All posts by Warren Krantz MD

Turmeric

August 24, 2016Better food better health, Natural TreatmentWarren Krantz MD

Turmeric – the number one spice for what ails you- best spice award

I often get asked what is the best spice to start with for those individuals who want to make the first move in a healthful direction. What spice would you say is the most important one if you want to introduce just one ?. I answer turmeric for several reasons. (This is not to be confused with the first spice I recommend to introduce to infant feeding which is cinnamon.)

Why turmeric

Turmeric with curcumin the main active ingredient thought to have food super powers- mostly from its anti inflammatory properties . It has been used for thousands of years in cooking. In the Geographic regions where turmeric is a food staple the populations have much less chronic inflammatory associated disease; heart, prostate, intestinal, and cancer. Turmeric acts as an antioxidant helping neutralize free radicals that cause damage thus slowing aging , keeping your skin elastic, and preventing harm to your cells.

Turmeric helps enhance your immune system. It helps fight disease and the associated inflammation.

Turmeric helps with everyday illnesses

In my line of work it is helpful in keeping the inflammation associated symptoms like pain, fever, coughing and congestion from viruses to a minimum while helping fight the infection.

Taste:

Turmeric has a mild taste. A little chalky but it blends well and is not overpowering in whatever you put it in. Not real spicy. Main drawback is the yellow color which to me is sign of health but to children and those new to spices when visual cues are sometimes just as important as taste may be a problem. Try to begin its use in foods which have a color that masks the yellow.

Amount

Goal to introduce turmeric (curcumin) slowly to avoid developing an aversion from the child or adult. Start with 1/4 teaspoon slowly over the first week or two going up by 1/4 teaspoon per week for a goal of 2 teaspoons a day and even more when you are not feeling well or having aches pains or for specific conditions

When I feel like I am getting sick I double or triple my daily turmeric dose heaping portions at every opportunity .

How to use it?

I use it as often as possible and carry it with me!

My first recommendation is to add it to your version of chicken soup or vegan non chicken soup, yellow vegetables like squash, hash browns, even sweet potatoes. I also make a point of including them in any vegetable dishes and meats if you are not vegan. A parent recently said she adds it to pancake mix, grains, and eggs.

Turmeric is my base for all my meals to make sure I get enough throughout the day..

Any chance you get add turmeric to your food.

How much?

I put a quarter to half teaspoon in my morning tea every day along with ginger.

I put one to two teaspoons on my vegetable mixture for lunch

I sprinkle turmeric along with my spice mixture on salad or any dressing I use.

Even put it on pasta or quinoa .

All my soups I add turmeric.

I take a spice mixture in a small container with me whenever I eat out (with a turmeric base), And add it to salads, soups, vegetable and bean dishes, etc. Any where, any time I am ready to add my spices beginning with turmeric,

To improve absorption of turmeric

Add black pepper along with it to food. In tea add a little coconut milk. Adding a small amount of healthy oil or fat to turmeric helps absorption -seeds and nuts have oil in them and can be added to any dish to serve as a vector for turmeric absorption, as well as the overall health benefits from seeds and nuts versus empty oil calories. Also avocado is a good fat to mix with turmeric to enhance its absorption.

Turmeric has been shown to have benefits for all sorts of diseases and illnesses.

Latest studies and those currently under review are indicating very positive results and benefit from large doses of turmeric including inflammatory bowel disease, joint disease, rheumatoid arthritis, heart disease, autoimmune conditions , and even cancer . Please consult your physician or particular specialist before beginning any mega dose trial of turmeric for any one of these conditions .Doses at this level usually comes in a pill form and precise medical information regarding dosing is not widely agreed upon yet.

Brands and form of turmeric

Consumer labs has reviewed a number of brands of turmeric for safety regarding foreign substances, and contamination. In general it is better to have organic turmeric and even better to buy it and grind it yourself. Some of the organic brands for reasons that seem logical have a percentage of bug parts and some non organic brands have chemical residues. It is better to include turmeric in any form. But your physician, grocer, or health food specialist might be helpful in selecting a safe and healthy brand.

If you are going to add one food supplement in natural form to improve your health make it turmeric

Warren Krantz MD, FAAP

HealthfulMD.com

Vitamins -general approach

August 24, 2016Better food better health, Natural TreatmentWarren Krantz MD

Vitamins in general (as supplements) not what you were told.

Since the days of Hippocrates physicians have been asked to recommend vitamins to cure what ails people. From poor eating for children to low energy in adults people want a magical vitamin pill to jump-start their health. All form of concerns seem to bring up this magic vitamin pill. But in reality other than the scientifically known disease associated deficiencies ( which by in large do not exist any longer in western society) vitamin supplements are rarely needed and of little true value.

Main points:

Vitamins are not as advertised. They have no magical healing or disease preventing properties in supplement form.

They are not a panacea for what ails you and in no way replace healthy nutritious whole food.

With the exception of b12 for vegans and possibly the new recommendations of vitamin d 3 , receiving the majority of vitamins from supplements are a poor substitute for real food as vitamin source.

Vitamins are not readily bio-available and as useful for what you need when you take them in a supplement form versus from food

Vitamins will not stimulate your appetite. Physician’s treat vitamins like a placebo. Doctors only give to children when parents request them to supplement a diet in order to encourage the parents stop pushing their kids to eat and relax. It takes the pressure off parents who are worried about adequate nutrition particularly vitamin intake. When parents relax and stop showing anxiety regarding the amount of food a child eats, regardless of the reason, then the children often actually start to eat better .

The real source of useful bio-active body enhancing vitamins is whole foods.

Enriched foods do offer an alternative to supplements but not nearly as valuable as in whole foods.

Vitamins like all supplements are not regulated for content, amount, value,claims, or quality.

Taking vitamin shots is not any more valuable than supplements. The rare exceptions are for true medical conditions like b12 deficiency anemia , pernicious anemia.

Organic whole fruits , vegetables, nuts , and seeds are the best form to receive your vitamins. Best method is to chew and eat them yourself.

Warren Krantz MD, FAAP

HealthfulMD.com

Iron Getting enough naturally

August 6, 2016Natural TreatmentWarren Krantz MD

Iron

I often get asked how do we get enough iron?.

Patients have been told and read that if they do not have enough variety in their diet or if their children are not eating a balanced (meat centric) diet they will not get enough iron and become anemic..

Is this fact or more marketing and tradition ?

It is confusing that the same physicians who are recommending you diet, eat healthier, exercise to lower your cholesterol and improve your health , also recommend meat as the only source to get your iron.

What is the best way to get your iron ?

“Best” meaning healthiest with foods that add to your health at the same time . Not merely treating with iron but recommending foods that will have a positive impact on your overall health; perhaps even improving your underlying condition which caused the anemia in the first place with optimal nutrition.

MAIN POINTS :

You can get as much iron from non meat sources as you can from meat.

Iron is in most foods including plant based foods in adequate amount to get your requirements except for the most medically necessary anemia conditions ( please check with your physician if this is the case)

Top plant foods for iron per serving

Fortified cereal 18 mg

pumpkin seeds 4.2 mg

dark chocolate 7 mg

soy beans, 8.8 mg

tofu, tempeh 3 mg

black beans 3.6 mg

lentils 3mg

quinoa 2.8 mg

Compared to a

hamburger lean- 2.2 mg

See extended iron list below

Why do people say meat is the best source for iron?

This comes from the fact that the iron (heme iron) in meat is more readily absorbed from your gastrointestinal system than plant food iron, which is non heme. But that does not make it better or necessary for meat to be your absolute source of nutrition for iron

Plant foods have plenty of iron in them to maintain and establish iron supply for your blood cells to carry oxygen ( some say not to replenish low iron stores – but with nutritionally sound diet you can)

The non-heme iron in plants is the same quality iron as any other source . There is no difference in quality or types of iron once your body absorbs it from your diet or supplements. It is strictly a quantity issue.

You do need to almost double the amount of iron requirement listed in a plant diet. This means you have to eat twice as much as the number listed of iron for a regular diet in the quantity of food to get the absorption as meat. See the chart below where I already calculated the amount of iron to ingest if you are vegan or from strictly plant food sources.This should in reality be easy since plant foods are usually eaten in bulkier quantities combined with several different types – greens, seed, nuts, soy products, etc.

Healthier source for iron – most people will admit that nutrition derived from a plant source is much healthier than meat. Usually the argument revolves around their contention that meat has a better iron content and protein. But that is not accurate as you can see from the chart below and a previous post on protein sources. Healthy plant based foods such as seeds , nuts, dark green vegetables, will add to your health with the fiber, anti inflammatory properties. , and anti-oxidants. People who depend in large part on plant based diet generally have larger portions of plants and more balanced whole meals of grains, seeds, beans , and greens. So in reality it should not be a problem. Scroll down below to see some examples of iron content in various foods and the amount you need to eat to be certain you get and give enough.

Iron absorption from plant sources is enhanced if you eat vitamin c abundant foods along with your meals , which if you are already primarily vegetarian you probably are already eating. Not just citrus foods, but most vegetables and fruits are rich in vitamin c, including dark fruits and dark green veggies.

Vegetarians and vegans do not have more anemia or poor iron intake than people who eat meat.

Milk and dairy products may interfere with iron absorption

As with all other posts regarding healthier non medical nutritional means to improving your health and medical conditions please check with your physician first before undertaking a non medical approach. Also not all conditions are stable enough to solely rely on nutritional methods of therapy. Anemia can be a serious medical condition and be a result from complicated conditions. Please consult medical experts first. Adding plant based healthy means to improving your health is always advisable but make sure you are stable enough to rely on that in lieu of your doctor’s advice.

The table below lists the daily requirement of iron in foods per age to get the necessary absorbed requirement of iron. The number is higher for plant foods because the non-heme iron is not as easily absorbed as heme iron from meats. For vegans the amount calculated to ingest is almost double so the necessary iron will be absorbed

Age	Male	Female	Vegan	Pregnant
Birth to 6 months assuming breastfeeding requires more for formula	0.27 mg*	0.27 mg*
7–12 months	11 mg	11 mg	19.8 mg
1–3 years	7 mg	7 mg	12.6 mg
4–8 years	10 mg	10 mg	18 mg
9–13 years	8 mg	8 mg	14.4 mg
14–18 years	11 mg	15 mg	19.8mg (m)/27 mg( f)	27 mg/48,6 vegan
19–50 years	8 mg	18 mg	14 mg( m)/32 (f)	27 mg/48,6 vegan
51+ years	8 mg	8 mg	14.4 mg

* Adequate Intake (AI)

Food	Milligrams per serving	*Percent DV for regular diet**
Breakfast cereals, fortified with 100% of the DV for iron, 1 serving	18	100
Pumpkin seeds 1 oz	4.2 mg	23
White beans, canned, 1 cup	8	44
Chocolate, dark 70% cacao or more, 3 ounces	7	39
Beef lean sirloin or hamburger, 3 ounces	2.2	18
Lentils, boiled and drained, ½ cup	3	17
*Spinach, boiled and drained, ½ cup is not as well absorbed	3	17
Tofu, firm, ½ cup	3	17
Kidney beans, canned, ½ cup	2	11
Quinoa cup	2.8	12
Chickpeas, boiled and drained, ½ cup	2	11
Tomatoes, canned, stewed, ½ cup	2	11
Steak NY strip 3oz	1.6	9
Potato, baked, flesh and skin, 1 medium potato	2	11
Cashew nuts, oil roasted, 1 ounce (18 nuts)	2	11
Green peas, boiled, ½ cup	1	6
Chicken, roasted, meat and skin, 3 ounces	1	6
Rice, white, long grain, enriched, parboiled, drained, ½ cup	1	6
Bread, whole wheat, 1 slice	1	6
Bread, white, 1 slice	1	6
Raisins, seedless, ¼ cup	1	6
Spaghetti, whole wheat, cooked, 1 cup	1	6
Tuna, light, canned in water, 3 ounces	1	6
Turkey, roasted, breast meat and skin, 3 ounces	1	6
almonds, dry roasted, 1 ounce (49 nuts)	1.3	6
Broccoli, boiled and drained, ½ cup	1	6
Egg, hard boiled, 1 large	1	6
Rice, brown, long or medium grain, cooked, 1 cup	1	6
Cheese, cheddar, 1.5 ounces	0	0
Kale 1 cup	1.2	6
Soybeans 1 cup cooked	8.8	48
Black beans 1 cup	3.6	20
Milk, 1 cup	0	0

* DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers compare the nutrient contents of products within the context of a total diet. The DV for iron is 18 mg for adults and children age 4 and older. Foods providing 20% or more of the DV are considered to be high sources of a nutrient.

The U.S. Department of Agriculture’s (USDA’s) Nutrient Database W

Several food sources of iron are listed in Table 2. Some plant-based foods that are good sources of iron, such as spinach, have low iron bioavailability because they contain iron-absorption inhibitors, such as polyphenols [15,16].

Sample meal

Salad with spinach , kale , soybeans, pumpkin seeds, tomatoes, tahini dressing , quinoa half cup=3, 2,1,2,4,2.4.4,2.7 for total of iron of almost 19 mg for the average sized salad or almost 70% of the 27 mg vegan requirement of iron in one salad, Add tofu or any other grain or vegetable and you probably have reached your daily requirements

Add any source of meat protein in the suggested minimal amount of 2-3oz 3 x a week them you are getting more than enough iron with a healthier nutritional profile

Add dark chocolate for dessert and you have your daily allowance of iron

Please consult your physician before starting any non medical treatment with nutritional sources. Not all conditions will respond to holistic or dietary or supplement for that matter adjustment.

Iron supplements are not recommended unless you are anemic or have a diet with insufficient in iron.

As with all supplements iron supplements are not regulated and the actual content can vary.

Absorption of iron from supplements can also vary so please check with your physician before taking any supplements.
Environment: The processing of supplements and disposal has a greater environmental impact as does meat based iron sources than natural organic plant food sources. Getting your iron from optimal nutrition both improves your overall health and that of the environment.

Warren Krantz MD. FAAP

HealthfulMD.com

Diarrhea dilemma

July 4, 2016Healthful approach, SymptomsWarren Krantz MD

Diarrhea the natural treatment

Ask any vegan how they treat diarrhea and they will offer a difficult response. When your whole life is high fiber plant based diet treating diarrhea and stomach issues is always a dilemma .

Traditionally we have and continue to treat diarrhea as naturally as possible but with low fiber starchy foods and electrolytes. Pediatricians refrain from using any medications particularly those over the counter medications which treat the symptoms and not the condition. Diarrhea is one of the few maladies where we are more patient than not and for the most part let your body heal itself. The symptom of diarrhea generally speaking is a natural tool to rid the body of toxins from pathogens such as viruses and even bacterial intestinal infections . We try to accomplish this while insuring that the child and adult do not become dehydrated or toxically ill from the infection .Our major emphasis is on fluid replacement with high electrolyte solutions and low sugar foods including a bland carbohydrate diet while eliminating foods that irritate the bowel.

Below is the basic natural approach:

Medical supervision

Medical supervision to insure the diarrhea source is not infectious, doesn’t need a culture, you do not have parasites , or require any medical treatment – always consult your physician before beginning any self treatment of diarrhea.

Hydration

Adequate hydration is the key to making sure you or your child do not get dehydrated and require iv fluids

Electrolyte solutions are our main source of hydration for diarrhea by containing the electrolytes you are losing in watery stool – pedialyte, coconut water, watered down and low sugar gatorade/powerade are the mainstays of re-hydration therapy and should replace other fluids.

Elimination diet

Elimination of foods and drinks that increase intestinal movement . Eliminate fibrous fruits and vegetables, oily fried foods, dairy ( including formula and milk but do not stop breast feeding), and spices should all be eliminated in the effort to control the diarrhea.

Tea

Healing Tea for diarrhea- in a cup of peppermint tea mix a teaspoon of ginger and turmeric to help settle bowel inflammation

Binding foods

Foods for control of diarrhea and resting your intestinal system particularly carbs. Binding foods should be low in oil . Breads crackers, low in fiber and low in whole grains. Particularly saltines and cuban crackers, with minimal ingredients, including bagels, plain rice, plain pasta, ( all the low fiber foods not recommended on a regular diet). Applesauce, bananas, mashed carrots. Try adding tumeric or ginger to your bland food to reduce inflammation.

Healthy healing

Healthy healing foods-pumpkin meat, coconut, carob powder, teaspoon of apple cider vinegar 2 -3 x a day.

Nutritional yeast and brewer’s yeast ( live yeast should not be used in crohn’s or patients with immune problems ). These have essential amino acids and protein, especially important for vegans who generally get their protein from high fiber sources like beans.

Probiotics for diarrhea symptoms: below are the most common bacteria reviewed to help restore bowel flora from diarrhea. No one recommended probiotic has everything. May use more than one. For instance start with culturelle, and can add florastar and another type listed below to come close to the full panel of helpful bacteria needed to replace the flora lost during bouts of diarrhea.

Certain bacteria you want for illness associated diarrhea include Lactobacillus GG, L. Acidophilus, bifid lactis, L. reuteri, and saccharomyces boulardii

Children- florastar for antibiotic associated problems, culturelle for general gastro problems,trunature, and natures way are all recommended . Can combine 2 of these once consulting with your physician. culturelle was not reviewed by consumerlab; one of my sources for safety.reviews

Adults- culturelle, nature’s way, align has one strain good for IBS, phillips, garden of life has many of the bacteria you would want.

Yogurt with pre and probiotics can be helpful such as Activa, but always be cautious with the dairy and not for vegans.

Medication for diarrhea should be very limited, and rarely for children. It can cause more problems than you started with. Natural food modified treatment is recommended more than any other condition . We do not use medicine in children it can cause bloating, abdominal pain, and blockage of the intestine. Check with your physician before using any meditation for diarrhea.

Warren Krantz MD, FAAP

HealfhfulMD.com

Sensitive skin- Eczema-Dermatitis-Psoriasis: a natural approach

May 29, 2016Natural Treatment, SymptomsWarren Krantz MD

Sensitive skin: Eczema -dermatitis-Psoriasis

Healthful natural rx inside and out

What is Atopic skin condition? – or eczema and psoriasis similar skin conditions on an allergic skin continuum .If you have it it means you are more sensitive to changes in weather, things you touch and eat. It is not an illness that we can give a medicine and it does not come back. Think of it like a life long condition. Like being allergic to cats. You have to keep constant maintenance of your skin and vigilance regarding irritants to control the severity. Being aware of your personal irritants is the best approach to helping maintain healthy skin. Changing your lifestyle, your habits, what you eat, touch, and what touches you are the cornerstones of minimizing long term inflammatory flare ups and progressive eczema and psoriasis. Like anything else we discuss please check with your physician or Pediatrician before making any changes or starting treatments natural or otherwise. This post involves a more natural approach to Atopic skin. There are many useful and successful medical treatments that your physician and Dermatologist can prescribe for successful dermatitis, eczema, and psoriasis care. These modalities including the standard skin maintenance with moisturizers and cortisone creams are very useful and I advocate their use for relief and treatment when the lifestyle I suggest below is less than adequate. . Sticking to a rigorous natural regimen is not practical or possible for everyone. Getting the best and timeliest medical care is more often than not the best choice when you or children are suffering with significant atopic skin.

Like any other condition it is important to find the source of the problems not just treating the symptoms.

These conditions can start at birth. We get a hint of things to come with babies that show signs of sensitive skin. Namely rashes, bad infant acne. Dry skin. Etc.
With the help of one of my patient’s moms who suffers tremendously from psoriasis and keeps her daughter as healthy as possible I have developed a go-to outline of natural eczema skin care. All the below also apply to breastfeeding moms as well.

[Always seek medical advice for any severe reaction or before starting any new treatment whether it is labeled natural or not].

Main points of interest for skin care:

Eliminate and limit-anything you touch, eat, or wear could irritate your skin.
Foods- eat healthier-cleaner. Natural food changes and anti inflammatory diet are helpful
Cream- natural organic aloe products, and healthy oils. Moisturize consistently.
Gentle soap- olive oil soap, oatmeal bar
Reduce stress-exercise, yoga, meditate.

Details on each point below. Scroll down to the end for more information on eczema conditions.

1.Eliminate and limit

Allergic foods and products and irritants. Review your diet and see what change or new food could be causing a recent skin flare up ( something you might have been eating more of lately)
Stay away from all creams and lotions with scents for you or your children ( remember anything you touch can be an irritant if you don’t wash your hands and then go on to touch yourself or your children) Cleaning solutions, perfumes, soaps, foods, oils. etc. are all are potential irritants).
Clothes and sheets should be made of plain untreated cotton.
Stay cool. Inside air conditioning if possible

2. Foods changes- improve your diet, include foods herbs and teas that heal

Eat healthier- generally processed, fried, sugar dairy, meat, all contribute to atopic skin .
Increase fiber to help keep your bowel and toxins flowing through and not absorbed
Make sure you and your children are hydrated. When the weather is hot and humid drink more.
Refine your anti inflammatory diet-increase organic colorful foods, greens, purples, oranges, yellows.
Increase healing, immune enhancing, anti inflammatory spices particularly the main ones turmeric, garlic, ginger, cinnamon,chili peppers, and oregano.
Teas are helpful in calming inflammation -green and red teas, chamomile tea,
Start a probiotic or adjust the amount of probiotic.to maximize it’s immune support and bowel proctection
Oils to take for additional anti inflammatory and immune support- fish oil , flaxseed oil, black currant oil.
Vitamin D3- seems like everyone is deficient in vitamin d and may help with eczema.

3.Creams lotions skin soothing support

Use California baby aloe cream or other organic aloe products..
Calendula cream reduces inflammation of skin, as well as lavender,chamomile, and rosemary based creams.
Coconut oil or coconut butter on skin has been shown to help. Also linseed and primrose oil.
Bathe in Earth Mama Baby Angel (no fragrance), Other fragrance free bath agents generally made of natural ingredients like oatmeal.
Healing Tree natural first aid anti itch cream helps with the scratching.
Vitamin E can also have anti inflammatory and soothing effect.

4.Soaps detergents water

Use olive oil soap bar or oatmeal bar for bathing
Limit bathing and swimming when skin is irritated. Water tends to dry the skin out.
Only use gentle natural clothes detergent. Baby detergents, even soap free.

5.Reduce stress

Well known that stress can exacerbate most illness including eczema and psoriasis

Meditate and become mindful of what sets you and your skin off. Big events and life changes as well as illness can be the instigator of a breakdown in immune defenses including skin changes
Exercise- always has a positive and mood lifting effect
Do something you love. Read, travel, cook, calm your internal and external flames with peaceful activities.
Yoga is built around exercising and mindfully paying attention to your body.

For more severe cases resistant to the above or medical treatments including steroids, the suggestions below may be helpful in improving your atopic skin condition and boosting your immune system.

Clean healthy vegan diet – no oil, no salt, no sugar,( possibly gluten free) – Switch to a soil based vegan probiotic .
Nutritional yeast to help immune protection
Take lauricidin, an immune booster to support good response to illness and challenges to your system.
Gluten free diet.
Eliminate nuts and seeds
Raw Shea butter lotion.

Main causes

Genetic- it’s difficult to get past your family tree. Generally speaking children and individuals with atopic profile , sensitive, allergic skin, have first degree relatives, parents, siblings,uncles , aunts, grandparents with similar symptoms

Atopic allergic – from the foods you eat to the perfume you wear many things can be irritants and elicit a skin reaction . Usually more sensitive to bug bites, and skin contact with scents and creams.

Seasonal weather- many people have dry itchy exacerbations or their eczema during cold season. In climates such as South Florida the dramatic change in temperature in the winter and the heat and humidity in the summer are the two more prevalent times for eczema patients seeking treatment.

Even babies react to change in temperature, over bundling, creams and lotions.

Man made diet- poor inflammatory eating habits especially dairy, processed

foods, eating specific-allergic foods.

Water makes most atopic skin conditions worse by drying it out. Limit the bathing , especially for babies to few times a week. For older children and adults quick shower with room temperature water not very warm .

Summers are a particularly bad time for sensitive skin with sunscreen, swimming , lots of showers, sweating , hot cars, intense sun,and insect repellent

What we touch and what touches us

Chemicals in our clothes, hands, lips, sheets, pillow cases. Even the car seat, couch. Your clothing material on your baby’s face. When you are cooking or eating and then touch your skin or that or your child’s .

Pay attention to all ingredients when applying to yourself or your child. Lotion detergent perfumes . sunscreen , etc.

[Wash all members of the family’s clothes in gentle detergent so whoever rubs up against you or holds the baby will not cause irritation

Always wash your hands before handling your children and baby and your face particularly if they have sensitive atopic skin Anything you or anyone who touches your children touch can be an irritant ( perfumes, cologne, insect repellent). What you touch touches them, when you are cooking – all the foods you touch can be an irritant.

Every towel cloth napkin wipe that you use has ingredients and previous irritants that could be the culprit

Try to stay cool as much a possible when the sensitive skin is acting up, moisturize vigilantly in am, after swimming, immediately after bathing.

Pay attention to the part of the body that is most affected- scalp, arms, shoulders, behind knees.

Think about something that might have been new or has ingredients that are not being tolerated, new shampoo, hot seat in the car.

The more natural the better. The less added chemicals and scents the better. Try to find products free and clear of anything but the essential ingredient .

For instance in sunscreen the two main ingredients in all natural products are titanium and zinc oxide which are considered safe and usually not a source of irritation for dermatitis sufferers

Eating healthy makes a difference. If you look at eczema ( atopic dermatitis) as the inflammatory process, it is easier to understand how anything you do or eat that would disrupt your body’s health and cause more inflammation would make your eczema worse. As in my other posts, the approach here is to be organic, natural, healthy and limit your sources of inflammation to limit your inflammatory conditions of which eczema is a prime example of one.

Warren Krantz MD, FAAP

HealthfulMD

Guide to stress and worry : 15 helpful suggestions

April 30, 2016Mindfulness and meditationWarren Krantz MD

Guide to worry-

My top suggestions for a mindful approach to defuse stress and worry .

Ideas and suggestions I have encountered and adapted through the years in one place ..

As you age you realize that many of those quaint trite sayings you mocked as a kid for being simplistic have actually been cultivated by insightful people in similar situations. They are common to the human condition and apply universally to most of us in so many ways .

“There are only two ways to live your life. One is as though nothing

is a miracle. The other is as though everything is a miracle.” — Albert Einstein

1.The serenity prayer. You might say this is where it all begins for most of us on our search for peace of mind. It has been a cultural go-to quote for times of stress and when we are stuck for centuries. A sort of approachable Zen answer to the dilemma of how to change the world…. is to change yourself first. “It’s not the stressed and difficult times in your life that cause you pain and suffering it is how you react to them”.

“God grant me the serenity to accept the things I cannot change . Courage to change the things I can . And the Wisdom to know the difference”.

10,000 feet- any time you are stuck and feel like you cannot go on or have not moved forward whether it be an illness, job, studying, etc. imagine you are looking at your life from a 10,000 foot view. As though you have made it to the top of the mountain and see clearer where you have been where you are, your relationship to your life and where you are going .Always good to give yourself perspective, seeing where you are and how far you have come. Your current situation looks smaller and minuscule compared to your whole life and the world in general. Then as they say your problems related to the world do not add up to a molehill.

Look up , the sky is blue- most of us just look down or only see what is immediately in front of us. We never look at the great expanse of opportunities and wonderment beyond our immediate surroundings, especially when we are trapped/obsessed in stress and worry . But you can always look up into the infinite to see the beauty beyond where you are. It is limitless and exhilarating to look up to the tops of the trees, the green all around, the birds flying, the clouds passing by, and the vast expanse of it all. Always changing , moving in the midst of when we are fixated on our worry- just look up – the possibilities are always there. The rain will pass, the storm will move on and the sky is always blue underneath the clouds.

I have done this 1,000 times and in more difficult circumstances and survived. Just think back to all the times of your life that you had complete fear and panic regarding some terrifying situation and you survived. Always being worried that something is going to turn out terrible whether it be a test, medical result, job interview, public speaking, etc. You also realize if you pay attention you realize that not only have you been able to deal with any worry, event, or difficulty, you actually faced previous adversity successfully and survived better than you expected. Just make sure you do not get too complacent with this tactic. You still have to deal with difficulties but you know that you can handle it not ignore it.

Worrying does not help and in fact Is counterproductive. Things are usually not as bad as you think. Your ideas compared to others may be good, But you feel you have to be perfect; perfection is not the goal , growing, expanding is the goal Always move forward, perfection keeps you stuck since it is unattainable, like they say “it’s the journey” which means it is a process and not perfection as long as you will keep moving forward and learn along the way.
Test yourself -keep a worry log. See how accurate your judgments, assessments, worries are and how they turn out moment to moment, ( mindfulness) and overall. Usually you are wrong. Your level of anxiety and worry distorts your viewpoint out of proportion with your concern.When you keep track you will realize that your perceptions are not reality. You have mostly worried for nothing. Even in the worst of times you can only die once but with worry you cause yourself a million deaths .
Who and what are your gurus- suffering and struggle are the best teachers.Lean in to the difficulties .Breathe and face your demons. What situations and which people stress you out the most?. These difficult things are your gurus- learning experiences. Face them and use then to make you stronger.
Meditate, breathe in and out.Count to ten- slowly then backwards.Find your breath- hands on tummy, finger right over your nostril, blow out slowly. Rapid panting breath or fast fire breath- like a mom breathing in a Lamaze class. All quick breathing and mediation shortcuts to diffuse anxiety. Meditation using visualization – some of your best calming situations to go to .Go to your favorite places. Real or imaginary.Turn off all devices, all media, all TV. “BE” with yourself. But go there. A place in the house that brings you peace. A library. Waterfront. Mountain.

Exercise – when compared to drugs for anxiety and depression is truly a better medicine. Push your workout until you feel the endorphins. You get a sense of well being from consistent exercise. Follow your breathing when you exercise not your pulse. You will notice when you are out of breath and can push a little more.

Babies are the best medicine. In my line of work it is easy. I could be in a terrible mood but all I need is one baby to smile at me and make a cooing sound and I am toast. Impossible to be in a bad mood around a little munchkin who is completely oblivious to your stress or worry. That is the moment you need to be in. Make a baby smile and laugh and you have no choice. As so many self-help gurus like to say we are born innocent and in the moment. Just observe children play with abandon and free of worry. Well play with babies and children and let them be your guide.

12.Find humor in any situation.Everything is an opportunity to be funny and find humor. The more stressful the more ridiculous the angrier , more frustrate, the more you need to turn it around. Observing humans acting badly has always been a staple of the best comedians and jokes. if you step out of the situation the humor is there. Think Jerry , Richard, George, and Chris. What would they do ? When you are in a bind, in a fit of anger, in the middle of a difficult situation – say to yourself what would Jerry do. Write it down and try to make a joke out of it. It only has to be funny to you. That is what counts. If it is really funny well you just started a comedic career.

Hold in that laugh! Have you ever been in a situation particularly with a friend where you found something ridiculous and funny but you could not laugh. In class, police pull over, airport-TSA line, etc.. Well think of something really ridiculous and try to hold in a laugh . The more you try to hold it in the more you want to laugh and finally burst out with tears from trying to hold it in so hard. You will stop your worry and the problem will look less threatening while you are trying not to laugh.

Put on your silly shoes. Silly clothes. Dance sing . Be a rock star. Lighten up . It’s only one moment in your life . Do you even remember the things that worried you when you were 5? Don’t take it so seriously.

14.Get help from your furry friend– hard to be angry around babies and your favorite dog. All those silly cute pet YouTube videos are downloaded by the millions for a reason. Put peanut butter or your dog’s favorite treat on your nose. Let’s see what happens? Try staring into your dog’s eyes . They say you both get a surge of oxytocin a calming and happy hormone .

15. Inspiration from others, from prayer, religious teachings or those who have been through far worse like Anne Frank. If they can go through all they did and be inspiring we can learn to as well.

“I keep my ideals, because in spite of everything I still believe that people are really good at heart” – Anne Frank

“How wonderful it is that nobody need wait a single moment before starting to improve the world.” “It’s really a wonder that I haven’t dropped all my ideals, because they seem so absurd and impossible to carry out. “Think of all the beauty still left around you and be happy.” Anne FrankT

Warren Krantz MD

HealthfulMD

Getting to sleep

April 10, 2016Healthful approach, SymptomsWarren Krantz MD

Simple and natural methods for getting to sleep.

Symptom: not being able to fall asleep or getting back to sleep if you wake up in the middle of the night.

This section is not considered part of sleep training for infants and toddlers – that is covered under behavioral issues.

[As with any guidance please consult your physician or child’s Pediatrician before beginning any treatments whether it be natural, holistic, homeopathic, or supplements.]

Natural treatments and lifestyle changes that can help you fall asleep and stay asleep longer are divided into behavioral or habits, food and meals, exercise, stress reduction, natural remedies.

Basic sleep schedule – consistency of bedtime. Make a bedtime routine for any age. give yourself time to wind down. Warm bath. Quiet time. No distractions . Peaceful fun and games. Reading. And any brain activity that is distracting and calming but not over stimulating to the body or mind.

One of errors people make when they do not get enough sleep at night whether it be by choice staying up late or a sleepless night is to sleep in, later. While it may seem like a good idea to help you catch up with your sleep, the overall effect is to change your natural circadian rhythm. This would have a negative overall impact on sleep and restfulness. If nothing else staying up late and sleeping in just reinforces the poor sleep pattern rather than your natural sleep cycle.

Rather than staying up late and waking up late, turn it around. Start waking up with the sunrise and stay awake until you create a new reasonable bedtime in order to get 7- 8 hours before the next day’s sunrise. This will tune your body and mind into daylight and reset your circadian rhythm. This process actually keeps you healthy , your immune system functioning at it’s peak, your brain focused and you feel less stress.

Psychological and stress reduction .

Calming yoga and meditation including visualization, corpse pose, mindfulness meditation

Reading, writing, art, music- listening to classical music has been shown to calm your brain waves. Activities with a lot of repetition will have a calming effect on your brain( like knitting).

Food that help calm and elicit melatonin

Dark cherries, tart cherry juice.

Good hard fermented cheese ( for those non vegan)

Foods with tryptophan- nuts(walnuts), bananas

Magnesium from nuts and seeds

B6 foods aide in melatonin production Pistachio nuts and garlic , banana are B6 rich

Potassium rich foods also help in muscle relaxation. Citrus,dates and figs,tomatoes.

Chickpeas

Lettuce leaf – eat a bunch shredded in salad sandwich wheat multigrain seed rich bread.

Easiest and best choice-lettuce tea. Use romaine , 2 – 4 large leaves to 6-8 ounces of water steep in boiled water for 15-20 minutes . drink cup of that. For infants a teaspoon or 2

Herbs and essential oils:

lemon balm. Lavender oil, candles, incense, put oil on your pillow.

Saffron oil or in food. . Valerian calming for stress- coming in tea, supplements.

Can put a few drops on your pillow. Light a candle or use essential oils in your bath .

Teas

Lettuce tea- see above

Chamomile tea – decaf

Lavender tea

Passionfruit tea

Peppermint

Lemon balm with lemon grass

Exercise regularly – aerobic and especially anaerobic like weight lifting should be earlier in the day. . Yoga is a good winding down exercise as is a slow swim.

Distraction

White noise

Noise machine, soft music, waves.

Rotating fan

Staying fit and healthy with good air circulation is very crucial to getting a good night’s sleep.

Please as with all information check with your physician to assure your poor sleep is not medically related.

Warren Krantz MD

HealthfulMD

Constipation

February 10, 2016SymptomsWarren Krantz MD

Constipation and You – a healthier approach

[ The following post is for informational purposes only. This is not meant as medical advice. Please consult your physician or your child’s Pediatrician before treating any constipation symptoms. ]

I had a Gastroenterology attending who once told me from the day we are born until the day we die we all are fixated on our bowel movements. When , how , how much, how hard, how often?

Of course constipation can be a medical problem which requires immediate attention by a physician. [Any changes in your bowel habits please contact a medical professional]

The vast number of people in western cultures who suffer from constipation or are actively treating it belies the fact that this is really for the most part a man made problem. A large percentage of bowel and intestinal problems are self inflicted. Most constipation is behavioral including diet, lifestyle, and poor potty skills. To a much less extent, especially in the elderly or patients with chronic illness it is medical or genetic. Even colon cancer is now considered to be caused in part by your diet. Meaning the more fiber, more plant based, the faster your bm comes through the less you are constipated, the less associated disease you may develop.

[Please consult your physician before treating any type of constipation on your own].

Is it part of our society, culture, diet , or is it a normal genetic variant as part of the human condition?

I believe that starting at birth with breastfeeding and following through with a primarily healthy plant based diet, humans would not be nearly as constipated. Ask your local neighborhood “healthy vegan” if they have problems passing stools . They will very gladly offer advice. But more than likely they will mention the virtues of fiber from plants and how they do not have to think twice about constipation quite the opposite.

What is constipation?

Reduction in normal frequency of stool to what is normal for age and individual, often accompanied by pain on defecation, hard stools, difficulty in evacuating a stool, blood around it. No matter where you start if it becomes difficult to have a bowel movement or accompanied with pain or bleeding this is constipation or could have a medical source and need to seek advice from your physician..

Constipation by age:

Babies when breastfed can go 10 times a day or once a week . It’s the consistency that counts . Pushing for a long period of time and either not going , straining to go, or a hard stool can be constipation.

The “Potty training” age is it’s own category. Children in this stage commonly hold in their stool and have problems with self induced behavioral constipation.

Children should generally go once a day. Certainly a child with hard stools, any blood or pain, or difficulty evacuating a stool could have constipation and should be checked by their Pediatrician.

Adults- any change in bowel pattern, pain, prolonged time to go, hemorrhoids, blood, difficulty passing stool. [please consult your physician}

Foods to avoid that are responsible for a large percentage of constipation consist of low fiber, highly processed,with added chemicals. Mostly unnatural foods changed significantly from their natural state.

How much fiber do we need?

Women 21-24 gm day, men 31-38 gm a day. A child’s general guideline is the age plus 5 gm for the total recommended grams of fiber for a day, but I believe more is probably healthier. Once an individual is used to a whole healthy food diet they will be able to manage with more then the recommended amount of fiber. For example a 7 year old should have a total of 12 grams of fiber a day based on this formula. Look below for some sample fiber amounts. In most cultures that are based on healthy plant based foods particularly bean based they consume much more fiber and have been shown to have better health statistics.

Dietary Culprits in constipation – foods to eliminate when you or your children are constipated

Any animal products, especially red meat and diary.

Sugary foods, fried food.

Carbs particularly processed white carbs like pasta and white rice.

Processed low fiber breads, crackers, bagels, cakes, cupcakes, etc.

Applesauce, bananas, chopped carrots also are binding due to the breakdown in the pectin.

Best foods to treat and prevent constipation.

Whole foods are the best food source of natural fiber.

My super constipation busting smoothie

Smoothie for bowel health and treating constipation- start with a good healthy fruit base- either apple, orange, pineapple, etc. avocado for an excellent source of fat and to thicken it like a milk shake .Add vegetables to your liking the leafier the better. Spinach hides well. If the green color is not tolerable for your child go with purple, like prunes, acai, grapes, or for orange color- add oranges, sweet potatoes, squash ( but NOT pumpkin). Include figs for fiber and substance, and dates to sweeten it if needed. Add ground flax seed or chia seed, nuts or nut butters which add good protein, oil, and fiber .

Juicing takes out a lot of the fiber and often defeats the purpose. So even though juice is often the go to treatment for constipation there is actually less fiber in juice than the whole fruit or smoothies.

Slowly make the change to a high fiber lifestyle. Increase the amount of healthy high fiber food gradually so you do not get cramping or bloating or pain.

Natural healthy treatment of constipation:

1.Natural fiber additives – senna. psyllium, ground flax seeds, hemp seeds or hearts. Can buy “greens” in a natural food store to add fiber

2. Vegetables all have fiber especially the leafy green ones. Iceberg lettuce does not have enough fiber to make it worthwhile. It only has 0.5 gm fiber compared to romain which has 1.8 gm, and arugula 1.6 gm.Kale 2.6 gm fiber per chopped cup, broccoli, 3.8 gm fiber, spinach 4.3 gm cup cooked. Sweet potato has 4 gm of fiber.

3. Nuts and seeds particularly adding ground flaxseed 1.9 gm fiber per tablespoon or Chia seed 10 gm fiber per ounce can offer a good source of healthy fiber.

Almonds 1 oz -3.5gm fiber , walnuts 1 oz 1.9 gm fiber, sunflower seeds, 1 oz is 2.5 gm fiber.

4. Fruits are filled with fiber not just prunes which has 12 gm per cup of fiber.

Figs 1.5 gm for each fig, 15 gm per cup, dates 12 gm per cup, apples 4.5 gm per apple (not applesauce), blueberries 3.6 gm per cup , raisins 6 gm fiber per cup, apricots 3.3 gm cup

5. Beans are excellent source of fiber, partially digested in your intestinal tract with both soluble and insoluble fiber. But start your bean introduction slowly. You know what they say? …One half cup of beans have 15 grams of fiber.

Red beans- kidney beans cooked has 19 gm fiber per cup, black beans 19 gms cup cooked, pinto beans 18 gm fiber cup cooked

6.Increase fluid – just water is good enough. Adults should have 8 glasses of water a day. Healthy smoothies are an excellent way to get fruits, vegetables, protein , and fiber. See above.

7.Teas – senna, peppermint , and basic green tea. The caffeine itself helps much like with your morning coffee

8. Probiotics help in those whose bowel flora has been altered by poor diet.

9. Exercise actually helps – so get moving . Like all parts of your body your intestinal system will move better if you move. There will be more blood flow to the gastrointestinal system in general, and the activity itself will cause your bowel to function better.

With any exercise make sure you hydrate well, before , during , and after.

General causes of constipation by age groups.

Baby

Breast fed babies are rarely if ever constipated .It is said that Breast milk is a laxative for babies stools but this reaction is for all intents and purposes normal or regular. Breast milk keeps the baby bowel functioning and flowing with the proper peristalsis and creating the proper bacteria flora so,a breastfed baby should not need probiotics , should not have constipation, have better immunity , and less colic.

Formula fed babies ( particularly milk based) Are much more likely to have constipation and colic. The ingredients in formula change the bowel flora and function. It is common for breastfed babies to become constipated with transition stools when making the switch to formula or milk.

Toddler 1 – 3 year old

Not getting enough fluids, the typical western toddler diet of pasta, carbs, junk foods, low fiber ,and the age of potty training is almost guaranteed to cause constipation. Much of the toddler diet contributes to having poor bowel habits.

Older child- poor bowel habits, not taking enough time to go to the bathroom, being too busy to go, holding it in, being painful, and the typical western diet. Biggest culprits are the most commonly eaten foods- all that cheese, pizza , milk, ice cream, macaroni and cheese, pasta, big plates of white carbs, cookies, breads, fried foods with breading .

Adult – stress, not eating enough, not getting enough fluids, not exercising, poor diet , and travel.

[Before self medicating with laxatives and pills please contact your physician or pediatrician.]

Warren Krantz MD, FAAP
HealthfulMD.com

Sweet life the healthy way

January 13, 2016Better food better healthWarren Krantz MD

Sweet life the healthy way

Processed added sugar vs fruit sugar directly from real fruit

The better food choice is natural organic fruit instead of processed sugar or added sugar for sweetener.

Eat more fruit.Add it to your food, as a sweetener to give your food a natural flavor and get healthier at the same time.

Real fruit sugar is processed differently than added sweeteners

The sugar in actual fruit is processed slower .

You do not get the glucose and insulin spike.

Real fruit : Has included fiber which helps in digestion and does not cause the spikes in glucose in the blood or inflammatory response from excessive insulin response. The fiber also helps a slower digestion of real fruit sugar. You are not hungry as soon and feel full longer. The fiber keeps you from gaining weight by helping slow the rate of carbohydrate absorption in the intestine.

In addition real fruit helps your intestinal system by preventing constipation and cancer.

Not to mention all the positive natural fruit benefits from the phytonutrients and antioxidants.

Water, vitamins, nutrients, anti inflammatory, and immune enhancing properties are all benefits of natural fruit

Label names for added sugar for which you should be on the lookout: Cane sugar. raw sugar,rice sugar, organic sugar, brown sugar, maltose, sucrose,high fructose corn syrup, corn syrup,anhydrous dextrose, dextrose,corn syrup solids,honey,invert sugar,lactose,malt syrup,maltose,maple syrup,molasses.

Refined or added sugar is broken down by the body rapidly and causes the insulin to rise in response to this rush of blood glucose, making this quite a different process than fruit sugar .This quick spike in sugar and subsequent rise in insulin has the opposite effect on the blood sugar levels causing it to drop precipitously. You become fatigued and hungry sooner. This exaggerated process takes place in the liver causing inflammation in your organs and blood vessels. Without the fiber from real fruits, added sugar calories turns into fat more readily and you gain weight faster.

Even fake artificial and natural artificial sweeteners of which stevia is the best one, trick your body into thinking it is real sugar and increase glycemic index response. You are hungrier like you ingested actual sugar even though you are trying to eat healthy. Artificial sweeteners make your system think you really had sugar. Artificial sweeteners end up having the same effect raising the insulin and same negative response to your blood.

List of natural sweeteners

Most fruits have a low glycemic index and an even lower glycemic load which is the amount per serving compared to other servings. This all means eating fruits and using them to add sweetness and taste to your food does not come with the sugar raising complications in the blood of adding processed sugars. A glycemic index under 55 is considered low and over 70 is considered high.The lower the index and load the less your blood sugar will be raised after eating a serving. The less your insulin will rise, and the less hungry you will be.

Table of fruits to use as sweeteners and honey. glycemic- index load

Apple	39	6
Banana, ripe	62	16
Blueberries	50	9
Dates, dried	42	18
Grapes,	59	11
Figs	61	4
Orange	40	4
Peach	42	5
Pear	38	4
Prunes	29	10
Raisins	64	28
Watermelon	72	4
Honey	55	3

HealthfulMD: My favorite sweet fruit are dates . Tastes like candy . Most of the natural organic baking and desserts use dates as their secret ingredient. In addition to the wonderful sweet taste, they are filled with fiber , vitamins, and potassium. Imagine you can enjoy a natural food and be healthier!

Eating fruits and using them to make your food sweet will make you healthful. Will cause less complications. Less obesity. Less processing in industrial plants which invariably have a larger environmental impact. Once again when you make a positive move to eat better foods you and the world are healthier.
Warren Krantz MD, FAAP

HealthfulMD.com

What my dad taught me about mindfulness and “quality of life”

January 4, 2016Mindfulness and meditationWarren Krantz MD

It’s only fitting that my first mindfulness blog is based on the lessons I learned from my dad during his terrible struggle with metastatic melanoma and generally with his poor health and medical treatments and mistreatment.

Portions of this was from the eulogy because you cannot discuss a life without discussing the struggles and how someone handles that . He has had major medical maladies for 25 years. The nature of these and their relationship to his lifestyle will be discussed in another post . But for now this is dedicated to him and how he lived .

I watched my dad fight his melanoma for a year after it came back with a vengeance, and metastasized everywhere . One thing you realize is that if you are not mindful of your life and breathing while you live you will be forced to at the end of your life .

As you weaken and become ill every day is a blessing . Every visitor is a joy. The simple movements become monumental and anything you can do better today than yesterday is a victory.

My dad went from strong and vibrant to laying in the ICU with an uncomfortable alien mask forcing oxygen into his face . He could not breath on his own, do any bodily function on his own, or even scratch his own itch. But as he had all year he wanted to live. It had moved from milestone to milestone. First making it to it to his birthday. To the next family celebration. The holidays. Children’s visits. Being able to walk on his own. To make it around the living room . To make it to next month. Next week. Next day . And finally next breath. .

What he taught me about mindfulness and being grateful for what you have is possibly his biggest gift to me. Treasuring the moment Appreciating the small things. The minutes the hours . Being with your family for the little things – that is life, that is the return on your investment.

He would buy an hour even a miserable one to be with us. He tried so hard to stay alive even in pain as long as he could.

This was his quality of life. As a physician we learn to talk about quality of life in terms doctor’s understand, not of the patients, but really not understanding that quality of life is individual. From the second he had his ferocious cancer come back… the doctors started whispering the term “good quality of life”. But what I learned from my dad—- is this; quality of life is individual… it is more about the life– it’s what you as a person feel is important. Living becomes much more important than doing. Who you are and with are much much more valuable than what you have. All the travel, and accomplishments pale in comparison to having the people you care about and love be part of your life. Quality of life is the quality you give to being alive- the value your life has and is worth fighting for —one minute is an eternity when you value that minute. Every breath is worth fighting for if you love to open your eyes and see your family that is what he taught me.

This ultimate mindfulness is a stark reminder to what is truly important and how when each breath counts when you treasure each moment. How do we learn from this painful experience and value each breath and recognize important moments now … while we think we have infinite breaths. If we pay attention we will realize that all our breaths are numbered. Then maybe we will start to value them, and enjoy each moment without wasting any.

Maybe we will use each breath to recognize and value the love, the people and things we truly care about while are still able to breathe,without an end in sight. Each moment that you get to spend doing something you love with people you care about is your real life.

Mindfulness is in it’s basic form is honoring each breath and what each moment has for you , your life , and loves. Mindfulness is the process of bringing that with you wherever you go. Find your breath in everything you do. Enjoy it. While you walk, while you drive,, when you work. Pay attention to each breath and let it bring you into life- each precious moment you are alive. Let your breath bring you gratitude for all things you will lose if you become ill. Treat each day as though you are about to lose it all.

Don’t wait until you realize you are getting close to your last breath to be mindful of what you have , who you are with , and what each moment really means.

What he taught me is that every breath, every moment, every day is a gift.

Warren Krantz MD, FAAP

To Bob