Is Breakfast Really the Most Important Meal of the Day?

By Natan Schleider M.D.

SOURCE AND QUOTES FROM:
JAMA. Published online May 1, 2019. doi:10.1001/jama.2019.2927

‘Back in 1917, the same year that she cofounded the American Dietetic Association (now the Academy of Nutrition and Dietetics), Lenna Frances Cooper authored an article in Good Health magazine that noted “in many ways the breakfast is the most important meal of the day, because it is the meal that gets the day started.” Good Health was published by the Battle Creek Sanitarium, a Michigan health resort run by Cooper’s mentor, John Harvey Kellogg, MD, the coinventor of corn flakes (his brother started the cereal business that would become the Kellogg Company).’

Recent studies indicate that eating breakfast may NOT improve weight loss and nutrition, speaking to how the public’s medical knowledge that ‘everybody knows’ has no scientific support. Other fallacies that our parents told us include sitting too close to the TV will cause eye damage, for example–it will not.

One Meal A Day (commonly called OMAD) has been a recent diet trend where a person consumes all calories within an 8 hour window or fewer.

Bottom line for the patient with a normal metabolic system is that total calories consumed per 24 hours will best reflect weight loss outcomes, regardless when calories are eaten. That said, plenty of serious body builders and models eat no carbs after 12 noon .

If breakfast is integral to your nutrition, diet and lifestyle, great, don’t change a thing. I personally am not big on breakfast eating usually some egg whites sauteed with some onion and tomato and chipotle tabasco sauce (about 200-300 calories). If you have been forcing down breakfast and not particularly hungry, recent data shows this may kickstart metabolism and hunger later in the day leading to weight gain.

Thanks for reading,

Dr. Natan Schleider

Turning 50? Get ready for a battery of tests…here is what is recommended.

‘Some men just can’t seem to grow old gracefully.’

By Natan Schleider, M.D.

January 14th 2019

I’ll be turning 50 soon and I can tell. I wake up 4 times nightly to pee )so my prostate is growing.’ My hair is thinning. Joints hurt. I shrunk from 5’9″ to 5’8″ based on my last physical. While I am researching anti-aging medicine, I am preparing for the slew of tests indicated at age 50.

In no particular order if you are 50 or older you should have these tests:

  • Screening colonoscopy for colon cancer every 10 years for those at normal risk of colon cancer. Alternate options which I am considering is Cologuard which is a stool based DNA non invasive test with 95% accuracy done every 3 years instead of colonoscopy (unless of course the test is positive in which case you need colonoscopy).
  • Screening Chset CT Scan (age 55 to 77) if you have ever smoked 30 packs of cigarettes in your life or have smoked any cigarettes in last 15 years.
  • Prostate testing in men annually–debatable, talk to your doctor.
  • Checking your weight, cholesterol, and blood sugar annually
  • Pap smear every 5 years in women
  • Mammogram annually for women
  • Annual skin exam by skin doctor
  • Make sure vaccines are up to date–these get confusing and probably warrant another blog/article–most common is tetanus booster with pertussis every 10 years

If anyone knows a good anti-aging doctor, let me know!

Natan Schleider, M.D.

‘Dear Blue Cross Blue Shield, Thanks for raising my fees because I know the 1+Billion Profit You Made in 2018 Will Go Straight to the Sick and Infirm!’

By Natan Schleider, M.D.

January 12th, 2019

First let me say if you are reading this blog and comment or follow me on social media and are a new patient with no health insurance, I’ll provide you free medical care for 3-6 months within the scope of my specialty. Why? Quite simply if I can afford to run a medical practice with zero income from some new patients, perhaps large insurance companies can do the same?

Anthem made 1.1 Billion Dollars in 2018 while dropping 888 thousand clients. Way to trim the fat.

If health care providers provide medical care and patients receive medical care why do the middle men–health insurance companies–make all the money? This complex question which seemed innocent in 1917 has snowballed to the point I pay over $2000 dollars a month for health insurance for me and my daughter which we sometimes use. But not $2000 a month! We are healthy fortunately.

So my proposal to Empire Blue Cross Blue Shield, the biggest insurance company in New York City: For every free patient I treat, you treat a free patient like a 9/11 victim, a pregnant mom, anyone warranting care.

If we both lose a 100 million dollars monthly then we regroup but if everything goes smoothly, become a nonprofit that gives out smoothies!

Hope to see some new patients soon as well as people commenting on my blog.

Natan Schleider, M.D>

Going for a routine physical exam? New guidelines suggest less is more.

January 4th, 2019

By Natan Schleider, M.D.

Early Electrocardiogram called a String Galvinometer Circa 1911

My primary care physician is a very bright internist in his early 70s who I saw recently for a routine physical exam. He examined my head, neck, chest, and abdomen and then, putting on gloves and grabbing some KY jelly, told me to bend over for a prostate exam.

‘Prostate exam!’ I said, ‘Why? I have no prostate or urinary issues, no personal or family history of prostate cancer, and don’t see the need.’

‘Just being thorough,’ he replied.

While I like my doctor, there is thorough and then there is ‘too thorough.’ Moreover, I reminded him, routine prostate exams are no longer indicated [Source: US Preventive Task Force].

‘We’ll skip the prostate exam.’ I said. He shrugged as if to say he wasn’t doing his job properly. He then checked my legs and the exam was over.

While some of you may like the comprehensive check every nook and cranny exam, I personally don’t nor do I recommend or perform them. I stick to what the data supports. Why some patients seem disappointed that I haven’t probed every orifice is beyond me but to each their own.

Next time you’re in for an adult physical, here are tests which are no longer considered routine or necessary unless, of course, the doctor feels they are needed based on your medical history, symptoms, or other risk factors.

  • Digital Rectal Exam (meaning sticking a finger into your anus and rectum)
  • Pelvic Exams in Women
  • Testicular exams are up in the air but consensus is that male patients, especially those age 20-35 (when testicular cancer is most common) can perform their own monthly self-examination and/or have the doctor do the exam. The US Preventive Task Force recommends against testicular exams during a normal physical [Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/table/vaphysical.t1/?report=objectonly]
  • Thyroid exam for thyroid cancer
  • Abdominal exam for pancreatic cancer, liver enlargement, or spleen enlargement
  • Lymph node palpation
  • Back exam for determining mobility
  • Checking reflexes in arms and legs
  • Breast exams need not be done if more sophisticated tests like mammograms are available

Some testing on routine physical exam are still being reviewed but as I peruse the medical literature, it seems that, to my old school doctor’s chagrin, much of the physical exam in adults is probably not helpful and may even lead to false positives.

Certainly some patients will swear that their doctor caught a disease by poking around or hammering on the knees with a reflex hammer and all I can say is: God bless those doctors. I’m interested in the facts here, just the facts.

Thx for reading,

Natan Schleider, M.D.

Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/

Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult

Hanna E Bloomfield, MD, MPH and Timothy J Wilt, MD, MPH.

Created: October 2011

‘I don’t need the flu vaccine, it always makes me sick plus I can count on ‘herd immunity.’

January 4th, 2019

By Natan Schleider, M.D.

Poster by Board of Health Advising People wear mask in 1918 to protect against Spanish Flu


‘I don’t need the flu vaccine,’ said a mid 30s healthy female patient to me yesterday, ‘it always makes me sick plus I can count on herd immunity.’

My patients are well read, opinionated, and know plenty of medical jargon to make their point. Herd immunity, if you’re wondering, means that if everyone else around you is vaccinated and immune to a disease, the chances of them giving it to you is very low.

Let me also add the influenza vaccines do not give live virus, just the proteins of the virus to illicit an antibody and immune response if you are exposed to the virus. The immune response caused by the vaccine results in some cold symptoms like fever, sore throat, runny nose, cough, aches/pains, but DOES NOT cause the flu.

So why all the hype about the flu vaccine?

There are several answers:

  1. The media often has nothing really news worthy so given the mantra’ if it bleeds it reads’ they can always turn to the dangers of the latest deadly flu virus bound to land you on a ventilator before you can change the channel. Remember all the media hype about Avian Flu (H5N1) about 5-10 years ago. Turned out to be nothing. And the dreaded Swine Flu of a few years ago infected the airwaves aggressively (and fortunately did not infect many people). If you really want information about influenza ask your doctor, check the CDC and WHO websites, and ignore the publish or perish journalists.
  2. Historically, certain strain of influenza were actually quite deadly. the most infamous in Spanish flu, an aggressive form of H1NI influenza virus that spread quickly and was unusual in that it killed more young health adults (ages 20-40) than the young or elderly. Over 100 years later, this pandemic killed more people than those that died in WWI.
  3. If another aggressive flu virus rears its head, the flu vaccine does a nice job at keeping you alive–presuming the CDC and WHO have guesstimated the right 3 or 4 viruses to put into the vaccine that season.

I recommend all my patients get the flu vaccine. I get it annually and have never had the flu (which let me remind you results in days of miserable fever and chills and 2-4 weeks to recover…this isa cold on steroids).

My flu vaccine of choice is the quadrivalent vaccine (meaning it has four flu virus proteins in it) while the classical influenza vaccine has three. If you are worried about mercury (thimerosal) get the preservative free vaccine. If you are worried about autism note there is little if any data to support vaccines causing autism but it is up to you. If you are worried the shot will hurt, make sure the doctor injects with a brand new needle (that is, not the same needle used to draw up the vaccine from the vial as this will blunt the end of the needle and cause more pain).

After the flu vaccine, you can take Tylenol or Advil or Alleve and can expect your arm to be sore for a day or three.

Take home message: get the flu vaccine yearly and stop wasting your time and losing sleep over the myriad of journalists that have nothing better to do than scare you about so they can make a living.

Thx for reading,

Natan Schleider, M.D.

Why I Avoid (Most) Hospitals At All Cost

December 21st, 2018

By Natan Schleider, M.D.

A few years ago, I met Rick B (name changed for privacy) at the Lenox Hill Hospital Emergency Room in New York City at around 3-4 am. Rick had severe arm pain and tenderness and I was concerned about necrotizing fasciitis, a deadly bacterial infection that can simply put eat through your skin and cause blood poisoning (septicemia). I had prescribed Rick Ketorolac (which is like super strength Advil–it is not addictive) but the hospital’s pharmacy was not delivering it and Rick was writhing and crying in pain. So I gave Rick his ketorolac, documented all this in the chart and told ER staff, and was pleased to see Rick feeling better.

Later that day, the chairman of the hospital, Jill Kalman, MD, called me. She was furious and short with me on the phone, stating I had put her hospital at risk by giving the patient a medicine that had not come from the hospital pharmacy. I apologized and Dr. Kalman’s response: have security follow me around all day (including into my patient’s rooms) to ensure I did not give patients any more medicines. Neither I nor the security guard (nor the patient) had experienced anything like this.

When Rick said he wanted to go home after the day’s testing confirmed nothing serious, I was happy to discharge him immediately.

The above true story is one of several that remind me why I try to keep patients out of the hospital at all cost. I no longer admit to Lenox Hill Hospital.

You don’t need to be a genius to realize if the hospital does not have the exact medicine you need in a timely manner, is it not reasonable to use your own? The US National Library of Medicine Patient Safety Guide suggests this is reasonable: https://medlineplus.gov/ency/patientinstructions/000501.htm

Prior to Rick’s admission, I admitted a pleasant 90 year old woman, BD, who had never been in the hospital before (except for childbirth) with pneumonia. BD had barely been in the emergency room for an hour before the hospital staff determined that BD should be immediately put on hospice and put out to pasture. BD’s daughter, her health proxy, greeted me with tears in the emergency room saying she felt quite bullied.

My personal experience tells me most patients over 90 with a serious health condition are likely to be pushed toward hospice or palliative care rather than normal care. I understand prognosis in the elderly is poor and many intensive care units are over filled with nonagenarians. That said, patients have a right to comprehensive medical care and if that means it will take a miracle to cure them, visit the local chapel or synagogue, find a good doctor, and provide your loved one with the best care indicated.

BD spent 3 days in the hospital and ultimately died of pneumonia but the family has no regrets, at least they tried.

Thanks for reading,

Dr. Natan Schleider, M.D.

DO I Really Need all these Adult Vaccines?

By Natan Schleider M.D.

December 19th, 2018

Vintatge Diptheria Vaccine Poster Circa Early to Mid 20th Century

Which routine (IE not for exotic travel) adult vaccines do I really ‘need’?

The Center of Disease Control (cdc.gov) provides up to date information on what vaccines each adult ‘needs’

Note ‘needs’ is in quotations as many of my patients say ‘every time I get the flu shot I get sick and I’ve never had the flu so I don’t want it.’ Hard to argue with this logic.

Other patients ‘pass out’ when they see a needle and the CDC doesn’t have much to add for these people.

My goal is a succinct review of all vaccines you’ll need in adulthood based on current 2018 CDC guidelines.

FYI, while I get all vaccines and have no issues with them, my daughter flipped out and cryed and cryed for her 4 year old vaccination so I haven’t had the heart to get her annual flu booster–bad Dr. Schleider.

So here are the vaccine you need in no particular order:

  1. Influenza recommended annually for everybody (unless you are allergic to it).
  2. Tetanus–Recommended every 10 years (5 years if it is a nasty wound like on a rusty fence). Try to get the tetanus booster that contains pertussis at least once in your adult life.
  3. Measles Mumps Rubella and Chicken Pox–You’ve probably had these in childhood (unless born before 1957). If there is any question as to whether you are immune I like to do blood tests for antibodies to confirm immunity.
  4. Shingrix 2 doses after age 50 2 to 6 monthts apart. No one is really using Zostavax anymore…
  5. Pneumonia Vaccine PCV13 (Prevnar) one dose after age 65 unless you have chronic medical issues like kidney or lung disease in which case have it earlier.
  6. Pneumonia Vaccine PPSV23 (Pneumovax) one dose after age 65 (don’t give at the same time as Prevnar) or 1-2 doses before age 65 if you have chronic medical issues.
  7. Human Papilloma Virus–3 doses through age 26 in females, age 21 in males
  8. Meningitis-There a re afew vaccines but bottom line get these before going to college or if you have any immune system disease
  9. Haemopholis Influenza B–Again for patient with compromised immune systems
  10. Hepatitis A and B–Hep B vaccine has become standard and I recommend Hep A to all travelers.

So that is my bare bones synopsis. We haven’t gotten into the exact timing of the vaccines but that is ok, just so you know what to ask your doctor or pharmacist (they get busy and may forget to remind you).

FYI I am a big advocate of vaccines and have had every one from yellow fever to rabies.

Reach out if you have any questions.

Thanks for reading!

Dr. Natan Schleider M.D.

Weight Loss & Lifestyle Tips to A Lean Healthy Physique: Dr. Natan Schleider Shares His Medical Secrets (Shhh Don’t Tell)

ARE YOU TOO FAT. Vintage weight loss advertisement circa 1900

By Natan Schleider, M.D.

December 12th, 2018

Gone are the days where I could simply skip desert and stay rather lean and toned. Having just turned 43, I literally feel my metabolism slowing and all I need to do is look at carbs and they go straight to my gut by osmosis. 

I weighed about 175 pounds (standing 5’9″) into my late 30s but after a recent physical I weighed in at 220 pounds and have shrunk to 5’8″. At this rate I’d be a walking doughnut with a head so I left my doctors office determined to get lean using every bit of advice I could find in the world of medicine, science, and technology.

Its been two weeks and I am down to 205 pounds. I could say I feel great but I’d be lying. My internal barometer seems to want me obese which I qualify for using a Body Mass Index Calculator. I’m tired as I don’t sleep well when I’m hungry. I’m cranky but fortunately I get a lot of telemarketing calls which allow me to toy with people trying to sign me up for ‘limited time offers’ on credit cards, business loans, and Nigerian Gold Mines.

I presume my mood and body will get used to my goal weight which is 180 to 190 pounds if I can get there. 

So here is what has been working to get the weight off…

  1. I go to the gym at least 5 days a week and workout with a trainer. This is my life one big luxury but I am so lazy if I didn’t pay the trainer I would barely work out. The trainer doesn’t let me skimp on those last few squats that leave me dizzy and gets a good laugh when I fall on my face doing box jumps. Bottom line: if you can afford a trainer or have a motivated work out partner that really helps. That said, weight loss is about 80 percent diet so if you cannot afford a trainer and hate the gym most of success lies in meticulous eating.
  2. I started using a My Fitness Pal app which is a real pain because it takes about 5 minutes to enter calories for every meal depending on the number of ingredients. The simpler the meal the faster I can enter and count calories. I’m aiming for 1500 calories daily, a few hundred more if the workout has been strenuous. Some of the things I snacked on like a slice of American Cheese or Prosuciutto have way more calories than I thought so the app has been educational. Even cucumbers have calories and if you are going to lose weight, you need to be rather meticulous in your calculations
  3. I’ve stopped eating out or ordering take out as I cannot count these calories–plus I like to cook so not a biggie for me.
  4. I have prepared healthy meals ready to be cooked or simply heated. I have a great healthy tomato bisque recipe–if anyone is interested let me know.
  5. I have my ‘skinny jeans’ front and center in my closet and try to put them on every few days. They obviously don’t fit (yet) and this negative reinforcement pisses me off, re-motivating me to stick to the diet exercise plan.
  6. Studies show drinking diet beverages can actually cause weight gain and other issues but when I have a sweet craving, I’ll go for a Diet Cherry Coke which is better than Cherry Garcia.
  7. I bough a food scale for about 10 dollars and while I think anyone weighing their tomato wedges is nuts, it is the only way for me to know exactly how many calories I am eating (because the common advice ‘just portion control’ means instead of eating an entire pizza pie, I eat half for dinner and half for dessert).

Some of the above I am sure you’ve read while other may seem somewhere between fanatical and disciplined but if I am serious about weight loss, this is a discipline which takes time and I just hope I can stick with it to the point it becomes routine.

Anyway, thanks for reading!

Natan Schleider, M.D.

Humorism: Why Modern Medicine is Still an Infant or Maybe a Young Toddler

December 11th, 2018

By Natan Schleider, M.D.

‘The Four Humors’ by Granger Drawing Circa 1574

So its the 21st century, you had a physical, and the doctor collected body fluids like blood and urine for ‘sophisticated’ testing. Ah the marvels of modern medicine.

But wait, doctors have been doing this for thousands of years. I would have been one impressed Gladiator in Ancient Rome if my doctor tasted my urine and explained I was feeling weak and urinating a lot because I had too much sugar in my blood. And doctors did just that. No glucose strips or little battery powered devices. Diabetes mellitus was diagnosed with a simple taste test, not blood test. 

Perhaps that doctor sends me to a specialist in Gladiators (who had the status and value of today’s NBA and NFL stars when Rome ruled the world) who likely would do a blood test. Sounds perfectly reasonable. Who wouldn’t want to know if their four humors (black bile, yellow bile, phlegm, and blood) were out of whack.

Today, we honor those four humors and their inventor, a physician known as Hippocrates (460-370 BC):

  1. Doctors take the Hippocratic Oath
  2. We take humors like phlegm and blood of out peoples bodies to test (IE for infection or anemia) and treat them (IE for Polycythemia)
  3. Doctors keep their patients humors in balance by reducing phlegm if they have too much of it so they can breathe

Around the 1500s doctors realized that there may be more to medicine than the four humors but that didn’t stop doctors from bleeding patients therapeutically for virtually any ailments into the early 1900s. Did you know George Washington died of being bled by his doctors for a throat infection. Seriously!

The greatest advances in medicine in the last few centuries include soap (probably saved more lives than all the antibiotics ever created), antiseptic surgical technique, and Viagra (not necessarily written in order of importance).

Sure we have fancy breathing machines, pictures that let us see inside our bodies, and robotic surgery. 

I’m no surgeon but I have to wonder about the bedside manner of robots, I mean, after fixing my heart valve will they reassuringly rest their arm on my shoulder and take a sip of my urine to confirm my diabetes is under control?

Thanks for reading!

Natan Schleider M.D.

Ten Signs You Are Seeing the Wrong Doctor

December 8th, 2018

By Natan Schleider M.D.

If dustballs in the corner of the doctor’s exam room and bullet proof glass separating your from the receptionist aren’t good enough, here are ten signs that you probably are not seeing the best doctor:

  1. An old expression states if the ink on the diploma is to wet or too dry, seek treatment elsewhere. If the diploma is a pile of dust behind a dingy glass frame, run.
  2. The doctor’s lab coat is dirty. This simple observation reflects the doctor’s hygiene and their respect for medicine. Dirty lab coat, dirty doctor.
  3. Magazines in the waiting room are over 10 year old. This shows the office is not up on the times, that is, if they can’t even update their magazines, what kind of archaic medicine is being practiced.
  4. The doctor spends less than a minute with you and can never remember your name. While I grant many doctors are overworked, they can spare a few minutes and knowing their patient’s names.
  5. The doctor is a social media star who does nothing but tweet, post, take selfies, and promote his brand. While I’m sure these doctors are attractive and interesting, they probably are not practicing as much medicine as the good old fashioned doctor–oh, excuse me for a second, someone just liked my latest post on instagram, just joking.
  6. The appointment is spent talking about the doctor and not about the patient (for example, ‘So you just had a little heart attack, big deal, I get my coronaries rota-rootered every year and since my 8th heart attack and some Lipitor, I eat at the buffet daily).
  7. The doctor cannot make a decision and refers you to a specialist for every problem (IE that splinter in your finger is tiny but just to be safe, let’s have a dermatologist look at it to make sure nothing is being missed).
  8. The doctor’s office frequently cancels your appointment or is late for your appointment.
  9. You arrive on time for your appointment and realize yo have read Was and Peace before being called in to see the doctor.
  10. You are asked to disrobe in the exam room for a talk therapy visit.

I’ve seen variants of all of the above so keep the above in mind before choosing your next doctor.

Natan Schleider MD