I am often asked about how much water one should consume each day.

For most people, the answer is straightforward: Drink enough to satisfy your thirst. But that’s a bit overly simplistic, so let’s explain in more detail:

Water is a vital bodily component. An average adult contains about 55% water by weight, and an infant, about 75%. So, to maintain this large amount, an adequate daily supply is necessary, especially in the summer months when needs are higher.

Sources of water for consumption are plentiful: plain water tops the list, but it’s present in most beverages and foods as well. Fruits like watermelon, grapes, etc. are excellent sources of water. But as I have mentioned before, avoid sugar-sweetened beverages and so-called “sports” drinks like Gatorade unless you are involved in prolonged strenuous activities in hot weather: This latter issue is noted at the following: l Water content in beverages such as coffee and tea counts toward this total as well.

An adequate intake of fluid from all food and beverages for men over age 50 is 3.7 liters (almost 4 quarts) daily, which includes about 13 cups from beverages and food sources combined. For women in this age range, this figure is 2.7 liters (slightly less than 3 quarts) a day, with about 9 cups coming from water and other sources. Most people actually consume that much, despite the popular concept that one should consume 8 glasses of liquids daily. Water contained in foods makes up to about 22% of the average individual’s water intake. According to national survey data, men actually drink a combined equivalent of about 11 cups of beverages per day, and women, about 10 cups.

The kidneys play a key role in regulating the body’s fluid balance, working best when supplied with adequate water and being more stressed in the presence of dehydration.

Since the brain is about 75% water, staying hydrated helps this organ function as well. Although research on the effects of dehydration on the brain is inconsistent, short-term impacts seem to enhance mood and alertness.

In some forms of arthritis such as osteoarthritis (the most common form), you can help fight the associated inflammation by staying hydrated. The Arthritis Foundation recommends “prehydrating”—drinking water before you exercise, not just after you’ve worked up a sweat—to help people with arthritis engage in physical activity with less discomfort.


It’s important to consume enough fluid from all sources to keep your body hydrated, but claims that drinking even larger quantities can enhance health are unsupported by science. So the idea that there are such things as “water cures” is a myth. One exception is that strong evidence links good hydration with reduced risk of kidney stones. So if you have had such a problem, or are at risk for any reason, then extra water makes sense.

As we age, the body’s needs may require more than is dictated simply by thirst alone because it’s easy to miss warning signs that may warn of dehydration. As a general rule, if you’re over 50, try to drink regularly even when not thirsty—an extra glass with each meal—especially in hot weather.

Extra fluid can help prevent constipation, especially if combined with plenty of fiber, but fluid alone is probably not very helpful.

Overall, for total hydration, plain water is the best choice, but also useful are fruit juices, coffee, tea and milk. As mentioned, sugary soft drinks and the like should be avoided, especially since they are major contributors to the obesity epidemic, as previously presented: (

I might add that bottled water is generally no better—and sometimes worse—than that taken from most taps, but that was reviewed in a previous post (

In conclusion, although there is no need to constantly guzzle water, there is reason to insure that you’re getting enough, especially it you’re over 50. So this summer and all year long, help yourself by staying healthy and hydrated and avoid the extra calories of sugary drinks. Opt instead for the inexpensive and ubiquitous choice of plain water out of the tap!





We medical practitioners have long been preaching about the dangers of both smoking (tobacco) and drinking in excess (alcohol). But nowhere has the old adage “familiarity breeds contempt” been more appropriate than in connection with these two vices. We seem to ignore the fact that tobacco smoke accounts for at least 450,000 deaths yearly in this country alone. And although the numbers are not as clear in regard to excessive alcohol consumption, we do know that alcohol accounts for numerous deaths yearly, both acutely or chronically. As we leisurely sip our martinis at cocktail parties, we pay little heed to this danger, finding it reassuring that—in contrast to many confirmed alcoholics—we are able to confine our intake to safe quantities at less frequent intervals.

And now we are being confronted by a new challenge: Marijuana! This substance is moving to center stage because of its legalization in such states as Colorado and because of political pressure on the federal government to avoid conflict with the states and stop incarcerating users and sellers of marijuana.

Unfortunately, until now, far too little research has been done on this substance—either for medical uses as well as for recreational purposes. But one thing is quite clear: Marijuana will never account for as many deaths as do both tobacco and alcohol.

For a clear-headed discussion of the subject of marijuana, I refer you to a recent article written by Sheila Kennedy, my cousin, who normally comments accurately on many important topics of public and political concern.

In this article, she makes an eloquent case for legalization, or at least decriminalization, of marijuana. It’s well worth reading!


Meal Replacement Products

diet alts

      Meal Replacement & Weight Management Powders and Beverages

      These days we are encountering an increasing number of nutritional supplements in a bottle. There are many different reasons for using such a product, which can be in a “ready-to-drink” form, or which you make from a powder. For example, you may not have time for a meal but want something more healthful rather than a snack food. Or you may be on a diet and it’s easier for you to use a single product with the right balance of nutrients and calories than having to select the right foods yourself. Or maybe you want to boost your protein intake with the convenience of a meal replacement rather than a strict protein product.

The United States Department of Agriculture (USDA) recommends that most adults who perform light to moderate activity get roughly 2,000 to 3,000 calories per day from a varied diet in which approximately 60% or fewer calories come from carbohydrates, at least 10% come from protein (meat and vegetable proteins), and about 30% come from fats — with less than 10% of calories coming specifically from saturated fat. Healthcare professionals tend to suggest a somewhat higher percentage of calories from protein (15% to 20%) and a lower percentage from carbohydrates, although recommendations vary. Nutrition powders and drinks can help provide some of these nutrients but they are not recommended as a total substitute for food, as they lack some of the vitamins, minerals, fibers, and phytonutrients found in whole foods.

Meal replacement powders typically come in canisters or packets ready to be mixed with water, milk, juice, or other beverage. Meal replacement drinks often come in ready-to-drink cans or bottles. These products are marketed as dieting aids and meal replacements. Unlike, protein powders, they generally provide a more balanced ratio of protein, carbohydrates, and fats, as one might get from a healthful meal.

Unlike nutrition bars, which need to contain a good amount of carbohydrates to give them a reasonable texture, feel and taste, meal replacement powders and shakes do not. Consequently, makers of these powders and shakes can offer more flexibility in the nutritional content of these products. For example, it is quite possible to find powders and shakes with half the fat and carbohydrates of most nutrition bars, while often offering twice the protein.

   Advantages: They have been shown to help people on diets lose more weight, improve blood sugar control for people with type 2 diabetes, and boost protein intake to increase muscle mass. They can also offer a more healthful alternative to snack foods when you are unable to have a regular meal. In particular, meal replacements offer protein in a convenient form, along with carbohydrates (and often fiber) as well as fats. The products, however, are not meant to replace all of your meals and consumption of whole foods, such as fruits and vegetables. Although quite variable, most products provide about 10 to 20 grams of protein per serving but vary in the amounts and types of carbohydrates and fats they include. They may also contain a range of vitamins, and minerals.. Serving sizes also range widely, from about 25 to 60 grams providing from 90 to 400 calories.

One important caution must be given for all such products: Do not substitute any of them for all of your meals or be fooled into thinking that you can skip eating whole foods.

Depending upon the needs of each individual, it’s impossible to suggest the best choices, but we can list some good picks based upon accuracy of labeling and features such as protein, energy, fiber and cost.

           Meal Replacements for Weight Loss:
A review of six randomized, controlled clinical studies comparing the effects of partial meal replacement plans (consisting of a reduced calorie diet providing between 800 and 1600 calories daily in which one to two meals per day were replaced with a liquid, vitamin and mineral fortified meal replacement product) with conventional, reduced-calorie diets found that after three months, those who used a meal replacement product lost an average of about six pounds more than those who followed a reduced-calorie diet without meal replacement (approximately 13 1/2 lbs. versus 71/2 lbs., respectively)    Among the four studies which continued for another 9 months, people who consumed meal replacement products had a total average weight loss of about 15 lbs. by the end of one year, while those who maintained a reduced-calorie diet without meal replacements had a total average weight loss of about six lbs. One word of caution:  It should be noted that the authors of the review were each associated with either Slim Fast or the “Slim Fast Nutrition Institute,” and that most of the studies in the review appeared to use SlimFast products and/or were funded by Slim Fast

Increasing Muscle Mass and Strength:
Protein is necessary to build, maintain, and repair muscle. Meal replacement products which are high in protein can help you boost your protein intake. Be aware, however, that while getting more protein can help you increase muscle mass, it won’t increase strength unless used as part of appropriate exercise program.

Quality Concerns:
Neither the U.S. Food and Drug Administration (FDA), nor any other federal or state agency, routinely tests meal replacement powders and drinks for quality.. One independent source found that among the 11 meal replacement powders and drinks selected and tested, only 7 met quality standards and were approved based on their quality and labeling.

Which product to consider: The product you choose depends very much on your purpose for it. However, when looking for a meal replacement, I would look for one with a reasonable balance of protein, carbs, and fat, some fiber, some vitamins and minerals, and, hopefully, a reasonable cost. With that in mind, the following are top picks among the products in this review which passed tests for quality:

For General Use:  Special K Protein has a good balance of nutrients, including fiber, provides a good amount of energy (180 calories), and is reasonably priced ($1.90 for a 10 fl. oz. bottle). However, the majority of its 28 grams of carbohydrates is from sugar (18 grams), which is a bit high, and some flavors may contain caffeine. Caffeine is absent in flavors such as Red Berry, Chocolate Delight, or French Vanilla.
Special K Protein is comparable to the very popular Ensure Original, which provides about the same amount of protein and fat. Ensure provides more carbs (40 vs. 28) and, consequently, more Calories (220 vs. 180), but, like Special K Protein, most of the carbs in Ensure is sugar (23 grams). Both products provide an array of vitamins and minerals. Ensure Original, however, provides no fiber, while Special K Protein provides 5 grams.

For extra protein:  IsAgenix IsaLean Shake Natural — Berry Harvest. This product provides more protein than most others . It also provides fiber, is low in sugar, and offers 250 calories. It’s more expensive than most products ($3.62 per 61 gram packet) but serving sizes are larger.

For dieting: There is likely no “magic” meal replacement formula for losing weight from a diet. What seems to be most important is that the dieter is able to stick with a reduced calorie diet over a sufficient period of time. A reduced-calorie meal which is convenient and satisfies the senses and hunger is what is needed. Having some fat in the meal helps with this (as well as being nutritionally important), and fiber may also help, as it slows digestion. Two lower-calorie products which seem to fit this bill are Atkins Day Break Strawberry Banana and SlimFast Advanced Nutrition — Creamy Chocolate. They are both come in 11 fl. oz. ready-to-drink containers and are relatively inexpensive: Atkins costs $1.50 and SlimFast costs 16 cents more — but provides twice the protein.

Conclusion: Depending on your needs, one of these products may be worth considering. If for nothing else, they could be used to replace the empty calories contained in most snack, or “junk” foods.




Woo (sometimes called Woo Woo) refers to ideas considered irrational or based on extremely flimsy evidence or that appeal to mysterious occult forces or powers.

According to the standard dictionary, this term is applied to emotions, mysticism, or spiritualism, outside of the bounds of science. It can also represent a person who harbors mystical beliefs. Medical science also recognizes woo as a synonym for pseudoscience or quackery. Basically it boils down to pure nonsense or irrationality.

   Now let’s apply Woo to a real contemporary situation: Did you notice several round red circles on the torso of Michael Phelps, the all time greatest swimmer?  These blemishes resulted from a practice known as “cupping therapy”, which is an ancient form of treatment in which a local suction is created on the skin, which is provided by suction created with heat (fire) or mechanical devices (hand or electrical pumps). Practitioners believe this mobilizes blood flow in order to promote healing. All the critics of alternative medicine, including myself, call cupping “pseudoscience nonsense”, “a celebrity fad”, and “gibberish” Pharmacologist David Colquhoun writes that cupping is “laughable… and utterly implausible”. Despite a total lack of validity, Chinese cupping has gained much publicity due to its usage by famous sport figures including not only Phelps, but also Denver Broncos player DeMarcus Ware, Olympians U.S. gymnast Alexander Naddour, and others. Actually, there is no evidence that cupping works any better than a placebo, i.e. any dummy pill or useless maneuver.

With regard to the placebo effect, however, it can be quite powerful, for past studies have demonstrated that even athletic performance can be enhanced slightly by placebos (dummy treatments), a point that I documented in my book, “Snake Oil is Alive and Well”. This effect supports the idea that the mind can be a powerful influence on not only the sensation of pain, but even physical performance! The placebo effect is ubiquitous and can explain identical “cure” rates stemming from other nonsensical forms of “treatment” such as magnetic therapy, reflexology, acupuncture, faith healing and many others. Placebo effects are most powerful when there is physical contact (laying on of hands) by the practitioner, supported by expectations of success, usually combined with elaborate and convoluted rituals and explanations. Aiding this effect is the natural tendency of all maladies to fluctuate or spontaneously resolve; thus any type of intervention that precedes an improvement stands to receive the unearned credit for “success”.

So, when Phelps goes out a winner, could the cupping have accounted for his success? You be the judge!


The Narcissistic Personality Disorder: Sound Familiar?

As a physician I have receiving training and dealt with various mental disorders, but have been impressed recently by a report shedding more light on the issue of narcissism, which seems to be entering into the political arena. While we now live in a culture that some would call narcissistic, with millions of people constantly taking selfies, spewing out tweets and posting everything they do on YouTube and Facebook, many of us possess some qualities that can be considered narcissistic. Only a few, however, harbor an extreme form, and thus, some would consider this a form of insanity.

So what are these features? The common characteristics of extreme narcissism were described by Joseph Burgo, a clinical psychologist, in his book “The Narcissist You Know”. In it he describes the extreme narcissist as a breed unto themselves. They may be highly successful in their chosen fields but extremely difficult to live with and work with. Their characteristics are the following:

*Highly competitive in virtually all aspects of his life, believing he possesses special qualities and abilities that others lack; portrays himself as a winner and all others as losers.

*Displays a grandiose sense of self, violating social norms, throwing tantrums, even breaking laws with minimal consequences; generally behaves as if entitled to do whatever he wants regardless of how it affects others.

*Shames or humiliates those who disagree with him, and goes on the attack when hurt or frustrated, often exploding with rage.

*Arrogant, vain and haughty and exaggerates his accomplishments; bullies others to get his own way.

*Lies or distorts the truth for personal gain, blames others or makes excuses for his mistakes, ignores or rewrites facts that challenge his self-image, and won’t listen to arguments based on truth.

Of course, nearly all of us possess one or more narcissistic traits without crossing the line of a diagnosable and pathologic disorder. And it is certainly not narcissistic to have a strong sense of self-confidence based on one’s abilities.

“Narcissism exists in many shades and degrees of severity along a continuum,” Dr. Burgo said, and for well-known people he cites as extreme narcissists, he resists making an ad hoc diagnosis of narcissistic personality disorder, as defined by the American Psychiatric Association.

The association’s diagnostic manual lists a number of characteristics that describe narcissistic personality disorder, among them an impaired ability to recognize or identify with the feelings and needs of others, grandiosity and feelings of entitlement, and excessive attempts to attract attention.

Dr. Giancarlo Dimaggio of the Center for Metacognitive Interpersonal Therapy in Rome, wrote in Psychiatric Times that “persons with narcissistic personality disorder are aggressive and boastful, overrate their performance, and blame others for their setbacks.”

According to the Mayo Clinic, people with a narcissistic personality disorder think so highly of themselves that they put themselves on a pedestal and value themselves more than they value others. They may come across as conceited or pretentious. They tend to monopolize conversations, belittle those they consider inferior, insist on having the best of everything and become angry or impatient if they don’t get special treatment.

Underlying their overt behavior, however, may be “secret feelings of insecurity, shame, vulnerability and humiliation,” Mayo experts wrote. To ward off these feelings when criticized, they “may react with rage or contempt and try to belittle the other person.”

Dr. Burgo notes that many “grandiose narcissists are drawn to politics, professional sports, and the entertainment industry because success in these fields allows them ample opportunity to demonstrate their winner status and to elicit admiration from others, confirming their defensive self-image as a superior being.”

The causes of extreme narcissism are not precisely known. Theories include parenting styles that overemphasize a child’s special abilities and criticize his fears and failures, prompting a need to appear perfect and command constant attention.

Although narcissism has not been traced to one kind of family background, Dr. Burgo wrote that “a surprising number of extreme narcissists have experienced some kind of early trauma or loss,” like parental abandonment. The family lives of several famous narcissists he describes, Lance Armstrong among them, are earmarked by “multiple failed marriages, extreme poverty and an atmosphere of physical and emotional violence.”

As a diagnosable personality disorder, narcissism occurs more often in males than females, often developing in the teenage years or early adulthood and becoming more extreme with age. It occurs in an estimated 0.5 percent of the general population, and 6 percent of people who have encounters with the law who have mental or emotional disorders.

As bosses and romantic partners, narcissists can be insufferable, demanding perfection, highly critical and quick to rip apart the strongest of egos. Employee turnover in companies run by narcissists and divorce rates in people married to them are high.

“The best defense for employees who choose to stay is to protect the bosses’ egos and avoid challenging them,” Dr. Burgo said in an interview. His general advice to those running up against extreme narcissists is to “remain sane and reasonable” rather than engaging them in “battles they’ll always win.”

Despite their braggadocio, extreme narcissists are prone to depression, substance abuse and suicide when unable to fulfill their expectations and proclamations of being the best or the brightest.

The disorder can be treated with drugs and psychological counseling, though therapy is neither quick nor easy. It can take an insurmountable life crisis for those with the disorder to seek treatment. “They have to hit rock bottom, having ruined all their important relationships with their destructive behavior,” Dr. Burgo said. “However, this doesn’t happen very often.”

If this disorder is actually a form of insanity—or at least a severe mental disability—one might logically ask whether such an individual should be allowed to run for high public office such as the presidency. You make that call!