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The sweetener fructose, sometimes labelled as 'high fructose corn syrup,' is found in many processed foods, soft drinks and confections. NOTE WELL:  This is the carbohydrate found in those wonderful fruit drinks that we feed our little children. This may be one of the main issues leading to pediatric obesity. 1. It has  been found to cause leptin resistance, one of the hormones found to control hunger, thereby linking it directly to weight gain and obesity. Shapiro A, Mu W, Roncal CA, et al: Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high fat feeding. Am J Physiol Regul Integ Comp Physiol. 2008. 2. Fructose corn syrup (HFCS) has been found to be as addictive, if not more addictive than alcohol, tobacco, opiates and cocaine. 3. When combined with salt, and saturated fats, (e.g. candy, ice cream, coffee creamer), it is even more addictive. 4. Sadly, pediatric obesity is a leading risk factor for adult obesity. Due to both development of unhealthy eating habits, it changes the nature of the insulin receptor, leading to insulin resistance syndrome, pre-diabetes, and the game is heading for a big time disaster. 5. Focus on Hemoglobin A1c as a primary medical indicator of how well the patient is doing ignores the fact that A1c remains within what is now considered to be 'normal' for at least 10 years before the patient is handed the 'DIABETES' diagnosis. Insist that your doctor monitor insulin to glucose ratios several times a year. In health, the lower the insulin level, the better. Optimal insulin levels are below 10, best if below 5. When insulin levels climb above 15, it is time to take action. Glucose levels optimally should be below 85. When the level creeps above 90, it is time to take action. The insulin receptor is very, very complex. There are hundreds of places in insulin receptor metabolism that are vulnerable to dysfunction. This is why the approach to lowering blood sugar is not as easy as a selection of a single medication. You simply have to use the right approach to fix the problem, AS IT EXISTS. Actions to be taken: Avoid eating prepared foods that contain high fructose corn syrup, dextrin, dextrose or 'added sugar.' Look to 'Weight Watchers' for diet suggestions. For the money, it is a great program. Supplements should include a balanced chelate containing the appropriate amounts of zinc, selenium, chromium and vanadium. NOTE: Too much can be dangerous. Ask your physician for advice. Suggestions from Stages of Life will be listed, below. You can do this on your own, if you pay close attention not only to the dose of the mineral, but also the form that is in. The chemical moiety affects absorption, toxicity and dosing. Herbal products that improve insulin resistance include olive leaf extract, green tea extract, inositol. and bergamot. There are many others, and I plan to discuss them, later. When starting an insulin resistance or diabetes mellitus nutraceutical program, it is best to start with the basic replacements, and then introduce them one at a time, observing morning (fasting is best) glucose levels. You can do this with a finger stick machine, or your physician can order the glucose and insulin blood work. Try to stay consistent with all medicine usage and try to get the blood work done at a consistent time of the day. Start with a complete vitamin and mineral product. It need not be expensive, but the quality of the ingredients is of paramount importance. When you buy 'store brand' products, they tend to move toward the cheapest ingredients and they are not necessarily consistent in potency. Down to basics without iron is where I prefer to start. We have a sister product with iron, but it can cause constipation and iron deficiency is not all that common. Down to basics is very strong, and should be taken two capsules with breakfast and two capsules with lunch. If causes upset stomach, start with 1 capsule twice daily, and then increase 1 capsule per day, per week, until you get to 2 capsules twice daily. After a month of the Down to Basics, you ADD to the multivitamin an additional dosage of vanadium & chromium, with cinnamon and alpha lipoic added. The product is called "DiabetStat." One of these twice daily with meals is as much as you should take. DO NOT TAKE additional zinc, vanadium or chromium, as the combination of the Down to Basics with Diabet Stat gets you to the safe limit of these minerals. After a month on the Down to Basics and Diabet Stat, you can start Berberine 500 mg twice daily, inositol 500 mg (2 twice daily) and Olive Leaf Extract David S. Klein, MD, FACA, FACPM Stages of LIfe Medical Institute Longwood, Florida, 32750 suffernomore.com Tel: 407-679-3337

Foot pain is an extremely common complaint. Often the result of 'shoe trauma,' attractive yet uncomfortable high heels, tight shoes and daily wear and tear, the result can be an annoying interference with your daily activities. Get relief of inflammatory foot pain using an inexpensive, rapid acting cream. The most common joint affected by arthritis is the MP joint of the great toe.  If left untreated, it can result in the deformity known as a bunion. As with most minor annoyances, if left alone and ignored, it will get worse over time and become an increasingly important impairment to comfort. Arthritis here can result in pain with walking, standing, reaching overhead.  Over time, arthritis at this point can result in bunion deformity and reduced flexibility of the foot. Over 20 years ago, I developed a transdermal high-concentration MSM salve, to treat my daughter's horse. The creature suffered from inflammation of the knees & hocks. The alternative was veterinary injections, costing over $400 each, and horses, after all, have four of these joints to inject. The salve penetrated horse-hide, and is being used to this day on horses and other animals. With humans, I have had very good response using the high concentration MSM cream, Kink-Ease.  Begins to ease pain in about 5 minutes, it does not stink or stain, and it is very inexpensive. Best applied before climbing into bed, it should be used several times, daily.  Effects last 2-4 hours, or more. After a day or two, the duration of action increases to 3-4 hours, and often longer than that. The major side-effect is that the cream acts as a skin softener. If you use it on your feet, the callouses will soften, and the skin exfoliates. Nobody seems to mind this side effect. For more information: Visit our vitamins store for more! David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute Longwood, Florida 32750 www.suffernomore.com

Nothing makes for better education than experience, and my family has had some interesting insights that I'd like to share. The typical dip and read urinalysis, performed for many decades is outrageously inaccurate. It relies on 50 year old technology. Performed in an enormous number of physician's offices, emergency rooms, and there are home kits for the 'do it yourself' customer, the test is a quick way to get affirmation of an infection. That is, if it is positive, you probably have an infection. The problem is that the test is inaccurate and will detect a UTI between 50-60% of the time, that is, it is wrong nearly as often as it is correct. Manufactured in China, these strips will miss urinary tract infections, perhaps as frequently as 50% of the time. Urinary tract infection leads to urinary sepsis (blood poisoning, to some) and is a leading cause of death. Do you really want to rely on a $15 dip stick if your life or kidney function depended on it? A problem in the senior population, it is also a real problem with children. Missing almost 50% of UTI's in young children with fevers. Missing Chronic Urinary Tract Infection can result in preventable death and kidney damage. Natural, non prescription treatments will follow in the next UTI Blog Post Note Well: If someone close to you starts feeling oddly, for no other apparent reason such as stroke or heart attack, consider urinary tract infection as a possible cause. Ignoring this, it nearly cost my wife her life in July of 2023. IT WENT SOMETHING LIKE THIS: My wife and I were enjoying our 5th wedding anniversary by taking a trip to Portugal. A marvelous vacation it was, right up until the day before we were to return home. She had an unfortunate fall, fractured her right ankle, and became somewhat immobile. The following day, she started having 'morning chills,' thinking that it might have been a reaction to the previous nights' dinner. Resolving quickly, we thought nothing of it. The next day, we flew home, believing all was well. The next day she felt normal at 8:00 a.m. but became febrile with a temperature of 102 deg. blood pressure dropped to 80/palpable and she was in and out of consciousness. Oxygen saturation was down to 82%. When we arrived in the emergency room 30 minutes later, she was in shock. Treated with fluids, quickly, and given intravenous hydrocortisone to treat her adrenal failure (Addison's Disease) she 'bounced back,' delirious, but communicative. I had mentioned to the ER internist that my wife had darker urine than baseline, fever, chills, and a change in consciousness. I insisted that they treat her for urinary tract infection. Evaluation was rapid, including chest CT and abdominal CT, but her blood work was pending and her 'urinalysis' was negative. Informed by the ER physician that UTI was effectively ruled out, I insisted that they look a little closer at UTI as her problem. When her White Blood Cell count (WBC) returned at 33,000 with a decrease in kidney function to an eGFR of 27, they took a closer look at the abdominal CAT scan and found that she had pyelonephritis on the right kidney (infection of a highly significant nature) and started her on intravenous antibiotics. Five days in the hospital, she recovered. Her infection, however, was not gone........ The Monday following her hospitalization for a 'cryptogenic' bacterial UTI, I took her to my medical office, did a repeat urinalysis with a much higher quality screen, and it was NEGATIVE! On suspicion that the technology was flawed, I sent the urine to be analyzed by PCR, and we found that she had large amounts of a bacterium called 'enterococcus.' I had already started her on doxycycline, and she seemed to improve even more. We repeated her urinalysis weekly, it was negative for 3 weeks in a row, with positive PCR each time. She had a mixed infection with E. Coli and E. Faecalis, and I added amoxicillin to her mixture. Referred to a urologist, she is scheduled for cystoscopy with ureteroscopy to see if there is an anatomic issue with the right kidney and/or ureter. This little recent bit of personal history has changed my medical practice significantly. Urinary Tract Infection is not easily ruled out with a simple $15 dip stick test. In the past month, I have sent samples for PCR if the patient had even trace WBC in the urine, and 50% of the time, the PCR was positive for E. Coli or one of the less frequently encountered pathogens. I am now performing PCR on negative dip stick evaluations, if the patient is showing mild to moderate mental status changes, and if the symptoms are severe, they go straight to the emergency room. The number of patients found to be walking around with mildly symptomatic urinary tract infections was astounding. What was eye-opening was the fact that when we found infection, the patients all reported confusingly mild symptoms that in retrospect, were suggestive of UTI. I have picked up almost a dozen 'occult' urinary tract infections in the past 3 weeks. One very fortunate patient had become wheel chair bound, and it was blamed on her Parkinson's Disease. I sent her to the ER with the diagnosis of urinary sepsis, and following IV antibiotics (started before the PCR results returned as positive) she is now walking again and in physical rehabilitation to regain strength. The commercial insurance companies do not routinely cover urine PCR unless it is done to rule out sexually transmitted diseases. For the practitioner, if you include an STD panel with the urine PCR, it has a high likelihood of being covered, if not, the test can cost $600 or more. In the future, it is my hope that the insurance carriers will follow the lead of Medicare, and cover this service. I am fortunate in that I own a laboratory that has the capability of performing the testing, but for my patients that do not, the laboratory owners have agreed to reduce the price to a more affordable level of $240. The commercial diagnostic laboratory can be reached at: www.floridalaboratoryanalysis.com I will update this blog post, as more information becomes available. I will add published references and such, for validation of the data mentioned above. David S. Klein, MD, FACA, FACPM Stages of Life Medical Institute Longwood, Florida 407-679-3337

Into each life some rain must fall? As we get older, perhaps a bit less flexible and certainly more brittle, the risk of falling increases. In fact, it is one of the greatest risk to life as we enter advanced age. Changes in balance, weakness of muscle, joint stiffness contribute to instability, diabetes with associated small nerve damage results in easy stumbling, sleep problems lead to mental fatigue. The net result is an increased risk of injury due to fall. So it went with my family. My wife slipped and fell, twisting her ankle in such a way that it resulted in ankle fracture, a minimally displaced fracture of the fibula. Unfortunately, it happened while we on vacation in Portugal, and getting her back home had its’ own challenges. No weight bearing under the circumstance resulted in a 'leave no soldier behind' variant to the potato sack race through Lisbon International Airport. Wheelchairs were not to be had, and we had a plane to catch. We made it home, safe and sound, but in the process of working our way through this, my lovely wife did her own research as to what supplies, durable medical equipment/goods and combinations of the above would work well for the person recently advised to “NOT BEAR WEIGHT ON THE FOOT.” This was much easier said than done. Note this well: The most expensive place to get these products and supplies can be the DME store or the medical practices. The hospital is even more expensive, most of the time. The reason is not necessarily what you might believe it to be. In the medical world, dispensing anything along these lines most frequently requires them to have a HCPS Code, limiting the selection that your doctor can peruse, it is expensive for the manufacturers to obtain the HCPS Code, and the ‘savings’ is passed right on to you. Knee scooter: We tried several and found that the cheapest ones were entirely inadequate, unstable and may result in an even more catastrophic fall. After several efforts, she found the one that we will illustrate. Next she bought the essential cup holder. Here in Florida, you should always have something to drink available. Ambulation: It takes many weeks for the bones to heal, assuming the bones are properly lined-up and immobilized. The first thing we did was get an ‘orthopedic boot.’ There are many choices, some good, many not so great, but none of them were terribly expensive if you buy them on Amazon. If you go to the DME store, thinking that you’re going to get it cheaper with your insurance, you may be unpleasantly surprised that it is 3 times more expensive for the same item, you may be hit with co-payments, deductibles and the unfortunate “Not covered” letter. Let us start with the basics. Stability of the joint: You will need a Support boot for the joint. These are often dispensed at the Emergency Room, Orthopedic Surgeon’s office or Podiatrists practice. This works most of the time, but you are going to want to have more than one for a few important reasons. They need to air out, frequently. They start to smell badly if not aired out and cleaned , having a second boot is a luxury, not a necessity. Your call. The process of cleaning implies that they need to dry out more. The need to rotate your boots will soon become evident. We went through a few of these boots, after the initial, ER dispensed device was used. It got us home from Portugal, but now it sits in a bag in the closet, in case one of the better ones breaks. We found one that was easier to use, more comfortable and less bulky. They come with a few different options, it is an individual choice but I've used AirCast products for years and they have been highly reliable and of the highest quality. This boot has air pads that are adjustable, allowing a 'custom fit,' as it were. It was quite inexpensive and was more comfortable, fit better and is seeing the most use. Not a fashion item, it simply does the job comfortably. This might seem like a frivolity, but getting a ‘furry pad’ for the scooter will keep you from abrasions and pain in the injured limb. You simply attach the ‘furry pad’ to the scooter seat, and in comfort, you shall go. Absorbent socks are very, very handy, and will minimize the hygiene hassles that you might encounter. Buy several, or more. They wear out faster than you will believe. Lastly, most importantly, you must remove carpets from the floors. These are scooter-traps and can put you right back in the ER, if you are not paying attention. Clearly, you do not remove wall to wall carpeting, but throw carpets, designer items and such must be rolled up and put away until you can adequately navigate your home without hazard. More to come! The next blog will be on items that you need for creature comforts & hygiene, during your convalescence. Our favorite knee pillow, cast covers and more. Stay in touch. David S. Klein, M.D., FACA, FACPM, FAACPM (and a few more, but it looks silly) Stages of Life Medical Institute is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.