Vitamin D and Pain

  1. Vitamin D deficiency can cause non-specific body pain
  2. Vitamin D deficiency is a contributor to chronic low back pain
  3. Vitamin D deficiency correlates with opioid drug need
  4. Vitamin D deficiency associated with muscle pain with statins (CoQ10 contributes to this as well)
  5. Vitamin D deficiency is associated with non-specific musculoskeletal pain

If you know someone with some kind of pain syndrome or are just in pain, don’t tell them to take Vitamin D but to get their levels checked.

Real is Rare

In Jewish tradition, the deepest mystical wisdom is proscribed to be communicated to one student at a time and only if that student shows he is deep in understanding and ready for what having that knowledge means. I have noticed that in teaching patients about health, something not at all secret or mystical or even deep, the same holds true, they must want to learn, they must have a deep desire to make changes, and they must be open to having paradigm-breaking experiences. Only then, can real transformative change happen and when that happens, the probabilities of modern science fall away and like Neo in the Matrix, they have an enhanced level of control and can choose a different health path for themselves. I am not exaggerating.

These patients often become leaders themselves and a real force for change or at least serve as role models for others. These relationships are the deepest and most satisfying of my career and even though they happen infrequently are worth the effort.

I was reading the website of a famous doctor today. I had a 30 min conversation with him once after one of his lectures at an event. What struck me about this conversation was the contrasting mission of this doctor. He is very famous but his contact with patients is now limited if he has any at all, as he seeks to influence the masses through films, TV, and being on shows and podcasts. Spreading the message with a missionary zeal doesn’t appeal to me because the kind of impact I seek can only be done in small groups or one on one. Which of course, doesn’t make my work or his work any more or less valuable, it is just measured on differing standards.

Unfortunately, though, and I don’t say this in regards to this famous gentleman, because I don’t know, but since society has placed fame at the very top of desired measurements of success, we ought to consider that some might construe fame for influence and importance. We know it is not. And others might mistake lack of fame to mean insignificance. To all those folks, I would say, that if you are blessed with children or even just a spouse, and you have created a loving home for them with all of your heart, you created a whole world, and in that, any feeling of insignificance can legitimately be tossed aside.

Hebrew mystical tales speak of souls that choose a full life here on Earth just to do one small favor for someone. What is of ultimate importance is certainly not always clear or made available to us. What is clear and self-evident is that we pursue authenticity and recognize our uniqueness which always reminds me of my favorite Chassidic story: Reb Zusha, lay crying on his deathbed in fear and sadness. His students asked him, “Rebbe, why are you so sad? You lived a perfect life like Moses, you will surely get a great reward in heaven!” “I’m afraid!” said Zusha. “Because when I get to heaven, I know God’s not going to ask me ‘Why weren’t you more like Moses?’ or ‘Why weren’t you more like King David?’ But I’m afraid that God will ask ‘Zusha, why weren’t you more like Zusha?’ And then what will I say?!”

It’s not so certain

Confidence is important in selecting your teachers, but a teacher who is over-confident and is so sure that his/her way is “the way” is probably the most dangerous of all especially when it comes to science. The saying that most medical students get when they enter medical school that “50% of what we will teach you is wrong, we just don’t know which 50%” still holds true and is even more correct as science progresses faster and faster which leads to more and more questions!

At some point, when you learn enough you realize that everything you thought was certain, just isn’t so certain, and is much more complex than you ever thought. One can even make the case that if you haven’t encountered this thought, you just haven’t learned enough on the topic you are talking about.

My teacher of blessed memory, Gerald Epstein, MD used to remind me that every time you open your mouth, you should ask yourself internally, “What do I myself, truly know about this topic?” as a reminder to be careful what you put into words. In the world of social media and edutainment, most content would probably disappear if this advice was followed πŸ™‚

Diet wars fill my feed

Most people don’t care about the diet wars. They don’t care about the debates or the guru’s. In this war, there will be no winners. It’s all “vanity of vanities” as Ecclesiastes says.

Most people see the groups that form around specific diets to be odd and peculiar. Most people don’t want to be recruited into a group that promises health and happiness based solely on food choices.

There will always be lots of utopian movements, they never end well, and almost always limit independent thought and growth. While some of my patients have joined this or that group, ultimately, the greatest ones, the ones that have become ambassadors of wellness and leaders themselves, have integrated a lifestyle, not a diet, into their existing life without alienating, in fact, almost always enriching the culture they come from.

They don’t leave their culture to join this or that movement, instead they innovate and bring more life to the culture that they come from. Most people feel comfortable in the culture they inhabit, they don’t want to leave it for some utopian food group. If you truly want to empower and inspire others, do some from the perch you know and come from, most people appreciate authenticity more than anything else.

Government Health

Its obvious that part of the PERSONAL solution to our current pandemic is to focus on you getting as healthy as possible, but for people to attack government and conventional medicine for not emphasizing that enough is like complaining to your local restaurant for not taking off your favorite dessert because it is unhealthy.

People in America at least, overwhelmingly do not want government or society dictating their health and lifestyle choices. They also overwhelming know that junk food is no good for them.

I offer lifestyle choices in a non-threatening, non-moralizing way to almost all of my patients and about 1 in 200 take me up on a full spectrum of lifestyle change. You think it would be any more successful if the government started telling you that? They can’t even effectively articulate how and why you should vote and you want them or Dr. Fauci to focus on lifestyle choices? Take control over your own health and that of your family and don’t rely on the mediocrity and overgeneralization of government recommendations and spokespeople.

Cannabis Complexity

I have spoken at length on my Wednesday Night Live show (which you can sign up for for free at drcarplive.com, prior episodes archived on YouTube) about cannabis. In Episode 17, I spoke about the endocannabinoid system and specifically how to activate it to improve your health WITHOUT cannabis. In Episode 51, I spoke at length about what I feel are some very negative societal messages and trends regarding marijuana as a recreational drug, yet still recognizing some of the benefits of cannabis in regards to medical use especially with in light of our continued, horrific, opioid crisis.

As many of you know, I am not a fan of the criminalization of cannabis even though I am very vocal in a social critic kind of way, about the trendy nature of pop cultures embrace and promotion of recreational cannabis. I’ve always shared the view of comedian Steve Harvey who when asked why he doesn’t and has never smoked marijuana, responded something to the effect that he never wanted to do anything that would take away from his God given gifts. While people on marijuana sometimes think that loosening themselves up opens them up to more creative thoughts, I can assure you being one of the few non-high people at some parties in my life, that I know why they used to call it “dope” πŸ™‚

When you understand those who supported and continue to support this criminalization, you start to grasp why it’s more complex than it seems. On the one hand, you have stoner celebrities who think cannabis is the cure all for mankind. I, once, had a patient clearly high, who was in the cannabis industry who truly felt it would usher in some sort of utopia. I couldn’t get him to stop chatting about πŸ™‚ Neither of these type of folks do much to convince me of anything. But who else supported/supports this criminalization? Privatized prison corporations, alcohol and beer companies, drug rehabilitation centers who get federal funding from court appointed rehabilitation sentences and of course, prescription drug companies like those who make opioids. (L Fang The Nation, 2014)

These industries through their very expensive lobbying efforts don’t benefit society as a whole. So while I am not in favor of some sort of push for legalization as that enlists a whole host of counter supporters and wasted money, it also in an unhealthful fashion allows the folks above, the utopians and the stoner celebrities to push for it like it is some kind of health food which it most certainly is not!

So, decriminalization, removing the penalties, takes pressure off the police, prevents people from being sent to jail for possession, silences the unhealthful pro’s and con’s of the argument and allows people to make their own decisions. I think this is the most healthful, immediate step, it allows for more rational discussion of the pro’s and con’s without allowing some of the big money to come in a muck things up. The trend is clear, it will eventually become legal, I just don’t think society has a mature understanding of it yet for full legalization, decriminalization makes the most sense to me right off the bat. In both of the episodes above, I address all of the health issues, so if you want to learn more about cannabis and the endocannabinoid system, seek out those 2 episodes as they are archived on my youtube channel.

Men in Crisis

Dr. Robert Glover describes eloquently how societal changes in the 20th Century resulted in a reduction of the time between boys and their fathers. In 1910, one-third of families lived on farms where boys and their fathers, brothers, and extended male relatives often worked hand in hand. This allowed boys to see and learn how to become a healthy male. By 1970, 96% of families lived in urban areas where fathers left for work early in the morning and came home late at night.

Fathers suffered also by this rapid change, with increasing addictions to work, TV, alcohol, and sex. Divorce tripled from 1940-1970 with increasing separation of boys from male role models. During this time, other factors distanced boys from having male role models. The educational system took a central role in socializing both boys and girls. With only 25% of teachers being male and even less in the lower grades, meaningful mentorship and contact between boys and men of authority was also reduced.

Then came the Vietnam War where young men often took positions opposite those of from their baby-boomer dads. During this period, gender roles and feminism started to evolve. While the majority of women didn’t hold to the ideas of “radical feminism,” a social climate was created that served to lead to men questioning whether traditional masculine behaviors like connecting deeply with other men, growing in strength and leadership qualities and seeking out male role models was something proper.

Robert Bly, author of the Iron John, wrote that this led to a new kind of man that he describes as follows “They’re lovely, valuable people – I like them – they’re not interested in harming the earth or starting wars. There’s a gentle attitude toward life in their whole being and style of living. But many of these men are not happy. You quickly notice the lack of energy in them. They are life-preserving but not exactly life-giving. Ironically, you often see these men with strong women who positively radiate energy. Here we have a finely tuned young man, ecologically superior to his father, sympathetic to the whole harmony of the universe, yet he himself has little vitality to offer.”

And the changes didn’t just affect men, they affected women as well. Camille Puglia, a well-known feminist and social critic comments on these changes as well “The hard driving woman has to switch personae when she gets home. She’s got to throttle back, or she’ll castrate everything in the domestic niche. Many white, middle class women has dodged this dilemma by finding themselves a nice malleable boy-man who becomes another son in the subliminally matriarchal household.”

It’s no wonder that boys struggling to find their place as they become men, with almost no instruction have led to problems in a healthy transition from boyhood to manhood or a lack thereof. And all this leads us to the current trend of social discussions of “toxic masculinity” almost exclusively without any insight into the historical trends that got us here. In fact, there is hardly any meaningful discussions regarding the obvious and historically evident answer to the problem which is to foster thoughtful transitions for boys to become men as has been a standard in every traditional society around the globe forever and to actively encourage on a societal level connections between men and boys.

People need to be judged on their behavior, so should a man behave in a morally repugnant manner, he should be punished, regardless of the causes. A healthy society seeks however, not the immediate emotional venting that social media abnormally rewards, but a thoughtful understanding of the tragic loss to society of entire generations of men who haven’t received the guidance to live up to their potentials as men.

Please tag or share with someone you think will find this valuable.

The Greatest Teacher of All

The root of the word doctor, means to teach. In a classic book of morals, named Pirkei Avot or Ethics of the Fathers, a much translated work of Hebrew, one that has become somewhat popular in Chinese due to its moral Confucian-like aphorisms, there is one saying by Rabbi Hanina : “Rabbi αΈ€anina said: I have learned much from my teachers and even more from my friends, but from my students I have learned more than from all of them.”

If a doctor is supposed to be a teacher, how does a doctor learn from his patients. Well, quite frankly, most don’t, doctors these days are under major time constraints such that modern medicine has often become cookie cooker medicine, that doesn’t allow an interaction that would benefit a healing relationship.

Yet, to regain the sacredness of that healing relationship and the reason why it is called the “practice of medicine” each new patient presents an incredible opportunity to learn. Dr. Sir William Osler, the father of modern medicine even if we have strayed from his wise precepts said β€œJust listen to your patient, he is telling you the diagnosis.”

The skill of listening OUTSIDE of the rules of conventional medicine are what are required, because each and every day of seeing patients is an opportunity to learn more about how the circumstances of life are contributing to the illnesses that we see.

No one has yet to account for why one person gets infected over another as an example. It is chalked up to immune system differences or other factors but really listening to the patient can often turn up circumstances that have caused stress or major life changes that with them often come changes in health.

These are all opportunities for both the doctor and the patient to see health as a composite picture with many contributing factors. A “diagnosis” often shuts down any sort of search for other factors when in fact, it should do nothing of the sort. With auto-immune disease, I and others have found that the onset of these diseases correlate often with some major life change or trauma. With that information on hand there are various strategies that can be implemented to account for this in a proactive way.

Ultimately, it is the doctors job to be open to learning from his patients. It is another reason again, why the call it the practice of medicine and with that I will leave you with another remarkable quote from Sir William Osler that can change any doctors mindset when seeing a patient :”It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”

The Performance Mindset

The performance mindset that many of us use to prepare and perform for very specific events in our lives, like interviews, negotiations, and on the work tasks can also be used for our exercise.

Let’s face it, most people don’t like exercise. For those people the only way to get it to be less onerous, is to set up a routine / habit until it becomes as easy as brushing your teeth. This can take anywhere from about 3-8 weeks (depending on the study) and then you do it automatically. So you don’t have to focus on forever, focus first on just the next 3 weeks and it becomes much more doable as unbelievable as it sounds.

Even more important to get through this beginning time is the performance mindset. Set an aim and do what you can to enhance your performance. In the past I was impressed by the RESULTS of some studies on fasted workouts (not eating before a morning workout) and so never really thought implementing the concept of a pre-workout meal even though the bodybuilding community has used it for years.

Yet, when I tried and continued with a small carbohydrate meal of 15g of carbohydrates in the form of steel cut oats before my workout, with a small amount of caffeine from my morning green tea, my workouts have become much more enjoyable and I am lifting more and getting much better results because I am able to perform better, with a better state of mind, feeling stronger and doing more.

The point I am trying to make is not that you need a pre-workout meal like me but to focus on what will make your performance at the gym better by assessing your mental state (maybe something motivational on your phone), hunger / lack of fuel, and even clothes (don’t underestimate the role of a “uniform” and what it does to your mindset). You have to take an inventory of all of this. The bodybuilding community has always had this performance mindset in the gym, watch the classic documentary Pumping Iron with Arnold Schwarzenegger to see the mindset they had in the gym. When I lived in Santa Monica, I worked out at the World Famous Venice Golds Gym for about 6 months until the gym in my building re-opened. I was always amazed at the singular focus of the people there. There is a lot to be learned from the bodybuilding community.

So, the main point here is you might need a small pre-workout shake or small piece of fruit or oatmeal, you might need music or motivation, you might find special workout clothes to help, you might need a little caffeine, do what you can to make that time in the gym focused and with a high performance so that when you walk out you feel like you can give yourself a high five.

As always, it is about incremental improvement, don’t beat yourself up if you don’t feel like it some days, even the great Jack Lalanne, used to say it is not easy, “To leave a hot bed, to leave a hot woman and go into a cold gym.” But to give of your gifts in this world, your physical state is important, so take small incremental steps and focus on your performance and mindset and leave the results to themselves.

Guru vs Guru

There is a disturbing amount of personal attacks on people’s body composition by members of certain dietary types. You have carnivore and keto diet guru’s ridiculing the physiques of vegan gurus and vegan gurus ridiculing low carb guru’s physiques. This is all nonsense. I have attended vegan and keto events (those 2 terms are not mutually exclusive by the way) and I can tell you there are lots of physically sexy people in both and you know what they often have in common? Youth and physical activity! There are people in their 50s, 60s, 70s also sexy and you know what they have in common? They are well read on the theories of their eating plans and follow them and . . physical activity. Personal attacks appeal to our basest interests and garner more engagement with those posts, so there is an incentive.

Underlying all of this is a more concerning trend, that these guru’s can’t seem to maintain any sort of discipline to criticize ideas and leave out the person. It’s always been parochial to narrow health and body composition and appearance to diet alone and it is misguided to have an ideal sexy frame which has more cultural influences than we would like to think. Everyone can agree that a lower body fat percentage and retaining muscle mass are important as one ages, but as to how one specifically looks, each community can have their ideal within that agreement like people living in 2 different cultures.

It’s seems that that quote attributed to Eleanor Roosevelt is quite relevant here : “Great Minds Discuss Ideas. Average Minds Discuss Events. Small Minds Discuss People.” Ridiculing a person’s physical appearance plays to the lowest and basest human drives. Want to win over quality people to your cause? Be a leader that creates more leaders by empowering those who learn from you. As Rabbi Jonathan Sacks OBM said “Good leaders create followers, great leaders create leaders.” Ridiculing others is often mimicked behavior on social media due to its popularity, this is however a tree without roots or can be likened to one who “builds a house on sand.” Neither will stand the test of time.