsy is performed endoscopically from the first part of the small bowel, the duodenum. However, those biopsies can be negative, and more distal small bowel may show the classic pathologic appearance. Those biopsies most often have to be done surgically, or with advanced endoscopic equipment.

The small bowel, under a microscope, has many small finger-like projections called villi. These serve to increase the surface area of the small bowel to allow for maximum absorption of nutrients. In celiac disease, there is atrophy of these villi – seen microscopically- and this improves when gluten is removed from the diet.

Above normal villi, below- atrophied

While celiac disease is classically called an “allergy” to gluten – it does promote some antibodies against the connective tissue elements – leading some to call this an auto-immune disease. However, when the foreign protein is withdrawn, there is no residual auto-immune function. The “auto-antibodies” may simply reflect the gluten protein unfolded – and having a similar structure to the bodies own endomysium protein.

There have been various reports about the prevalence of celiac disease – ranging from 1:300 among Northern Europeans (Celtic) to 1:122. There is a large genetic distribution of the disease – with a high concordance among identical twins of up to 70 per cent. There are some genetic markers that have a high association with celiac disease, but the expression of the disease is variable – meaning that the genetic marker is a tendency but not a certainty of celiac disease. If everyone who had the genetic markers were to develop the disease, it would be estimated that 1 in 22 people would have this. However, this is not the case.

Diagnosis of celiac disease is made based on clinical suspicion of the classical presentation (iron deficiency, osteoporosis, with abdominal complaints) followed by some tests. A biopsy is the most reliable test, however there are blood tests ( IgA anti-gliadin and IgA anti-endomysial and anti-tissue transglutaminase) that are over 90 per cent accurate. Even with a negative blood test but a high enough suspicion, duodenal biopsy or even surgical biopsy is warranted.

There are plenty of questions about celiac disease- we don’t know the actual prevalence in the population, we don’t know if being gluten free as demonstrated by follow up biopsy has a lower incidence of lymphoma.

What we do know is that gluten is not a health issue in people who do not have celiac disease. Gluten-free will not cure autism. Gluten free will not facilitate weight  loss. There are, however,  groups who will claim that gluten is a health issue- there is no basis for this claim. If someone has told you to remove gluten from your diet, and you do not have a test showing celiac disease (one of the tests listed above)- please see a physician to resolve this.

For people who have celiac disease- there is a bit of culinary hope. Thomas Keller, one of the world’s greatest chefs and owner of Ad Hoc, French Laundry, Per Se, and Bouchon- has developed a flour that works well. You can purchase it from Williams-Sonoma.

Thomas Keller has come up with a great flour, gluten Free.

The results, as they were with President Eisenhower- are not likely to be different.  Eisenhower ended up eating almost nothing but Melba toast and grapefruit, obsessed with his cholesterol level, and having more heart attacks until the last one killed him.

What is the evidence that a vegan diet is healthier for a person than a diet with animal proteins? None. There is no evidence that a diet that is based around plants or a diet with low animal fat does little.

Some will cite epidemiologic data- a poor source for data less than a level one.  If you cite epidemiologic data you have to explain all the data—and often they ignore the “French Paradox.”  Or ignore that while the Japanese eat little meat and have few heart attacks – their average consumption has increased over 22 percent with no increase in heart attacks (often people cite data from post World War 2 Japan, and not current Japan – and then ignore the data about stroke rate). When all epidemiologic studies are examined – one cannot justify a plant based diet on those.

Some cite the Journal of the American Medical Association (JAMA) study claiming that an animal based diet had more mortality than a plant based diet – but few have read the study.  While Dr. Ornish jumped on this study, saying it justified what he has been telling people- apparently he didn’t read the study either.

This study divided people into two groups- the low-carb group received 37 to 60 percent of their calories from carbohydrates (that isn’t low carbohydrate by any standard). The meat group was not divided out for those who smoked and were overweight (a higher portion of the meat group smoked and were obese). The vegetable group had 30 per cent of their calories from animals, as opposed to 45% for the meat group (so not really a vegetable group).  Once again, an epidemiologic study  and it is flawed.

What we do know from science about low-density-lipoproteins is that they fall into two groups- one group is far more deadly than the other, causing the majority of atherosclerotic plaques.  That is the group with the high tri-glyceride levels is the one that is deadly. Of this there is no doubt in the scientific community.  When the Very Low Density Lipoprotein and apo B – leading to high low density lipoprotein – leads the the increased in artery plaque leading to heart attacks and strokes.  The lower the triglyceride levels then the lipoproteins secreted by the liver become the subspecies of intermediate-density lipoproteins, which are far less cause of atherosclerosis than the others.  Where does the triglycerides come from? Not animal proteins, but primarily carbohydrates.

Bottom line from science – the more triglycerides – result in atherogenic small, dense LDL proteins – and this happens from carbohydrate rich foods.

What about Greece, and Southeast Asia, and Japan(after world war 2) . These populations barely had enough food to survive.  They didn’t use refined carbohydrates – and ate whatever they could. It was not the low-intake of saturated fat that protected them, rather the relative lack of a refined carbohydrate leading to low triglyceride levels. Still, those studies, championed by the late Ancel Keys, are still cited.  This in spite of overwhelming evidence to the contrary.

Back to President Clinton – a vegan diet will not save his heart. Saturated fat is not what led to the atherosclerotic plaques – rather, it was the abundance of triglycerides from highly processed and abundant carbohydrates. What he has done that will help him is, lose weight, have heart surgery, take medication –but  in terms of diet, President Clinton falls into what Eisenhower did, as well as every anorectic—when the only thing they can control is diet, they will fall victim to fads that sound healthy, are promoted by TV MD’s – but have no science to back them up.

If you want to be a vegan for health, there is no data to support that. In fact, vegans have a life expectancy that is less than pescetarians (fish eaters) and omnivores.President Clinton – a Vegan

I’m always looking for new ingredients to cook with that make an impact on flavor and calories. Spaghetti Squash is a great substitute for pasta. It has more flavor, fewer calories, more nutrients – and is just as easy to cook as pasta.

Making this is pretty easy. The hardest part is cutting the squash. There are two ways to do it: brute force, or heat. If you’re feeling really strong, you can use a serrated knife- cut off both ends and cut from the inside out. Or with a very sharp knife, pierce the skin with the tip- and pull toward you. All of which require being careful or you will need my surgical services to sew you up.

Not liking brute force when it comes to knives (we surgeons like a delicate touch) – I prefer this method: With a fork, pierce the skin of the squash. Pretend the squash is a rectangle and pierce it twice per side with the fork. Place in a microwave on high for two minutes. This will allow the squash skin to soften then you can cut it with minimal force.

Once it is cut in half- scoop out the seeds with a spoon. You can roast the seeds if you like. I like to drizzle olive oil over the squash as well as some Sea salt and pepper. Bake at 350 degrees for 30-45 minutes (its done when you can easily pierce the skin with a fork). Take it out of the oven- let it sit for ten minutes- then pull the pulp away from the skin and it will naturally form into noodles.

I like to use tongs to separate the squash from the skin. You can season the squash after you separate it from the skin. This can be used as the basis for its own dish- a much healthier and less fattening dish than any pasta.

My Favorite, And the Easiest Method

You can do it all in the microwave. Pierce the skin of the squash with the fork and place it into the microwave for 10 to 12 minutes. Once it is cooked let it rest for about five minutes. Cut the squash and scoop out the seeds (you can roast the seeds for a healthy snack). Drizzle on olive oil (with some a touch of truffle) and salt and pepper to taste (I like sea salt).

(Watch Dr. Terry Simpson and Jineane Ford cook up a healthy, low calorie halibut dish. It’s fast, healthy, and delicious!)

* * * * *

My good friend Jineane Ford stopped by and we decided to make a simple Halibut dish that anyone can make.  Here are the ingredients:

Halibut fillets, or Halibut cheeks if you can get them.  About 4 inches of soda or Ritz crackers,  salt and pepper,  and one stick of butter.

To make it:

• Pre heat the oven to 400 degrees
• Melt one stick of butter
• Crunch up the crackers
• Cut the fillets into 1-2 inch pieces
• Dip them in butter
• Cover them in the crunched up crackers
• Then put remaining crackers over them and some butter

Into the oven it goes for just 10 minutes or so, or until the halibut is flaky. That’s It!

This is best with fresh halibut– but you could use any flaky white fish.  A two inch piece has about 225 calories.

I am proud of Jineane – four years ago she had lap band surgery and now is the weight she was when she won Ms. USA in 1989.  Now she is able to eat great food- like halibut- and keep her weight off.

The average person will pack on 5 pounds this Holiday season. But you don’t have to! Check out Dr. Simpson and the lovely Jineane Ford as they discuss how to avoid Holiday weight gain.

In terms of the Swine flu — that vaccine is specific for that flu. So if you had the Swine flu vaccine last year, or if you had the swine flu- you don’t to be re-vaccinated against the swine flu, but you DO need this year’s flu vaccine.

(Watch as Dr. Terry Simpson talks one-on-one with Daytime’s Cyndi Edwards about the cold and flu season and how to fight it!)

Who Should Get the Flu Vaccine?

We break it down into those people who cannot afford to get sick — the elderly, people who have transplants, people who work in the health care industry (yes, I’m getting the vaccine), and anyone who’s immune system is compromised.  If you have any questions, check with your physician.

A few simple myths about the flu:

Antibiotics don’t help it get better faster.  Patients call me wanting a Z-pack, or some antibiotic because they have the flu.  Antibiotics don’t make the flu go away any sooner. The flu is caused by a virus– and antibiotics are meant for bacteria.

Those surgical masks people wear — most of them won’t protect you against the flu. First, the flu virus is very small, and it can get through that mask.  Second, if you shake someone’s hand, who has the flu – well, that mask didn’t help did it?

Soap and water are the best thing you can use– and the new special soaps, that are alcohol based, do help prevent the spread of  the virus.

So, this year — get the vaccine.  If you don’t and you get the flu, do your co-workers a favor and stay home.  If you cannot afford to stay home with the flu, it’s simple:  Get the Vaccine!