Monday, February 4, 2008

Managing Type 2 Diabetes with Michael Bihari, M.D.

Six minute video interview with Dr. Michael Bihari, a medical doctor who has had type 2 diabetes for the past six years.

Dr. Bihari discusses the role of exercise and diet in the management of type 2 diabetes and relates his own struggle with trying to maintain a healthy lifestyle.

This video was produced by Monte Ladner, M.D. and

Thursday, January 17, 2008

Blog 021 - training philosophy for life

I get a lot of e-mails about how one should train for fitness (as opposed to a specific sporting event). I like this question, but I’m sure my answer will raise eyebrows among the exercise and sports-training experts. Here it is:

I view myself as training for the game of life, and in life there is no off season, and one day is not more critical than the next , they all count and they are all here only briefly before they pass into our history and are gone forever. I want each day to be as perfect as it can be. Therefore, I want to be optimally fit all the time – regardless of the season.

Having said that, it is important to recognize that we cannot train "full-speed" all of the time. This will quickly lead to an "overtraining" syndrome and a decline in our overall health.

I regularly fluctuate the intensity of my workouts to avoid this issue of overtraining. But, (and you may be surprised to hear this) I am much less "scientific" and rigid about the structure of my workouts than most people. I workout seven days a week without fail. And I do specific routines each day (Monday is upper body weights and an aerobic component, Tuesday is leg weights and another aerobic component, etc.) But, some Mondays I feel really strong and so I do a really intense workout on upper body. Some Mondays I feel tired - I still workout, but maybe I vary the workout to be less intense. Sometimes I feel tired at the start of a workout and so I plan to lighten up a bit, but then as I get into it I start to feel really good - so I pick it up.

Basically, I create a broad outline of what I am going to ask my body to do, and then I listen to what it has to say about how we do it. I NEVER let my body tell me "I just don't feel like doing this today, lets take the day off." I just change the intensity.

In 1994 I got an unexpected phone call from the American Society of Anesthesiology (ASA). They wanted to know if I could take the place of another anesthesiologist who had volunteered to teach anesthesia for six weeks in Africa, but had to back out at the last minute? The hospital was in Tanzania, located at the base of Mount Kilimanjaro.

Ever since I read the Hemmingway story “The Snows of Kilimanjaro” I had wanted to climb that mountain (volcano) – here was a chance to do it. The ASA would pay for my plane ticket to Africa, and they didn’t care if I went a couple of weeks early in order to climb the mountain before I started teaching.

To take advantage of this unexpected offer of a trip to Africa I had to leave in two weeks. Kilimanjaro is just over 19,000 feet high. Could I be in shape to climb it in just two weeks? Irrelevant question – I train every day, year in and year out. I knew I was ready.

This photograph is a picture I took from the summit of Kilimanjaro looking past another peak at the first rays of the sun coming up through the clouds below me to shine on a new day. The moment was an emotionally powerful one for me – and one that I would’ve never had if I hadn’t been fit enough to make the climb on short notice.

My personal tag line stemming from that experience is this: “When life calls, will you be ready?”

Have a great workout.
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Tuesday, December 4, 2007

Blog 020 - telling stories

Medicine is supposed to be a “scientific” endeavor, and it mostly is. But practicing medicine means also being a bit of a philosopher, a friend, a parent, an advocate, a teacher, a student, and, most important, a listener.

Telling stories is how we humans bond with one another and understand the world around us. Stories reach us in a way that other forms of communication cannot. Stories can teach us, inspire us, and either strengthen our convictions or invite us to reconsider our beliefs.

Somewhere in my medical training and practice I learned that if I listened to the stories that patients told me long enough, they would tell me what was wrong with them, and what to do about it.

I believe in the power of telling stories, and the power of listening to them.

This week on Fitness Rocks I interviewed a remarkable woman. She tells a wonderful story of strength and courage and determination to change a set of bad lifestyle habits into good ones.

Listen to what she has to say. I know you’ll find something in it that will touch you, and maybe even change you, no matter who you are, or whom you think you are.

For all of us our life is our story. We can write it better if we listen to the one’s that other people are telling.

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Monte Ladner

Monday, November 12, 2007

Blog 019 - should I weigh myself?

A lot of people send me e-mails asking about the importance of weighing regularly as part of a fitness program. They often ask “As long as I’m fit, isn’t it OK to be overweight?” Here is my typical answer:

Weight does matter, so don't completely ignore it. It does seem true that one can be "Fit and Fat" as Dr. Steven Blair has said many times in his research articles on fitness.

If you’re overweight and trying to lose weight my advice has always been to focus first on the basics of a healthy lifestyle - healthy eating with an emphasis on fruits, vegetables, whole grains, nuts, beans, healthy fats from olive oil, canola oil, and fish, and combine this with a regular exercise program. If you do these things really well, I believe that your weight will find its way to exactly where it should be. Remember, a big part of healthy eating is to avoid consuming excess calories.

Good health is a multifaceted phenomenon – and everything matters. Luckily, the formula for success is pretty simple, at least in concept – eat right, exercise, maintain a healthy weight, don’t smoke, don’t drink excessively, and manage stress as best as you can.

These days we have a lot of good evidence that chronic stress is an important area to pay attention to as part of an overall fitness program. Chronic stress has a negative impact on our physiology and increases the risk for chronic disease.

We talked about Transcendental Meditation for stress relief in podcast 071. There appears to be good medical evidence that a regular meditation practice can help to lower blood pressure and even improve insulin resistance.

If you need to lose weight then it is a good idea to step on the scale at least once a week to monitor your progress, and to catch any slips in the wrong direction. But don't focus only on your weight. Yes, an optimal weight with a BMI under 25 has consistently been associated with reduced risks of chronic disease. But, fitness is about more than just weight.


Tuesday, October 30, 2007

Blog 018 - a wake up call

I came across an article in the associated press today about how so many young people are taking medication to lower cholesterol and blood pressure. There has been a 68% increase in the number of people between the ages 0f 20 - 44 taking drugs to lower their cholesterol over the past 6 years.


I made a video blog in which I discuss the article. Send me your comments.


Monday, October 22, 2007

Blog 017 - thinking

The first really chilly fall weather blew through our coastal New England town a few days ago. It was a good chill, the kind that makes me feel giddy and full of energy. I had an irresistible urge to pull on a sweater and go for a walk outside, and maybe afterwards have a cup of coffee and a conversation at the kitchen table.

I followed Old Dock Road to the harbor where a few boats are still waiting for one last chance to go out into the bay before being pulled out of the water for dry storage until next summer. Ducks were paddling around in the water and seagulls were waddling around on the boat ramp. It isn’t much of a ramp, just a narrow concrete driveway that slopes down into the water. On either side of the boat ramp there is wet, squishy sand where trailers get stuck if their wheels veer off the side.

Scallops were dangerously exposed on the muddy banks of the harbor because of the low tide. Seagulls love scallops.

I’ve seen the occasional seagull eat a scallop before, but this evening there were lots of seagulls eating scallops – it was a feast in progress.

Before a seagull can eat a scallop it has to open the shell, and that is what makes watching the whole thing so fascinating. It would seem that the only way a seagull could eat a scallop is if it happened to come across one that had already been opened by another animal with nimble fingers and maybe a pocketknife. But they don’t need any help at all. They have figured out a way to open the scallops all by themselves.

The birds have recognized the difference between the hardness of the concrete boat ramp and the squishy sand on either side of it. The first time I saw a seagull drop a scallop on the boat ramp I thought it was just a quirky chance event. After all, it’s just a dumb seagull, how could it know that a boat ramp would be a better place to drop a scallop than the squishy sand?

But, this evening the seagulls were dropping scallops on the boat ramp over and over until finally the shells popped open and the birds could get at the prize inside. They never dropped a scallop on the squishy sand.

The seagulls have figured out how to use the concrete to their advantage. A real biologist would probably have a different explanation for this behavior, but to me it is clear that they are thinking at a level that is higher than what I had given them credit for being able to do.

Seagulls were flying in over the water clutching a scallop in their beaks. As they approached the boat ramp they would swoop up high and circle around making sure there were no other birds nearby that could steal their cargo and then with laser guided precision they would drop the scallop on the concrete and chase it down to the ground to see if it had cracked. They repeated this process as long as it took.


We humans live in our artificial world and scarcely even acknowledge the millions of other creatures with whom we are sharing this planet and this life. It is to their detriment that we behave so arrogantly, and to ours as well.

If a seagull can figure out how to open a scallop what else might it be thinking about? Do seagulls feel giddy and full of energy on brisk fall days, like me? Because we can’t speak to them we assume they have nothing to say, and no stake in the future of this planet.

Turn off the television that is streaming nonstop garbage into your brain and go outside for a walk. If you look around you will almost certainly be amazed at what you see.

It’ll make you think.

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Monte Ladner

Wednesday, October 10, 2007

Blog 016 - an inflammatory response

In medical school a professor once told me that I would forget half of what I was being taught, and the other half would ultimately be discovered to be untrue. It was a bleak and discouraging perspective. Hopefully, it was an exaggeration.

But, since I started medical school in 1981 there have been some big changes in the way we think about a lot of important issues. One of these is heart disease.

Back in the day, we believed that coronary heart disease was a consequence of eating too much cholesterol with all of the excess cholesterol being deposited onto or into the inner lining of the arteries to our heart. The metaphor often used to describe the process was “corrosion accumulating inside a pipe.” It was an overly simplistic point-of-view that led to the “obvious” mechanical solution of coronary artery bypass surgery – “putting in new plumbing” as a heart surgeon once joked to me and my peers while on rounds one day.

Coronary artery bypass surgery has extended the lives of many patients, but bypassing the clogged blood vessels does absolutely nothing to change the underlying disease process that got the patient into trouble in the first place.

We used to think that a heart attack was a consequence of a coronary artery getting progressively more narrow because of cholesterol accumulating in the artery wall until it was finally swollen shut, thereby obstructing blood flow to the heart muscle. Now we think that a non-obstructing plaque inside the lining of a coronary artery breaks open and causes a blood clot to form inside the coronary artery, thus acutely obstructing blood flow and causing a heart attack.

We are beginning to recognize that our fundamental understanding of what causes coronary artery disease was not exactly right. It is more complicated than corroding pipes and globs of fat accumulating inside blood vessels. Now we are talking about “oxidative stress” and “chronic systemic inflammation” as the underlying causes of heart disease.

The phenomenon of oxidative stress and chronic systemic inflammation are consequences of our modern, unhealthy lifestyle. And, these phenomena cause more than just heart disease. It’s beginning to look like oxidative stress and chronic systemic inflammation play a role in most of the chronic diseases that afflict us today.

Here’s the good news – oxidative stress and chronic systemic inflammation can be largely prevented or reversed with a healthy lifestyle.

I’m not even going to pretend that I understand the nuances of oxidative stress and chronic systemic inflammation. The more I read about them, the more confused I become. But, I am fascinated by the cellular biology involved. Over the next few weeks on the Fitness Rocks Podcast I will be sharing my efforts to understand these complex processes that are at the origin of so much sickness.

While you’re waiting for me to get a handle on this stuff you should be eating your fruits and vegetables and exercising every day. And, if you smoke – quit.

Have a great workout.
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Monte Ladner, M.D.