The purists would argue about these two terms and get wrapped around the axle. TRF is technically a version of IF. There are no definitive long-term studies that prove which IF or TRF protocol is the “best.” Being a purist is not necessary, although calorie restriction and IF are not the same.

We evolved in a world of feast and famine. (Famine is fasting, but not by choice—i.e., starving.) We now live in a world of only feasting, with groceries within blocks, a fridge/freezer in your kitchen, another freezer in the basement, and a beer fridge in the garage. There is no shortage of food in our modern environment, but that does not mean feasting without fasting is normal.

Do you have any medical problems?

I ask patients this question frequently. Some immediately get irritated with me and tell me to “just look in the computer.” And as with every patient, I do look in the medical record regarding their prior medical problems, recent clinic/ER visits/hospital admissions, and medications. However, asking the question tells me a lot about how tuned in they are to their medical problems, and it gives me some idea of their medical literacy. Their involvement and degree of concern about their medical problems often figure into whatever is going on.

Pain Medicine 101 Acute and chronic pain are common reasons to visit the ER. Obviously, the list of painful things is endless: acute injuries like smashing a finger in a door, ankle sprains and wrist fractures from falling, headaches, chest pain, abdominal pain, back pain, dental pain… The list goes on.

It’s quite common for patients not to try anything at home for their pain. There seems to be a widely held belief that taking something at home will cover up their symptoms and somehow lead to a missed diagnosis. I’ve never seen this happen in practice, and I’m not sure where the idea even comes from. If you actually have something serious going on, a couple of doses of OTC meds won’t cover that up. If you are already prescribed opioid pain medicine and you load up on that to the point that you’re barely awake, well, that’s obviously a different problem. For the sake of argument, let’s assume most people fall into the former category and not the latter.

IONS should be the sign over the door of the ER. IONS stands for “Interrupters Of Natural Selection,” which is what we do. The same patients—both medical and trauma—100 years ago would not have survived without us. Those who work in emergency settings recognize this as part of the dark humor that we share. Those who don’t likely see it as somewhat insensitive and disrespectful.

However, the other truth is that through my many years of doing this, I see that all patients are simultaneously treated as if we (the providers) are fighting the Grim Reaper. Regardless of who comes in the door, we are doing battle against death on their behalf. We don’t accept that whatever they did—if it was worthy of a Darwin Award—will end them if we have anything to say about it. I have not seen patients treated with bias against their race, color, creed, sex, socioeconomic status, or any other thing that we get accused of.

“Living my life.” That was the answer from a 45-year-old, 300 lb man in the ER for a simple injury related to a slip on ice while intoxicated. I was examining him while simultaneously asking about his medical problems. I was determining what needed X-rays, and our conversation went something like this:

“What medical problems do you have?”

“Hypertension and being overweight.”

“What are you doing about that?”

“I’m on meds for the hypertension.”

There are many types of law enforcement officers (LEOs) at the local, state, and federal levels, but for the sake of simplicity, I’m going to use “cops” in this post.

The media often paints cops in a bad light. They frequently rely on the same three points to add drama to their reporting, making police actions appear excessive and aggressive. I’m going to briefly address those points.

First, the term “armed police” is used instead of just “police.” In America—and in most of Europe—patrol officers (i.e., the ones who show up first when you call) carry a gun. A duty pistol with extra magazines is standard, along with other control devices like batons, Tasers, pepper spray, a flashlight, and handcuffs. More specialized units commonly carry rifles—often called “assault rifles” for dramatic effect, despite the term lacking a uniformly agreed-upon definition. Most patrol officers also have a rifle or shotgun in their patrol vehicle.

Food Addiction I think there are more people addicted to food than there are addicted to alcohol, smoking, and drugs. There are a number of reasons for this, and I think these are the most common.

Eating junk food is widely acceptable. Even the word “food” has lost its meaning. It should refer to things that God made, but it has instead come to mean anything you can buy at the grocery store or any restaurant. It doesn’t matter how processed it is, how fake it is, how many chemicals are in it, or what extreme lengths a company went through to make it palatable—it all counts as food.

Moderation is a junk term. It is too ill-defined to provide any actual structure for changing behavior. It’s most often used in relation to eating patterns, as people like to say, “I eat everything in moderation.” When pressed for details, those are hard to come by.

I can personally eat a package of bacon in a single sitting. For many, that would be excessive, while two pieces of bacon feels adequate. How many, then, is considered moderation? Four? Six? Eight? Ten? What defines a moderate amount of bacon?

I have four kids who are now in high school and out of the house. When my two oldest were very young, I read some books by Gavin de Becker. The first was called The Gift of Fear, and it changed the way I think about what I teach my kids.

Very early on, we taught them to talk to strangers—it’s the opposite of the advice I grew up with. I encourage you to check out the books, but one of the main points is that we model talking to strangers all the time. So it’s better to teach your kids which strangers are okay to talk to rather than have them grow up unable to talk to anyone—especially including someone when they actually need to ask for help.

I saw a 5-year-old recently with viral illness symptoms. The parents seemed pretty well educated. By the end of the visit, we had had a very good conversation about what was going on with their child, what we did in the ER, and what to expect. However, the start of the conversation when I first met them was not impressive.

The mom started by telling me about the symptoms the child had been having over the preceding few days. This consisted of typical viral URI and GI symptoms. I was thinking to myself that all of this sounded very reasonable. But then Mom said something that made me deduct 40 IQ points from her. Besides the parents’ concerns that prompted the ER visit, they said their 5-year-old had said he wanted to go to the doctor.