September 22nd - I have been doing yoga for years but recently started to have pain after sessions. What should I do?

Maintaining a specific pose with opposition of the 'arthritic', less padded parts of the bone could be damaging the joint and inciting inflammation. Avoid poses that are painful, even if you previously could perform those poses. We must adapt to what our bodies are telling us.

September 15th - I have been doing the program for months and have found that I can cheat but not more than 2 days. Can you explain that?

Everyone is different. If 2 days is your max then that is the amount of time it takes for your body to become inflammatory.

September 8th - A friend told me to stop eating avocados because they are fattening. Is that true?

Avocado does have a high fat count but it is also high in fiber and vitamins. The fat content is overwhelmingly monounsaturated, which we like. This is a great summary article:

Crit Rev Food Sci Nutr. 2013;53(7):738-50. doi: 10.1080/10408398.2011.556759.
Hass avocado composition and potential health effects.
Dreher ML1, Davenport AJ.

Hass avocados, the most common commercial avocado cultivars in the world, contain a variety of essential nutrients and important phytochemicals. Although the official avocado serving is one-fifth of a fruit (30 g), according to NHANES analysis the average consumption is one-half an avocado (68 g), which provides a nutrient and phytochemical dense food consisting of the following: dietary fiber (4.6 g), total sugar (0.2 g), potassium (345 mg), sodium (5.5 mg), magnesium (19.5 mg), vitamin A (43 μg), vitamin C (6.0 mg), vitamin E (1.3 mg), vitamin K1 (14 μg), folate (60 mg), vitamin B-6 (0.2 mg), niacin (1.3 mg), pantothenic acid (1.0 mg), riboflavin (0.1 mg), choline (10 mg), lutein/zeaxanthin (185 μg), phytosterols (57 mg), and high-monounsaturated fatty acids (6.7 g) and 114 kcals or 1.7 kcal/g. The avocado oil consists of 71% monounsaturated fatty acids (MUFA), 13% polyunsaturated fatty acids (PUFA), and 16% saturated fatty acids (SFA), which helps to promote healthy blood lipid profiles and enhance the bioavailability of fat soluble vitamins and phytochemicals from the avocado or other fruits and vegetables, naturally low in fat, which are consumed with avocados. There are eight preliminary clinical studies showing that avocado consumption helps support cardiovascular health. Exploratory studies suggest that avocados may support weight management and healthy aging.

September 1st - My doctor diagnosed elevated liver and kidney blood tests. What should I do about my anti-inflammatory medication?

Most likely you'll need to stop the anti-inflammatory. This might be a good time to consider a gentler supplement program to replace your anti-inflammatory. You should only do this under a doctor's supervision.

August 25th - I love to run but running has become quite painful. Can you help me get back to running?

Running blinds some runners. I told this patient that I could get him back to running but not in the manner he was accustomed. At some point, life changes. And for those with relatively severe arthritis, activity modification is necessary. Running long distances daily needs to stop and occasional short distance running mixed with swimming, biking, rowing, elliptical, and perhaps aerobic dance needs to be considered.

August 18th - I love having juice with my breakfast. What juice is best?

I like tomato juice because of its low glycemic index. Unfortunately, orange juice isn't the best. If you don't like tomato juice grapefruit and apple juice are better as well.

August 11th - What is your opinion of coffee?

I like tea better. It isn't as addicting and has positive effects on cartilage cells.

August 4th - My husband has a terrible habit of eating just before bedtime. What can I do?

This may be a great situation because nighttime 'starvation' isn't good for growth hormone (GH) secretion. As you may know GH is important for maintaining muscles so eating a slow digesting protein bar or shake just before bed could actually benefit your husband.

July 28th - I know you don't like vegetable oils but I don't understand how vegetable oils can be unhealthy if vegetables are healthy?

That is rather perplexing. The answer is that the healthy parts of the vegetables are not generally the fats. The fiber and antioxidants are the healthy parts. In addition, the oils are concentrated from the large quantities of vegetable. You don't get large amounts of fats/oils when you eat a serving of a vegetable.

July 21st - How could you recommend playing football to any youngster when it is so dangerous?

I understand your point and for many youngsters it is a good idea to avoid football. For me, at least, I took more away from the game than the game took from me. Once you have played it you understand its value.

July 14th - I wish your supplement program came in powder form. Would you consider offering it that way?

My supplement program contains 18 different supplements. The reason I haven't offered it as a powder is because, if offered that way, the entire program will be off limits to any patient who cannot take even one of those supplements. As presently offered, in pill form, if a patient can't take one or a few of the supplements then that particular level/pill can be eliminated but not the entire program. It is a definite possibility in the future that I will offer the program as a powder because I know that some people would prefer mixing a powder in water as opposed to taking pills.

July 7th - I am on a blood thinner so I can't take your supplements. What should I do?

Just because you're on a blood thinner doesn't mean that you can't take the supplements. You should contact your doctor. The key concept with blood thinners is to have consistency to your daily program. For instance if you want to eat spinach or kale daily you can but you need to adjust your blood thinner dosage for such daily consumption. It's the same with supplements. You need to tell your doctor and add the supplements in slowly. For instance instead of two pills of level 1B two times daily you would add in one pill daily and monitor your levels and then add one pill two times daily and monitor your blood levels until you got to the full dose of two pills twice daily. Obviously you would need to do this under a doctor's supervision.

June 30th - My friend was very surprised that your program included peppers and other vegetables in the foxglove category? Why is that?

My personal and professional experience with foxgloves has not been similar to what I have read about foxgloves. I've read about the negative effects of the foxgloves but I haven't seen such effects regularly. That is not to say I've never had a patient report problems with tomato sauce in particular but I haven't seen such problems frequently. I certainly wouldn't argue with anyone who told me that foxgloves bother their joints but I believe this to be a minority of patients. I've often wondered if it is not more of an old wives tale than reality.

June 23rd - I am very concerned about the quality of the supplements that I take.

I agree and I don't blame you for having concerns knowing what Consumer Reports said about various supplements. I can tell you that I take the same supplements that I offer to patients and the public. The product comes with a guarantee and is of the highest quality.

June 16th - My hands hurt when I try to hold weights. What should I do?

1-2 pound Velcro weights for your wrists may work well for you.

June 9th - I have a difficult time exercising in the morning. My knees and shoulders are terribly stiff.

Try placing a heating pad on your joints I like the "heat in the click" portable and reusable heating pads. Keep the heating pad on the stiff joint for five minutes and then range the joint repetitively. This may be effective for relieving some of your stiffness. Avoid salt in your food as well.

June 2nd - I love to walk but I can't do it for more than a block. What should I do?

You need to follow a progressive plan. Walking may be off limits at first but as you improve walking may be a possibility. At first consider biking and swimming or an elliptical machine. Gradually as the nutrition and supplements kick in you may find walking a possibility.

May 26th - I found a great recipe for a breakfast smoothie that includes cranberry juice, bananas and flax-seeds. I love it. What do you think of it?

This question is a great example of a patient who foiled her program with the best of intentions. She was having joint pain despite being on the program. When evaluating the specifics of her nutrition program she was making several critical errors, the first with breakfast. I look at inflammation as a fire and things that fuel inflammation are like gasoline on the fire and things that squelch inflammation are like water on the fire. To start her day her smoothie was fueling the fire of inflammation with too much sugar. Her supplements were dumping gallons of water on the inflammatory fire while her diet was simultaneously dumping gasoline on the fire of inflammation. Diet, supplements and exercise work together as a team to relieve joint pain.

May 19th - I am concerned about the quality of the supplements I take. As a physician, don't you have concerns as well?

I don't blame you for having concerns. On your behalf I share the same concerns. You should also know that I take the same supplements, as well. Whatever I offer to patients and the public I take myself. The supplements offered in Healthy Joints for Life are tested and substantiated as authentic and top quality. My program is guaranteed.

May 12th - I've been on your program for nine months and I lost 12 pounds but I haven't lost any weight for the last month. What should I do?

This is a question that has pivotal implications. My recommendations for nutrition are not solely about losing weight. My recommendations are about reducing inflammation and the joint pain that is intrinsically related. This patient felt good but wanted more weight loss so I suggested an increase in her fiber intake and the aerobic activity in her exercise program. Just this minor suggestion led to an additional 3 pounds of weight loss over the next 2 month.

May 5th - I am 50 years old and recently had a wrist fracture. Should I be worried about my bones?

Absolutely. The highest frequency of distal radius fractures (wrist fractures) occur in women over 50 years of age. This may be a sign of osteoporosis so a DEXA scan should be done to assess bone density. This is an extremely important test that should be done without hesitation because instituting treatment for osteoporosis is best done early before too much bone density is lost.

April 28th - What is the difference between white and whole wheat bread?

This is a great question because many times wheat bread is actually worse than white bread. You need to understand that finely ground whole wheat flour is no better than the finely ground flour of white bread. Both cause the same inflammation-provoking insulin spike that wreaks havoc with your joints. In addition, many whole wheat breads use molasses to color the bread. Molasses is made by sequentially boiling cane sugar multiple times. The molasses, in combination with finely ground flour, can lead whole wheat bread to have an inflammation-provoking higher glycemic index than white bread. This is the reason why supposedly healthy wheat bread can be more unhealthy than white bread.

April 21st - I am getting swelling when I walk. What should I do?

The first thing we need to do is figure out why you are swelling. It may be that you have a mechanical problem, like a meniscal cartilage tear, that necessitates a small surgical procedure. If we determine that there is no mechanical tear and diagnose that it is osteoarthritis that is causing the problem then you may need to walk on level ground vs hills, reduce the length of the walks or the pace of the walks. It might be that you need to consider cross training; mixing in biking or swimming with your walks. Sometimes lubricant injections, shoe inserts or braces can be helpful. While there are many possible treatments, an orthopedic evaluation should be a safe and smart starting point.

April 14th - I am on a strict budget. What supplements do you recommend?

Supplement programs need to be individualized. Depending on diet different supplements may be recommended. For example, I love omega-3s however if you eat salmon regularly and sprinkle flax seed on your salad or in your oatmeal then you might not need omega-3s.

April 7th - Why do you recommend so many supplements?

Joint health is complex and multifaceted. We need to address the bone, cartilage, muscle, tendon, ligaments, synovial lining and immune system cells. All these tissues are physiologically different and respond to different supplements. We've also learned that inflammation plays a large role in osteoarthritis. Addressing all of these aspects of joint health requires multiple supplements.

March 31st - I love pasta and can't give it up. What should I do?

I have several suggestions. Try whole grain pasta, egg fettuccini or Dreamfields low carb pasta. Thicker pasta like linguini would be better than angel hair and al dente is better than softer. Portion control! One other tip, and I say this with all sincerity because it is one of my biggest problems, don't mop up the sauce with bread!

March 24th - How strict do I have to be on my diet to get joint relief?

This will definitely vary from person to person based on many factors including, severity of arthritis, whether you exercise or not and whether you supplement or not. Stress and obesity cause inflammation as well. Managing inflammation is a total sum game, meaning you can decrease inflammation by eating well but increase it by exercising too much or having too much stress at work. That's why we stress lifestyle with diet, exercise, supplementation and stress relief components.

March 17th - I have to exercise or else I suffer mentally. What can I do so I don't wear out my joints?

Try interval training and cross training. Interval training mixes high intensity and lower intensity exercise and tires you out more quickly so you don't have to exercise as long. Cross training varies the type of exercise you do, biking one day, walking another and running a third. Remember to mix in swimming when possible, the water unloads the normal gravitational forces on the joints.

March 10th - I have GI upset when I eat a salad with olive oil. What oil should I substitute?

You might like avocado oil.

March 3rd - My shoulders hurt when I do exercises and I really want to avoid having flabby arms. What should I do?

#1. Try to avoid overhead activities like pull ups, pull downs, military presses. Use as a rule of thumb, if you are doing any exercise with your arms above your head you are doing a high risk exercise. Instead of pull ups or downs do bent over rows. Instead of military presses do lateral raises.
#2. Stay away from heavy weights. Heavy is a relative term so keep that in mind. What may be heavy to a 140 pound man unaccustomed to lifting may be light to a 220 pound life time weight lifter.
#3. Exercise caution when you exercise. Too many reps or sets, too much weight, too frequent sessions can all lead to overuse and pain.
#4. Keep a journal so you can identify what exercises cause your pain.
#5. Utilize resistance bands and isometric exercises as an alternative.

February 24th - When I start to exercise my joints ache but then after a few minutes they feel fine. Am I damaging my joints?

This pattern of pain is very typical for those suffering with arthritis. Exercising through mild start up pain is not damaging to your joints. Start your exercise gently and increase intensity as your joints get warm and loose.

February 17th - I find it very difficult to stick to a diet plan. What flexibility is there in your program?

I agree 100% that it is difficult to diet. Don't feel like you are alone. The idea of my diet plan is to fight inflammation with healthy foods. Some foods fight as antioxidants and some help block DNA caretakers that make inflammatory messengers. The idea is to fight inflammation in many ways: with jabs, uppercuts and right crosses. Many of my patients report to me that they allow a day off a week without ramifications! My patients' feedback tells me that the diet is flexible but I&apose;m not sure that it would still be effective if you alternated days on and off. Remember, even a little gasoline keeps a fire burning.

February 10th - My doctor says that there is no scientific backing for the use of supplements. What should I say to him in defense of my belief that supplements can be beneficial?

I know how you feel. Without scientific papers to back your position it is difficult to debate a doctor who has years of training and education. However, rather than debate simply ask your doctor to visit my web site,, The Author>The Book>Extended Bibliography, for a list of 500-600 scientific articles written about joint health, a majority of which are about joint healthy supplements.

February 3rd - I know that you recommend coconut oil for higher temperature stir-frying but my husband doesn't care for the smell. What other oil do you recommend in its place?

Avocado oil is an excellent replacement that is joint healthy. While I absolutely love the smell of coconut oil I can understand how some might find it overpowering.

January 27th - I am concerned about the amount of pain that I have in my joints when I exercise. How do I know when I am doing too much?

Patients ask me this question all the time. It should be expected that you would have some discomfort if you have moderate or severe arthritis. You know you are doing too much if you are developing swelling in the joint or if the pain from one exercise session lingers to the next. Remember you have to choose exercises that are appropriate for your severity of joint disease and the joints that are affected. Healthy Joints for Life can help you with some direction and a personal trainer might be of assistance as well in structuring an arthritis appropriate training regimen.

January 20th - My husband and I are both interested in the supplements from your program. I am only half his size. Should we be taking the same dosages?

Excellent question, Sara. For the most part it is safe for both of you to take the same dosages. An exception is Vitamin D, a vitamin that we ask that you test at your doctor's office. In order to maintain sufficient levels of 25 hydroxy vitamin D at 50ng/ml, you both may need different dosages. You will notice that in my "line" we stay at 2000IU vitamin D, which is safe for lighter weight people.