Skip navigation

Part 1 of a several part post

Introduction-What is the structure of Human Performance?

The definition of Human Performance: the part of human functioning that accomplishes tasks according to measurable standards of efficiency, completeness and accuracy. In other words, performance is that part of our function that literally represents the purpose of our lives. Forming a coherent and rational understanding of human performance seemed obligatory to me as a practicing clinician; I began this pursuit two years ago. As in all scientific and philosophic inquiries, I knew that I needed to find the right question to answer which, as always, meant going back to basics. Recalling that nothing can function without possessing structure my inquiry into the nature of human performance began with my asking myself the following question, “If our performance is a part of our function, what then is the structure of our performance?”

The structure/function relationship is the basis of all rational scientific thought. In essence, structure and function is the same thing.  Take a simple sheet of paper; when you place it on a flat surface it functions as something upon which you can write; fold it in a specific way, and it can fly like an airplane; crumple it tightly into a ball and you can toss it into a trash can ten feet away. Regardless of how many ways you may change the same sheet of paper, the relationship of its structure and function remains constant and immutable. While the proof of the existence of sub-atomic particles long ago disproved Plato’s conception of the atom as the smallest and indivisible form of matter, the concept that the structure of any physical object in the universe is inseparable from its function continues to hold firm and regardless of scale, whether sub-atomic, microscopic or astronomical. A single proton in its core, or nucleus, is all that separates the 112 individual elements on the periodic table from those to its right or left. The element, Hydrogen with a single proton in its nucleus functions perfectly as a trigger of an atomic reaction; inhale the next element to the right on the periodic table, Helium, which has two protons in its nucleus and you will speak with the voice of a Munchkin from the land of Oz; skip the next four elements and we come to the Carbon atom with its 6 protons, that functions as the exclusive template upon which all life on our planet was manufactured for 3.5 billion years and counting. Finally, on the astronomical scale, with a structure more than 1300 times the volume of Earth, Jupiter functions as a gravitational shield, protecting our relatively tiny world from catastrophic collisions with the orbiting debris left over from our solar system’s creation some 5 billion years ago. In essence, Jupiter’s structure provided the Carbon atom the opportunity to function as the designated element for all life on Earth. What’s more than its sublime, ubiquitous even poetic nature is the relevance of the structure-function relationship to our understanding human performance. What follows is the answer to the question that I asked my self two years ago, “just what is the structure of human performance?”

Human Performance; a window to Human Health

Human performance is an aggregate of actions or behaviors that take place exclusively in the physical world and it is executed entirely by the human body; its skeleton, muscles, joints and connective tissues. Examples of human performance include speech, driving a car and making love; separately or all at the same time. In turn, each of these constituent behaviors or actions is a direct reflection of an ever-changing or plastic structure of the human central nervous system (CNS). At the core of the brain’s plasticity is a process called, neurotransmission which is the communication via chemical-electrical signals between one brain cell, or neuron and another. In all there are one hundred billion such neurons originating in the human brain, each having as their final destination a muscle fiber somewhere in the human body. At the molecular level of this inter-neuron communication process are chemical-electrical messengers, or neurotransmitters each of which has a unique chemical structure limiting its interactions to only with, structurally compatible, molecules located on the surface of the neuron known as receptors There are trillions of these chemical-electrical signals communicated in the human brain every second, thus giving the brain a nearly fluid, or plastic molecular structure which over time actually change the visible, or macroscopic structure of the brain. Hence the recent addition of the term, neuro-plasticity to the vernacular of neuro-science.

Within this neuro-plasticity framework, we can conceptualize human health as the sum of all forces, internal and external, which affect the plastic molecular structure of an individual’s central nervous system. Examples include exposure to a stressor such as Hurricane Katrina or a medical illness such as an infection. The extent to which any such force, whether external or internal, will impact an individual’s performance is limited by, or is to the same exact extent to which this force impacts, or molds the plastic structure of the individual’s brain. Conversely, only if a given force, whether internal or external, impacts the plastic structure of an individual’s brain will it have any impact on an individual’s performance. Within this framework, which represents the consensus scientific view, health and performance are the structure and function, respectively of  any individual human being. Thus, an individuals’ health and performance are indivisible and direct reflections of each other.

My health-performance proof shows that an individuals performance is a surrogate for their health and vice a verse. The clinical implications of this relationship are profound and far reaching. My understanding of this fundamental relationship between our health and our performance has served as my main cognitive tool for providing medical care to my patients that is far above the prevailing standard of care in our healthcare system. In my next post I will show how this tool is easily scalable and can be applies potential to fundamentally  change our healthcare system for the better and enhance its real value.

End  Post

Mitchell R. Weisberg, MD, MP



A person is what a person does. What defines us is not what we believe, it is what we do. In life, the only thing that we truly own is our actions, everything else is on a temporary loan. While our homes, our cars and all of our material possessions add joy to our lives, only what we do affects the world during our lives and long after we are gone. What we do determines if we are important, irrelevant, famous, infamous, or eternal. What we do is the essence of who we are and a sign of our vitality; but is it a vital sign? I say that our performance, what we do and how we do it, is the most vital of all of our vital signs and here’s why.

The relationship between our Health and our Performance

Just as nothing in the physical universe has structure without also having function; our health and our performance are inseparable, linked by these same fundamental physical laws. Performance is defined as that part of our function that accomplishes tasks according to measurable standards which raises the question, what is the structure of our performance?

Our performance is an aggregate of behaviors and is executed exclusively by our bodies; our skeletons, muscles, joints and ligaments. Each of these behaviors, in turn, directly reflects the state of our ever-changing, plastic central nervous system (CNS). When viewed from this perspective, our health is defined as the sum of the forces, internal and external, that mold our plastic central nervous systems. The extent that any given facet of our health contributes to this molding process, is the extent that it will affect our performance; and only if it contributes to this molding process will any given facet of our health affect our performance. Our health and performance is our structure and function, respectively. Metaphorically, our health is the roadway to our performance  with our central nervous system being the final stop on the journey.

What our Performance (function) says about our Health (structure)

While we may not find and fix the problem, we all know that when our car stalls while we are driving (mal-functions) there is something wrong with our cars’ engine (a corresponding structural defect) and if you are like myself, you will call an auto-mechanic. The first thing an experienced mechanic will do before popping the hood is take our car for a test drive to see how it performs so that he can visualize what structural defects may be causing the malfunction. While I can’t take my patients out for a test drive, I can get a heck of a lot more information regarding their health from asking them how they are doing at school, work or home than by weighing them, taking their blood pressure, running a battery of laboratory tests or, dare I say, even looking at an MRI scan. Regardless of how thoroughly a pediatrician may examine a child during a checkup,  if she does not look at their report card she has no idea whether or not her patient is healthy. The same is true for the child’s mother and father when they go for their annual checkups and they are not asked about their work performance.

Our performance is, indeed, the most vital of all our vital signs. For more on this topic, please see my previous post,

A Tale of Mental Health in Two Settings

End Post

Mitchell R. Weisberg, MD, MP


This is an update of our nation’s mental health crisis  from my perspective. I define the crisis and look at at its causes and  impact on the American people. In addition, I explore the perspectives of this crisis in the American healthcare system, the American workplace, and the American employer. Following this update I will propose my solution to the American mental health crisis. 

Setting 1

Mental Health in the American Healthcare System

This is the worst of times for people with mental health problems in the American healthcare system. One in four (58 million) American adults suffers from a diagnosable mental health problem, preventing a normal and productive life. (1)

In general, people with undiagnosed and untreated mental health problems use the healthcare system more often than people of the same age group who are unaffected. The services most often used in the healthcare system include Emergency Room visits, non-psychiatric hospitalizations, and primary care visits. (2)

For American adults with any form of chronic medical condition, the likelihood of also having a diagnosable mental health problem is higher than for adults in the same age group who do not have chronic medical conditions.  Furthermore, those people with both a chronic medical condition and a mental health problem who have their mental health problem diagnosed and properly treated will show more improvement in their chronic medical conditions than those who do not receive treatment for their mental health problems. (3)  Between 70% and 90% of those with mental health problems experience a significant reduction of their symptoms and an improved quality of life with a combination of medications, talk therapy, and other support mechanisms. (4)

So why is it the worst of times in the American healthcare system for people with mental health problems? In spite of using the healthcare system more often, less than one in three of the 58 million American adults with mental health problems have their problem diagnosed and one in ten receives the treatment they need to get well and lead a normal, productive, and fulfilling life. (5)

Why does our healthcare system, which has highly effective remedies for mental health disorders, fail to recognize them most of the time? The explanation leads to the solution to the American mental health crisis.

To begin, take a full minute look at this optical illusion. When you first look at this picture, you may see either a young woman or an old hag. But the longer you look at it, eventually the one that you did not see initially will appear. This demonstrates the limits of our human senses. We may not see, hear, smell, or feel what we are not looking for, even when it is right in front of us. Similarly, our healthcare system fails to recognize mental health disorders in most cases. While all health problems impact a person both structurally and functionally, our health care system tends to focus exclusively on the structural part of health problems.

For example, a 50-year-old man sees his doctor because he is feeling severe pain in his left lower abdomen. The doctor’s evaluation reveals that the man experiences discomfort, especially when the doctor gently pushes on his left lower abdomen. A CAT scan shows severe inflammation in the left side of his colon (a condition called diverticulitis). After 5 days in the hospital with nothing to eat or drink, and a regimen of intravenous fluids and antibiotics, the man recovers completely. This man’s inability to work or take part in family or community activities is an expected functional byproduct of his structural health problem (diverticulitis). Thus, information about this man’s functional status was not required to successfully diagnose and treat his medical problem.

Now let’s imagine that this same 50-year-old man sees his doctor for the same complaints.  The doctor’s evaluation is the same as in the first scenario, except the CAT scan shows that all structures, including the colon, are perfectly normal. The physician tells this man that he likely has something called Irritable Bowel Syndrome (aka, functional bowel syndrome) and in spite of the man’s bowel being structurally normal, the doctor advises him to increase the fiber in his diet and prescribes a medication to cut the bowel spasm when the abdominal pain occurs. While these remedies may or may not help, one thing is certain: this man’s problem has not yet been identified or resolved. Therefore, he will suffer more and  go back to his doctor or the emergency room.

Had this man’s physician looked at him just a little longer after his extensive and costly evaluation, much like we looked a little longer at the picture of the young woman and the old hag, he would have been able to do more for his patient than simply assure him what disorders he didn’t have. Had he looked at his patient from a functional perspective using a sophisticated diagnostic tool such as asking him, “How are you doing?”  the doctor may have discovered that his patient had not been performing too well at work and had not engaged in family and community activities for the past six months. This information could have uncovered the primary diagnosis and lead to the proper course of treatment, reducing this patient’s suffering and prevented him from continuing to return to the healthcare system again and again. In this man’s case, his abdominal pain was a physical manifestation of an Anxiety Disorder and had this been recognized and treated appropriately, not only would his abdominal symptoms have subsided he would have been able to function a lot better at work and at home, as well.

When functional impairments, such as poor work performance or lack of participation in family or community activities, do not accompany an identifiable structural process, neither the person nor his physician necessarily recognizes this as a medical problem. Unfortunately, this is the exact scenario experienced by of one in three of all disabled adults on our planet all of whom have a diagnosable and treatable medical problem called mental illness.

Our healthcare system fails to recognize and treat our mental health because it is purely a structure driven system. Our system is more adept at telling us what structural health problems we do not have, than at actually identifying those health problems that most impact our ability to function fully. For instance, a person suffering from severe headaches may see a Neurologist and have a normal neurological examination and a normal MRI of his brain. The Neurologist will tell him that his headaches are not caused by a brain tumor or an aneurysm. While the reassurance may offer a temporary sigh of relief, it does not resolve the man’s health problem; the system fails.

I assure you that the next time any of us see our primary care physician or go to the emergency room, we will be looked at structurally, regardless of the reason for our visit. The nurse will measure our height, weight, blood pressure, temperature, pulse, and respiratory rate. Then,  a physician will ask us to point to where our problem is. The doctor will look at, touch, listen, probe, and possibly scan the area in 3D. With almost equal certainty, neither the nurse nor the physician will ask us how we are doing at work or in school, or if we take part in activities with family or friends, or in our communities.  Not looking for or seeing a person’s functionality or performance is the deficiency of our nation’s healthcare system that makes this the worst of times for Americans with any degree of mental health problems.

Setting 2

Mental Health in the American Workplace

For American employers and employees, with mental health problems, this is also the worst of times to deal with mental health problems. Employers’ indirect costs arising from their employees’ mental health problems–in the form of short- and long-term disability, absenteeism, and presenteeism–is four times greater than  a company’s direct costs for employee healthcare. (5)

Why do these employees with mental health issues contribute more to healthcare costs? In a service-based economy such as ours, an employee’s productivity is most dependent on her cognitive abilities, such as deductive reasoning, task management, effective communication, and creativity. Health issues of all types will likely impact a service workers’ performance. Workers with mild or even “sub-threshold” mental health problems have measurable productivity problems early on, well before they experience more serious health effects. (5) And these employees tend to use the healthcare system more often than people of the same age group who do not experience mental health issues. In essence, American employers are paying for their employees’ mental health problems twice–once for the direct costs of frequent use of healthcare services, and again for the indirect costs for the diminished productivity of the affected employees.

Two facts emerge from employers’ data on the impact of mental health on the productivity of a workforce. First, based on the current numbers, it is clear that employers have not yet found a remedy for an extremely costly problem in both financial and human terms. Second, based upon the numbers, employers prove capable of measuring its workforces’ performance in a way that accurately identifies a health problem that eludes identification in the healthcare system; our healthcare system has proven remedies for the problem but fails to recognize it. When employers demand their money’s worth from a healthcare system for which they are paying, it will be the best of times.

For a detailed plan of how employers can get what they and their employees need and deserve from the healthcare system, contact me @

End Post

Mitchell R. Weisberg, MD, MP

Weisberg Medical Consulting

Weisberg Medical Consulting adds a clinical perspective to an Organizations Balanced Scorecard, aligning the health of their workforce with the health of their enterprise.

To check the details of my nutritional plan please see the following link:


What follows are some of the prerequisites for following my nutritional recommendations:

  1. Go grocery shopping at least once per week
    • Buy foods that are portable and contain  3 to 6 grams of fiber per serving. The food should be packaged in such a way that freshness is maintained, you can take or store it anywhere including in your car.
    • Make sure you buy enough to last you the entire week.
  2. Never be more than an arm’s length away from your food.
    • Keep it in your desk drawer, purse, backpack, briefcase, coat pocket and glove compartment.
  3. Find your new hunger equivalent
    • If we eat only when we are hungry we will always be in one of two states, famished or full; and, neither one is compatible with optimal functioning.
    • Eat for optimal function. The next time you have to read an e-mail twice or notice you are having a little difficulty keeping focused, eat something. Our function deteriorates before we feel hunger and we should respond to these functional signals by eating, well before we feel hunger. Start paying attention to your performance level and when you sense a slight drop, time to re-fuel. Find your new hunger equivalent, respond to it and you will start eating small amounts frequently, especially if you add fiber each time that you eat.

In summary, eat upon awakening; eat four to six times per day and consume four to six grams of fiber every time that you eat. You will function optimally and the scale will do the right thing.


Mitchell R. Weisberg, MD, MP

to an

Organizations Balanced Scorecard


Mitchell R. Weisberg, MD, MP

  • Employers’ indirect costs (absenteeism, presenteeism, employee turnover, diminished talent attraction-retention and successorship) resulting from Employee Mental Illness is 4 fold greater than their direct costs for Employee healthcare. (1)
  • Arguably, at least some part (in this physicians informed opinion, the majority) of this burden is due to the ever-increasing cognitive demands on the American Workforce that was the result of a continuous servicization of the American Economy that began with the dawn of the information age just under 6 decades ago. It was within this time period that our national economy transformed (I say, evolved) from one highly dependent on its workforces’ brawn to one almost entirely dependent on its brains. *
  • In spite of the fact that people with mental illness use the healthcare system much more often than does the general population, most (2/3) of Mental Illness is never recognized (diagnosed) or treated. (2)
  • Once diagnosed, Mental Illness is highly treatable with between 70 and 90 percent of people having significant reduction of symptoms and improved quality of life with a combination of medication, talk therapy and other supports. (2)
  • A major obstacle to recognizing mental health disorders is their lack of symptoms in the traditional sense of the word thus making mental illness the invisible epidemic. (3)
  • Identifying mental illness is dependent upon an awareness of a person’s functional status such as their social-interpersonal functioning and workplace (vocational) performance.
  • People with any form of chronic medical (physical) condition such as Diabetes or COPD, experience minor mental health or cognitive impairments as well as full-blown mental illnesses much more often than their healthy counterparts.
  • Not uncommonly chronic medical conditions may initially manifest with mental health impairments including full-blown mental illnesses.
  • The recognition and effective treatment of mental illness in people with other chronic medical conditions results in better overall outcomes than those in whom their mental illness remains unrecognized and untreated.
  • The early recognition and effective treatment of mental illness has a profoundly positive impact on human health in general.
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered. (1)
  • Over the past two decades The Balanced Scorecard has been widely employed as the Business Management tool of choice by most major employers worldwide. (4)
  • The Balanced Score Card aligns the goals of an Organization with the personal goals of its Employees for the purpose of achieving optimal performance at the Organizational level.  (5)
  • Periodic measurements of Employee Performance in terms of achieving their personal goals (employee performance metrics) are an essential part of an effective Balanced Scorecard. (5)
  • Contained within the core of Employee Performance Data is vital information about Employee Health in general as well as the most essential and most overlooked information required for the early recognition of Employee Mental Health in particular. (1)
  • Since there is evidence that even workers with mild or “sub-threshold” problems begin to show productivity problems early on – perhaps long before they experience other health consequences – employers are in a unique position to effect significant change in the way services are delivered. With more than 2 decades of clinical experience as both a Primary Care Physician and a Mental Health Care Provider and a career commitment to optimizing the health and performance of his patients, this physician is in a unique position to aid employers in getting healthy returns on their health and human capital investments. (1)
  • This physician can show the stakeholders of any Organization that there indeed is a tremendous value in adding a clinical perspective to their Balanced Scorecard.
End Post       

Basic Principles

Just as I eliminated the word, diet from my vocabulary because of its common association with self deprivation, I also refuse to use the word, exercise because it has become synonymous with the word, torture. Rather, I refer to it as physical activity and liken it to an essential nutrient which for our optimal health and performance we need to get our recommended daily requirement. Just as we must eat first to live and function (not to lose weight), similarly we must get regular physical activity. In order to make sure we  meet our physical activity requirements we must first  overcome our own inertia.

  • Drop the all or nothing approach to fitness. Not having the time to get to the gym for an hour is no reason not to do any physical activity at all.
  • Get at least 10 minutes of moderate physical activity such as calisthenics within the first 60 minutes of waking up in the morning.
  • Incorporate more physical activity into you activities of daily living such as making shower time into fitness time.
  • Throughout the day, for every hour that you are sedentary get 3 to 5 minutes of physical activity.
  • When you can get to the health club for an exercise class or a work out, that’s terrific but you should not rely on this as the only way to get your daily dosage of Physical Activity.

My fitness formula



From a rest, start your physical activity at a low intensity level and gradually increase it so you are at your target heart rate after 5 minutes; keep up your target heart rate for 10 to 30 minutes and then cool down so that you return back at your resting heart rate after 5 minutes. Try to do this 3 to 5 times per week. There are many ways to get your cardio fitness with equipment or without it.


The core is our body’s center of gravity and is the area from the bottom of our rib cages to the top of our hips. The benefits of strengthening  the core is to improve our balance and prevent common injuries such as low back pain. As little as 5 minutes per day of core strengthening has significant health benefits. To begin strengthening your core, you simply need to get on the ball.


This is the most important yet most neglected part of fitness especially in the western world. After all, it is the cerebral cortex that distinguishes humans from all other animals on the planet. It is our seat of reason and creativity and it is the part of our brain that most influences what we actually do in the course of our lives. Without cortical fitness, the lower centers of our Central Nervous Systems will have undue influence on our behaviors and place limitations on our reaching our personal potential and leading fulfilling lives.  It is my professional opinion that cortical fitness is the missing link to achieving  and maintaining our optimal levels of health and performance.

Now that you have the formula, apply it to your life for just 30 minutes per day and I am certain that you will see that this small investment of time will pay you significant dividends.

End Post

Mitchell R. Weisberg, MD, MP

Childhood Obesity


Dr. Mitchell Weisberg

I originally published this post two years ago but I decided to re-post it in response to a new “weight-loss” product gaining popularity called, Sensa.

It just can’t be true!  How can a mere 12% increase in our daily caloric intake can result in a three-fold (300%) increase in the childhood obesity rate in just a single generation? According to statistics from The United States Department of Agriculture (USDA) this is precisely what occurred in the United States between the years of 1980 thru 2004. While I am not one to rely on damn statistics, in this particular instance, the stats quite literally add up, and they point squarely at the root cause of the  world-wide Obesity Epidemic;


This 12% translates into each American eating an additional 300 calories per day, 138 of which are coming from refined grains. Understanding how such a seemingly minute amount of refined grains can have such an exponential impact on our national Body Mass demands a  review of some of the basics of cellular metabolism. Based upon its proportions of Carbon, Hydrogen and Oxygen atoms, dietary fiber is classified as a carbohydrate. Unlike other carbohydrates, such as sucrose (table sugar), fructose (fruit sugar) and lactose (milk sugar) which contain 4 calories per gram, there is no enzyme in the inner lining of the human digestive tract that allows fiber into the bloodstream where cellular metabolism takes place. Therefore, in reality, fiber has no calories.

By remaining within the digestive tract, fiber enhances satiety (the sense of being full or satisfied) and effectively reduces the total amount of food an individual consumes. Moreover, fiber reduces the rate at which other nutrients (carbohydrates, fats and proteins) ingested together with it are absorbed into the blood stream. This in turn facilitates a more complete extraction of the energy in the food that we eat by our 40 trillion cells, the actual site of cellular metabolism and reduces the amount of energy left over that would be stored in our bodies as fat. In other words, the physical and chemical properties that cause fiber itself not be metabolized are the same properties that  allow dietary fiber to optimize the process of cellular  metabolism.  It is these same properties  that underlies the abundant evidence that a generous intake of dietary fiber reduces risk for developing the following diseases: coronary heart disease,1 stroke,2 hypertension,3 diabetes,4 obesity,5 and certain gastrointestinal disorders.6 Furthermore, increased consumption of dietary fiber improves serum lipid (cholesterol) concentrations,7 lowers blood pressure,8 improves blood sugar control in diabetes,9promotes regularity,10 aids in weight loss,11 and appears to improve immune function. However, average fiber intakes for US children and adults are less than half of the recommended levels.

Always the optimist, I see the silver lining in the USDA’s statistics. Rather than our collective obsession over what not to eat, we can turn our attention to a much more positive and practical message about what it is that we should eat. To illustrate the rationale for this paradigm shift, I will naturally offer you some food for thought. Imagine that we eat a slice of chocolate cake and then test ourselves for the glycemic index of this piece of cake. The technical explanation of the glycemic index of food is the area under the two-hour blood glucose response curve (AUC) following its ingestion. Simply stated, the glycemic index measures how much of the energy from the piece of cake will be turned into actual energy available for our bodies to use versus how much of the energy from the piece of cake will go un-utilized and stored in our bodies in the form of fat. Now imagine we eat a second piece of chocolate cake identical to the first one but, the only difference being that to this piece of chocolate cake, 3 grams of fiber is added to the recipe. The glycemic index after  eating this piece of cake will be be significantly lower than the first piece. In other words, the addition of a relatively small amount of dietary fiber allows us to get more useable energy and store less of the energy as fat from, an otherwise identical piece of chocolate cake.

Processing food breaks down whole grains and causes a classic double whammy. First, the refinement of whole grains removes the two major benefits of fiber I just stated; enhanced satiety and metabolic optimization. Secondly, once whole  grains are refined they become the metabolic equivalent of pure sugar. Now when we ingest processed grains they are completely and almost immediately absorbed from our digestive tract into our blood stream and flooding our 40 trillion cells all at once. This does not allow our cells to be efficient in extracting usable energy which explains why diets high in processed sugar leads to Obesity. Ironically,  Obesity is a sign of cellular starvation!

When viewed from the perspective of cellular metabolism, we can see that it is no coincidence that in the same 25 year period that we added an extra 138 calories per day of refined grains to our diets that our nations childhood obesity rate tripled. The lesson we need to be passing on to our children now becomes equally clear; let them eat cake and their fiber too!



My Nutritional Formula for Optimal Performance

Eat upon awakening in the morning: this does not mean that we have to cook or go out for breakfast; it’s as simple as opening an energy bar or pouring cereal and skim milk into a cup and drinking it.

Eat frequently: Eat at least at least 4 and as many as 6 times per day. Do not let 3 hours go by where you do not eat. The evidence shows that when we eat in response to being famished that we will consume more calories than if we eat before getting hungry. In addition, based on the principles that govern the process of cellular metabolism by the time that we feel hungry our cells’ efficiency at converting our nutrients into energy that we can actually use goes down and you know what that means? The cells will store more of the food that we eat as fat.

Consume 4 to 6 grams of Fiber each time that you eat: Fiber while classified as a carbohydrate, in the pure sense, is not a nutrient at all in that the human intestine does not have the necessary enzyme for absorbing fiber into the blood stream. Therefore, it is not metabolized, or used as a source of energy for life processes. However, due to its unique properties, fiber slows down the absorption rate of food from the intestines into the blood stream . This is why it is essential to consume fiber every time that we eat; as a result of this slower rate of absorption, the 40 trillion cells that make up our bodies can more efficiently capture the energy (calories) from the food that we eat for activities such as thinking, moving, growing our bones, our hair and our skin and leaving less total calories to store in our bodies in the form of fat. In addition, by not being absorbed and remaining in our digestive tracts, fiber enhances satiety, making us feel fuller from less food.

When people on fiber deficient diets gradually increase their fiber intake to the recommended level of 25 grams per day, they drop weight, they can sustain this weight loss, improve their blood levels of sugar and cholesterol, cut their risk of heart disease, improve their bowel regularity and cut their risk of developing Diverticulitis of the colon. 1 Pretty impressive effects for something that never even gets inside the human body. Isn’t it nice, for once that someone is telling you what you should eat instead of what you should not eat?

Eat before you are hungry! This sounds counterintuitive, and will make many dietitians cringe but, compare the task of learning to eat before you are hungry to the task of trying to not eat when you are hungry. It is a behavioral change that is readily achievable, and is more in synch with how our cells use energy most efficiently. In fact, hunger puts us in a sub-optimal functional state in which we are more prone to make mistakes and to fly off the handle. Eating often enough to preempt hunger, however, will keep your performance and your mood on a more even keel. Numerous studies have demonstrated that when people eat before they are hungry they eat fewer calories as compared to when they eat in response to being hungry.2 In addition, more frequent eating leads to a higher rate of efficiency of our cellular metabolism, making it more likely that the food that we eat becomes energy used by our bodies and not stored as fat around our bodies.3

Sources of Fiber: Look at the nutrients labels and check out what you are getting. Here are my general guidance with a few personal recommendations:

  • Whole Grain Cereals: 3 to 6 grams of fiber per serving: the entire line of Kashi cereals ; there are many other Cereals on the market that have 3 to 6 grams of fiber per serving
  • Whole Grain Breads: 2 to 4 grams of fiber per slice.
  • Whole Grain Crackers: > 3 grams of fiber per serving (Kashi brand, once again)
  • Fruits and Vegetables in general are good sources of fiber.
  • Soy, which is a vegetable, is high in protein as well as fiber. Here are some soy recommendations:
  1. Edamame; try Melissa’s brand. It is in the frozen section. Microwave it for 2 minutes and add course kosher salt; it’s awesome.
  2. Boca Brand of burgers and sausages (it’s all soy and actually tastes great)
  3. Morning Star is another brand of the faux meat products (and I am not a vegetarian)
  • Trail Mixes: with 5 grams of fiber per serving these are extremely practical because of how portable they are. Trail mixes can vary in their content quite a bit; some are more candy than anything else. Just check the nutrient content for the  and go for it. This is something you can keep in the car at your desk in backpacks, purses, brief cases, etc.
  • Energy Bars: 3 to 6 grams of fiber per serving.
  1. Cliff Bars
  2. Kashi GoLean

Here is a plug for Starbucks because they seem to get it. They have prepackaged trays such as their protein breakfast with apple, peanut butter, whole wheat bagel, hardboiled egg, cheeses and grapes.They make their sandwiches  on high fiber bread. They sell individual small packages of trail mixes. While on the pricey side, they deserve credit for offering truly healthy food.

To Summarize: Eat 4 to 6 times per day and eat 4 to 6 grams of fiber each time that you eat. If you make Fyour focus, you will see that your dietary fats, carbohydrates and proteins will fall into place, your function (performance) and mood will improve and, the bathroom scale will most definitely do the right thing.

  • Enterprise Performance is a direct result of the collective performance of its employees.
  • Employee Performance is a sensitive indicator of Employee Health; performance is literally a vital sign.
  • Thus, Enterprise Performance and Employee Health are in alignment.
  • Therefore, unless participation in an Employer Based Health Initiative is performance driven the outcomes will be suboptimal. 

The time has come to add a clinical perspective to your Organizations Balanced Scorecard.

Mitchell R. Weisberg, MD. MP

There was evening and there was morning……

In its description of the story of Creation, the book of Genesis, or B’rashit describes each day as beginning in the evening.  Is there some message in this about how we should conduct ourselves as human beings? As a Jew I believe that while, indeed, there is a G-d and that She created us in Her image, that Creation was not simply a historic event that occurred at sometime in the past. To the contrary, our Creator, being infinitely creative, created the Universe much like the playwright created Tony & Tina’s Wedding; we are never mere observers (a passive audience) of the events that occur all around us. We play as much a part in how the show ends as our Creator, Herself. In Yiddishkeit, this  is called Tikun Olam or repairing the Universe. Tikun Olam reconciles the seemingly paradoxical concepts of an omniscient Creator while each of Her creations have free will. While we mere mortals do not have the power to change the past, we can, by exerting our will, change the outcome of anything that has already occurred. An unfortunate but powerful example of Tikun Olam in action is the Holocaust. Two out of every 3 Jews living in Europe in the 1930s and 40s were systematically exterminated by the Nazis and their collaborators and, try as some may, there is nothing anyone can do to change this fact. However, within 3 years of being liberated by the Allied Forces (including the former Soviet Union), many of the survivors of the Holocaust garnered their collective will and not allow Hitler to reign triumphant they instead repatriated with their ancient Homeland in the newly formed modern State of Israel!

So you may ask, what does this have to do with whether our day starts at midnight versus when we decide to wake up in the morning or at sundown? The answer is that to live a life where we effect the world in which we live and not it affecting us, we better bring our A Game every day.Modern neuroscience teaches us that we can only function (perform) optimally when our Circadian Rhythm (our internal clock) is aligned with the rhythm of our planet, such as night and day (Diurnal Rhythm). After all, Hashem created us here, on the 3rd rock from the sun. If our Creator wanted us to be angels perhaps we would have wings and be floating somewhere up in the atmosphere but, instead She planted us firmly here on the ground otherwise known as the planet Earth; and us Earthlings must begin today with some preparation this evening. Rabbi Tarfon taught: “It is not your responsibility to finish the work [of perfecting the world], but you are not free to desist from it either” (Pirkei Avot-2:16). That being said, each day must have a beginning and an end. Just as we know that if we want our beloved Personal Computers (PCs) to function optimally each day when we turn them on, we need to close down each open Window, one at a time before we shut it off, we Earthlings share this same need.  Our G-d given human effectiveness runs on the same set of tracks as our sense of wakefulness, which peaks soon after awakening and gradually degrades as the day progresses into evening, when we become drowsy and the cycle starts anew. While feeling drowsy is something with which we all can identify, diminished effectiveness or our executive function (the neuroscience equivalent of Tikun Olam) is not as noticeable. Never the less, executive function is the first of our brain’s functions to decline when we are sleep deprived or drowsy. A major review conducted in 1996 suggested that the oil spill of the Exxon Valdez, the destruction of the space shuttle Challenger, the nuclear accident at Chernobyl (costing over 4,000 lives) and the near nuclear accidents at the Three Mile Island and Peach Bottom reactors were all associated with sleep deprivation of the people involved. Sleepy driving causes as many car crashes as driving under the influence.

During the course of our hectic days, there are multiple Windows open in our brains, as it should be when we are putting our signatures on the world. However, just as our PCs, our brains cannot switch from having multiple open Windows to off without some untoward effects upon reopening these same Windows come morning time. In order for it to be fully restorative, we must not only get the proper measure of sleep, we must get the proper quality of sleep, as well. Many people, under the incorrect assumption that work time and sleep time is a zero sum game, will continue to attempt to problem solve up to the minute they fall asleep. In reality, their productivity is reduced by this habit. Just as with our PCs, to keep our performance of Tikun Olam at an optimal level, we need to start the process of closing down some of our open Windows well before it is time for sleep. The 90 minutes we spend chilling out and relaxing in the evening is a mandatory pre-requisite for restoring our ability to do Tikun Olam come morning time; it was evening and it was morning.


Mitchell R. Weisberg, MD. MP