A Succinct Review of the Top Medical Research Studies of 2018 for Family Physicians

By Natan Schleider, M.D.

May 19th 2019


Every year I try to some up the most important easy to understand studies for my patients, doing my best in eliminating fancy medical mumbo jumbo.

Here are the important points for 2018:

  1. Home blood pressures are more accurate than doctor’s office blood pressures. Sooo, if your blood pressure is high at the hospital or doctor’s office (which it should be unless you are super zen), check your blood pressure at home with any machine that measures above the elbow OR ask a friend who knows how to check blood pressure. If you find yourself surrounded by machines as in the above photo, you are doing something wrong…that photo is actually an old ECG machine.
  2. Lower blood pressures are almost always better EXCEPT in elderly patients 85 or older.
  3. Shorter courses of antibiotics are almost always as effective and have fewer side effects than longer courses. So, for example, if a Zpack usually helps your bronchitis or ear infection or sore throat, opt for the 3 day Zpack rather than the 5 day.
  4. For women who suffer from 3 or more UTIs annually, drinking an additional 1.5 liters of water daily reduces risk of future UTI by 50%.
  5. Several studies show that non-opiod pain medicines are as effective for relieving acute injury of arm or leg pain in the emergency room compared to opiods.
  6. Patients who exercise (at least 150 hours per week or more) have lower risk of depression.
  7. For patients being medically treated with anxiety who then stop their medicines, 1/3rd will have a relapse and require medication again. 1/6th of all patients with anxiety will have worsening anxiety despite treatment.
  8. Stool testing for colon cancer screening using DNA found in stool (called Fecal Immunochemical Tests or FIT) is better than standard stool testing for blood and an optional substitute for colon cancer screening other than colonoscopy.
  9. Type II diabetics should shoot for a HbA1c of 7-8 percent (and not lower as previously advised).
  10. If you are 60 or older, a blood pressure of 150/90 or lower is ok presuming you do not have other serious medical issues. Below 60 lower than 140/90 is ok.

Please contact me with any questions or comments.


Natan Schleider, M.D.

Is Breakfast Really the Most Important Meal of the Day?

By Natan Schleider M.D.

JAMA. Published online May 1, 2019. doi:10.1001/jama.2019.2927

‘Back in 1917, the same year that she cofounded the American Dietetic Association (now the Academy of Nutrition and Dietetics), Lenna Frances Cooper authored an article in Good Health magazine that noted “in many ways the breakfast is the most important meal of the day, because it is the meal that gets the day started.” Good Health was published by the Battle Creek Sanitarium, a Michigan health resort run by Cooper’s mentor, John Harvey Kellogg, MD, the coinventor of corn flakes (his brother started the cereal business that would become the Kellogg Company).’

Recent studies indicate that eating breakfast may NOT improve weight loss and nutrition, speaking to how the public’s medical knowledge that ‘everybody knows’ has no scientific support. Other fallacies that our parents told us include sitting too close to the TV will cause eye damage, for example–it will not.

One Meal A Day (commonly called OMAD) has been a recent diet trend where a person consumes all calories within an 8 hour window or fewer.

Bottom line for the patient with a normal metabolic system is that total calories consumed per 24 hours will best reflect weight loss outcomes, regardless when calories are eaten. That said, plenty of serious body builders and models eat no carbs after 12 noon .

If breakfast is integral to your nutrition, diet and lifestyle, great, don’t change a thing. I personally am not big on breakfast eating usually some egg whites sauteed with some onion and tomato and chipotle tabasco sauce (about 200-300 calories). If you have been forcing down breakfast and not particularly hungry, recent data shows this may kickstart metabolism and hunger later in the day leading to weight gain.

Thanks for reading,

Dr. Natan Schleider

Turning 50? Get ready for a battery of tests…here is what is recommended.

‘Some men just can’t seem to grow old gracefully.’

By Natan Schleider, M.D.

January 14th 2019

I’ll be turning 50 soon and I can tell. I wake up 4 times nightly to pee )so my prostate is growing.’ My hair is thinning. Joints hurt. I shrunk from 5’9″ to 5’8″ based on my last physical. While I am researching anti-aging medicine, I am preparing for the slew of tests indicated at age 50.

In no particular order if you are 50 or older you should have these tests:

  • Screening colonoscopy for colon cancer every 10 years for those at normal risk of colon cancer. Alternate options which I am considering is Cologuard which is a stool based DNA non invasive test with 95% accuracy done every 3 years instead of colonoscopy (unless of course the test is positive in which case you need colonoscopy).
  • Screening Chset CT Scan (age 55 to 77) if you have ever smoked 30 packs of cigarettes in your life or have smoked any cigarettes in last 15 years.
  • Prostate testing in men annually–debatable, talk to your doctor.
  • Checking your weight, cholesterol, and blood sugar annually
  • Pap smear every 5 years in women
  • Mammogram annually for women
  • Annual skin exam by skin doctor
  • Make sure vaccines are up to date–these get confusing and probably warrant another blog/article–most common is tetanus booster with pertussis every 10 years

If anyone knows a good anti-aging doctor, let me know!

Natan Schleider, M.D.

‘Dear Blue Cross Blue Shield, Thanks for raising my fees because I know the 1+Billion Profit You Made in 2018 Will Go Straight to the Sick and Infirm!’

By Natan Schleider, M.D.

January 12th, 2019

First let me say if you are reading this blog and comment or follow me on social media and are a new patient with no health insurance, I’ll provide you free medical care for 3-6 months within the scope of my specialty. Why? Quite simply if I can afford to run a medical practice with zero income from some new patients, perhaps large insurance companies can do the same?

Anthem made 1.1 Billion Dollars in 2018 while dropping 888 thousand clients. Way to trim the fat.

If health care providers provide medical care and patients receive medical care why do the middle men–health insurance companies–make all the money? This complex question which seemed innocent in 1917 has snowballed to the point I pay over $2000 dollars a month for health insurance for me and my daughter which we sometimes use. But not $2000 a month! We are healthy fortunately.

So my proposal to Empire Blue Cross Blue Shield, the biggest insurance company in New York City: For every free patient I treat, you treat a free patient like a 9/11 victim, a pregnant mom, anyone warranting care.

If we both lose a 100 million dollars monthly then we regroup but if everything goes smoothly, become a nonprofit that gives out smoothies!

Hope to see some new patients soon as well as people commenting on my blog.

Natan Schleider, M.D>

Going for a routine physical exam? New guidelines suggest less is more.

January 4th, 2019

By Natan Schleider, M.D.

Early Electrocardiogram called a String Galvinometer Circa 1911

My primary care physician is a very bright internist in his early 70s who I saw recently for a routine physical exam. He examined my head, neck, chest, and abdomen and then, putting on gloves and grabbing some KY jelly, told me to bend over for a prostate exam.

‘Prostate exam!’ I said, ‘Why? I have no prostate or urinary issues, no personal or family history of prostate cancer, and don’t see the need.’

‘Just being thorough,’ he replied.

While I like my doctor, there is thorough and then there is ‘too thorough.’ Moreover, I reminded him, routine prostate exams are no longer indicated [Source: US Preventive Task Force].

‘We’ll skip the prostate exam.’ I said. He shrugged as if to say he wasn’t doing his job properly. He then checked my legs and the exam was over.

While some of you may like the comprehensive check every nook and cranny exam, I personally don’t nor do I recommend or perform them. I stick to what the data supports. Why some patients seem disappointed that I haven’t probed every orifice is beyond me but to each their own.

Next time you’re in for an adult physical, here are tests which are no longer considered routine or necessary unless, of course, the doctor feels they are needed based on your medical history, symptoms, or other risk factors.

  • Digital Rectal Exam (meaning sticking a finger into your anus and rectum)
  • Pelvic Exams in Women
  • Testicular exams are up in the air but consensus is that male patients, especially those age 20-35 (when testicular cancer is most common) can perform their own monthly self-examination and/or have the doctor do the exam. The US Preventive Task Force recommends against testicular exams during a normal physical [Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/table/vaphysical.t1/?report=objectonly]
  • Thyroid exam for thyroid cancer
  • Abdominal exam for pancreatic cancer, liver enlargement, or spleen enlargement
  • Lymph node palpation
  • Back exam for determining mobility
  • Checking reflexes in arms and legs
  • Breast exams need not be done if more sophisticated tests like mammograms are available

Some testing on routine physical exam are still being reviewed but as I peruse the medical literature, it seems that, to my old school doctor’s chagrin, much of the physical exam in adults is probably not helpful and may even lead to false positives.

Certainly some patients will swear that their doctor caught a disease by poking around or hammering on the knees with a reflex hammer and all I can say is: God bless those doctors. I’m interested in the facts here, just the facts.

Thx for reading,

Natan Schleider, M.D.

Source: https://www.ncbi.nlm.nih.gov/books/NBK82767/

Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult

Hanna E Bloomfield, MD, MPH and Timothy J Wilt, MD, MPH.

Created: October 2011

‘I don’t need the flu vaccine, it always makes me sick plus I can count on ‘herd immunity.’

January 4th, 2019

By Natan Schleider, M.D.

Poster by Board of Health Advising People wear mask in 1918 to protect against Spanish Flu

‘I don’t need the flu vaccine,’ said a mid 30s healthy female patient to me yesterday, ‘it always makes me sick plus I can count on herd immunity.’

My patients are well read, opinionated, and know plenty of medical jargon to make their point. Herd immunity, if you’re wondering, means that if everyone else around you is vaccinated and immune to a disease, the chances of them giving it to you is very low.

Let me also add the influenza vaccines do not give live virus, just the proteins of the virus to illicit an antibody and immune response if you are exposed to the virus. The immune response caused by the vaccine results in some cold symptoms like fever, sore throat, runny nose, cough, aches/pains, but DOES NOT cause the flu.

So why all the hype about the flu vaccine?

There are several answers:

  1. The media often has nothing really news worthy so given the mantra’ if it bleeds it reads’ they can always turn to the dangers of the latest deadly flu virus bound to land you on a ventilator before you can change the channel. Remember all the media hype about Avian Flu (H5N1) about 5-10 years ago. Turned out to be nothing. And the dreaded Swine Flu of a few years ago infected the airwaves aggressively (and fortunately did not infect many people). If you really want information about influenza ask your doctor, check the CDC and WHO websites, and ignore the publish or perish journalists.
  2. Historically, certain strain of influenza were actually quite deadly. the most infamous in Spanish flu, an aggressive form of H1NI influenza virus that spread quickly and was unusual in that it killed more young health adults (ages 20-40) than the young or elderly. Over 100 years later, this pandemic killed more people than those that died in WWI.
  3. If another aggressive flu virus rears its head, the flu vaccine does a nice job at keeping you alive–presuming the CDC and WHO have guesstimated the right 3 or 4 viruses to put into the vaccine that season.

I recommend all my patients get the flu vaccine. I get it annually and have never had the flu (which let me remind you results in days of miserable fever and chills and 2-4 weeks to recover…this isa cold on steroids).

My flu vaccine of choice is the quadrivalent vaccine (meaning it has four flu virus proteins in it) while the classical influenza vaccine has three. If you are worried about mercury (thimerosal) get the preservative free vaccine. If you are worried about autism note there is little if any data to support vaccines causing autism but it is up to you. If you are worried the shot will hurt, make sure the doctor injects with a brand new needle (that is, not the same needle used to draw up the vaccine from the vial as this will blunt the end of the needle and cause more pain).

After the flu vaccine, you can take Tylenol or Advil or Alleve and can expect your arm to be sore for a day or three.

Take home message: get the flu vaccine yearly and stop wasting your time and losing sleep over the myriad of journalists that have nothing better to do than scare you about so they can make a living.

Thx for reading,

Natan Schleider, M.D.

Weight Loss & Lifestyle Tips to A Lean Healthy Physique: Dr. Natan Schleider Shares His Nutritional Low Calorie Food Secrets (Shhh Don’t Tell)–Part II

December 24th, 2018

By Natan Schleider, MD


So I wanted to follow-up with the nitty gritty foods I eat that have been working for me to maintain reasonable weight loss (current weight 203, I peaked at 222 earlier this month).

Disclaimer: These are not official physician or nutritionist recommend foods as some are high in sodium for example BUT they taste great (to me) and are low calorie…

Dr. Schleider Go-To Meals and Snacks for weight loss including calories per serving:

  1. Canned artichoke hearts–I love salty foods and while these tend to have high sodium, at only 20 calories per serving or 60 calories per can these are a great snack when you have a strong craving for something like chips.
  2. Mushroom Bisque Soup with little to no cream–This is actually easy to prepare and there are lots of great recipes on line. Given mushrooms have virtually no calories nor nutritional value while tasting great, you can substitute White Kidney Beans (Cannellini Beans) for cream which gives the bisque a nice creamy texture when blended. These beans are nutritional with zero fat, 19 grams carbs, and 7 grams protein per 1/2 cup serving which only has 100 calories.
  3. Salsa–I love salsa and put this on everything from egg whites in the morning to chicken breast in the evening. At 10 calories per two tablespoons I get a lot of flavor for otherwise tiresome foods.
  4. Unsweetend Almond Milk–At only 30 calories per serving vs 70 for skim milk, I use this in my morning tea or coffee.
  5. Bone and Vegetable broth–If you are a quasi-serious cook, you know that a good broth serves as key base to great soups (I’m big on soups if you can’t tell, especially in winter). One cup of chicken bone broth has 35 calories, 9 grams protein, no carbs, no fat. Vegetable broth at 20 calories per cup has no fat, no protein, and 4 grams of carbs.
  6. Boneless Pork chops–At roughly 300 calories per 8 ounce serving, these have virtually same calorie and protein as chicken breast which just gets dry and tiresome for me week after week.
  7. Sumo tangerines–I get these on freshdirect and at 40 calories they are delicious and better yet, peel so easily (unlike most oranges where I spend about an hour removing peel).
  8. Cucumbers–I get the foot long ones and when starving or cooking I can easily polish a whole one which for about 100 calories is quite filling.

So the above foods have been working for me this month. My next challenge is to balance exercise with diet in that days when I work-out, I am way hungrier (like 5 times as hungry) then days I don’t and I HATE feeling hungry. I turn into a grouchy, ‘hangry,’ sleepless man so when I figure this out, I’ll let you know.

Happy Holidays!

Dr. Natan Schleider

‘Stop the heroin,’ says the New York doctor to his opiod dependent patient, ‘medical marijuana will ease pain and save your life!’

December 23rd, 2018

By Natan Schleider, M.D.


Mr. J.B., a 24 year old male up and coming advertising executive for a NYC start-up looks great on paper. He has a Masters Degree from a reputable Ivy League school. His rowing strength, skills, and discipline landed him an undergraduate scholarship, at least until he injured his back and was prescribed Percocet. He is from an affluent family, the kind that consider yachting a sport.

Issue is, he may be getting drug screened as part of his promotion at work. The recreational once monthly use of oxycodone that started a few years ago has ‘blossomed’ into daily use of what is supposedly heroin–he suspects it is ‘some garbage laced with fentanyl, different high you see’ which he snorts every few hours so he doesn’t ‘get sick.’

Appropriately concerned that his habit may be life threatening, I find him sitting in my office, nose running, pale and fatigued, yawning, and rubbing the goose bumps on his restless legs.

JB is clearly in opiod withdrawal and in New York State medical marijuana is recently approved to prescribe for Opiod Use Disorder.

Why? Because studies show that marijuana reduces the dose of opiods needed by at least 1/3rd and relieves pain.

As my predecessor physicians did during prohibition which began 100 years ago in 1919 when one of the few legal means of obtaining medicinal alcohol was by prescription, so now can New York State doctors prescribe marijuana for various medical ailments from cancer to post traumatic stess disorder to Opiod Use Disorder.

Given that New York like the rest of the USA is in the midst of an opiod epidemic causing countless deaths, any tool we can use to save lives from naloxone to buprenorphine to methadone to medical marijuana should be easily at doctor’s disposable.

This begs several questions:

  1. Why do doctors need a special DEA number and special training to prescribe buprenorphine, a medicine FDA approved for treating opiod withdrawal and dependence which it is virtually impossible to overdose on.
  2. Why do doctors need special training to prescribe medical marijuana as patients drop like flies from illegal pain killer and opiod use?
  3. Why don’t doctors need a special DEA number to write for powerful prescription opiods that are highly addictive and cause respiratory depression and death at high doses.

These complicated questions are based on history dating back to prohibition, reflect lobbying power of ‘big pharma,’ and ignorance that leaves marijuana a Schedule 1 medicine meaning the following according to the DEA:

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are:heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote. [See https://www.dea.gov/drug-scheduling].

Should marijuana become legalized for recreational use as Govenor Cuomo intends next year, perhaps medical marijuana prescribing will become a relic like the 100 year old prescription for medical alcohol?

For the interim New York doctors can and should, where medically indicated, offer patients medical marijuana instead of opiods.

Thanks for reading!

Natan Schleider, M.D.


So Your Doctor Says You Have High Cholesterol: How To Read Your Cholesterol Report

December 22nd, 2018

By Natan Schleider, M.D.

Dr. Schleider Cholesterol Report

So you had a physical and your doctor told you you have ‘high cholesterol’ but what does this really mean?

Historically, labs could only test ‘Total Cholesterol’ so alevel above 200 was considered high and below 200 was considered normal. This is a vast oversimplification to the point that in the 21st Century, Total Cholesterol tells doctors very little as it includes both Good (HDL) and Bad (LDL) cholesterol. So, for example, if your LDL cholesterol in 90 (which is quite low) and your HDL cholesterol is 120 (which is quite high but that’s good, the higher the better) your Total Cholesterol would be above 200 and you would have enviable cholesterol.

I included my own cholesterol test results above. This is a fancier panel which some insurance companies will not cover but it is detailed and a good teaching tool.

The common cholesterol test (aka lipid test panel) your doctor performs includes the following which I will help you to interpret (so you can decide whether to skip the bacon cheeseburger and/or exercise more and/or add a medicine for cholesterol.

Cholesterol Tests:

  1. LDL (Low Densiy Lipoprotein)–If you remeber anything, the LDL is THE MOST IMPORTANT NUMBER ON YOUR CHOLESTEROL TESTING. Commonly called bad cholesterol, LDL is the stuff that sticks to and clogs arteries anywhere in the body cauisng heart attacks and strokes and peripheral vascular disease. [Note different sub-types of cholesterol are sometimes called ‘particles’ and the smaller the particle the more likely it is to clog arteries. You will note my test has a ‘Lipoprotein Particle Evaluation’ which for our purposes is too complex to review and not that relevant for most patients]. As a general rule, if your LDL is above 160 treatment is immediately indicated, generally with a medicine. This does not mean you are committed to Lipitor for life but if your cannot keep you cholesterol below 160 you may need medicine indefinitely. Note I take Lipitor 40 mg daily for prevention reasons as current USPTF guidelines show that artifically lowering your cholesterol from normal to low reduces risk of artery clogging, heart attack, and stroke. If LDL is below 100 you are in the clear (unless you have high risk factors for artery clogging like diabetes, tobacco smoking, or perosnal history of heart attack or stroke) in which case LDL should be below 70. If your LDL is between 100 and 160 there is some debate but as a general rule, if you have zero risk factors for artery clogging try to get LDL to 130 or less without medicine. If you have some risk factors for artery clogging like obesity or high blood pressure try to get LDL to 100 or lower.
  2. HDL or Good Cholesterol–This should be above 40 ideally but the higher the better. While some new injectable medicines can raise HDL, as of 2018 these are not commonly used in primary care. Only regular exercise brings up good cholesterol although statin medicines like Lipitor may help a bit.
  3. Triglycerides–These are a type of fat that do not stick to arteris very well so I won’t say they are not important but will say try to keep levels below 150 with diet and exercise and consider a medicine if they run above 150.
  4. Total Cholesterol–As mentioned before, no real information here, the devil is in the details of the other tests.

So that covers the basics on cholesterol. I know I am seeing an educated intelligent patient when they say “Tell me about my LDL and HDL, the total cholesterol doesn’t matter much.’

Thanks for reading,

Natan Schleider, M.D.

DO I Really Need all these Adult Vaccines?

By Natan Schleider M.D.

December 19th, 2018

Vintatge Diptheria Vaccine Poster Circa Early to Mid 20th Century

Which routine (IE not for exotic travel) adult vaccines do I really ‘need’?

The Center of Disease Control (cdc.gov) provides up to date information on what vaccines each adult ‘needs’

Note ‘needs’ is in quotations as many of my patients say ‘every time I get the flu shot I get sick and I’ve never had the flu so I don’t want it.’ Hard to argue with this logic.

Other patients ‘pass out’ when they see a needle and the CDC doesn’t have much to add for these people.

My goal is a succinct review of all vaccines you’ll need in adulthood based on current 2018 CDC guidelines.

FYI, while I get all vaccines and have no issues with them, my daughter flipped out and cryed and cryed for her 4 year old vaccination so I haven’t had the heart to get her annual flu booster–bad Dr. Schleider.

So here are the vaccine you need in no particular order:

  1. Influenza recommended annually for everybody (unless you are allergic to it).
  2. Tetanus–Recommended every 10 years (5 years if it is a nasty wound like on a rusty fence). Try to get the tetanus booster that contains pertussis at least once in your adult life.
  3. Measles Mumps Rubella and Chicken Pox–You’ve probably had these in childhood (unless born before 1957). If there is any question as to whether you are immune I like to do blood tests for antibodies to confirm immunity.
  4. Shingrix 2 doses after age 50 2 to 6 monthts apart. No one is really using Zostavax anymore…
  5. Pneumonia Vaccine PCV13 (Prevnar) one dose after age 65 unless you have chronic medical issues like kidney or lung disease in which case have it earlier.
  6. Pneumonia Vaccine PPSV23 (Pneumovax) one dose after age 65 (don’t give at the same time as Prevnar) or 1-2 doses before age 65 if you have chronic medical issues.
  7. Human Papilloma Virus–3 doses through age 26 in females, age 21 in males
  8. Meningitis-There a re afew vaccines but bottom line get these before going to college or if you have any immune system disease
  9. Haemopholis Influenza B–Again for patient with compromised immune systems
  10. Hepatitis A and B–Hep B vaccine has become standard and I recommend Hep A to all travelers.

So that is my bare bones synopsis. We haven’t gotten into the exact timing of the vaccines but that is ok, just so you know what to ask your doctor or pharmacist (they get busy and may forget to remind you).

FYI I am a big advocate of vaccines and have had every one from yellow fever to rabies.

Reach out if you have any questions.

Thanks for reading!

Dr. Natan Schleider M.D.