Friday, June 30, 2017

The link between stress and addiction

“People should watch out for three things: avoid a major addiction, don't get so deeply into debt that it controls your life, and don't start a family before you're ready to settle down.” — James Taylor, American singer-songwriter, guitarist and five-time Grammy Award winner

I'M SHARING the below piece from The New York Times especially for someone Paul and I worry about. I'm hoping she'll find it helpful. She's been telling me lately that she feels that the stress of her living situation is contributing to a recent spike in the temptation to resort to using drugs again, and according to the author, Dr. Richard Friedman, research validates her theory. 

I don't often read comments attached to articles, but this time one of them caught my eye. Several commenters make the same, in my opinion, cogent point: the advent of 24/7 access to digital content on the internet as well as gaming, texting, tweeting, instagraming and so on and so on have increasingly acted as a barrier to meaningful personal relationships that are an antidote to both stress and addiction, while at the same time offering never-before-available options for addictive behavior.

Because I have a tendency, I think, toward obsessive/compulsiveness, I've always been hyper-vigilant about not becoming addicted to anything, so much so that if anyone ever wonders whether I like something or another, and if by chance I do, Paul just laughs and says, "Oh yeah, she enjoys that. Which means she'll be giving it up any day now." It's pretty true, actually. Fortunately that hasn't extended to him; i haven't given him up.

The one thing I can personally relate to in this article is the section about food cravings. Those of you who read my blog often may remember that more than a year ago I set out to lose 20 pounds . . . and I did. 

I've managed to keep it off since then. It's feels great to be trim again, but the thing I like at least as much is that due to the change in my diet, I've entirely lost all of my food-cravings. It's such a relief, and so much easier not to overeat if you don't endure constant cravings for fattening, sugary, empty calories. It's been freeing. 

FYI: I've also included a link to this piece so that you can access the comments as well as the original article. 

What Cookies and Meth Have in Common

By Richard A. Friedman

June 30, 2017

As a psychiatrist, I have yet to meet a patient who enjoys being addicted to drugs or compulsively overeating.

Why would anyone continue to use recreational drugs despite the medical consequences and social condemnation? What makes someone eat more and more in the face of poor health?

One answer is that modern humans have designed the perfect environment to create both of these addictions.

No one will be shocked to learn that stress makes people more likely to search for solace in drugs or food (it’s called “comfort food” for a reason). Yet the myth has persisted that addiction is either a moral failure or a hard-wired behavior — that addicts are either completely in command or literally out of their minds. Now we have a body of research that makes the connection between stress and addiction definitive. More surprising, it shows that we can change the path to addiction by changing our environment.

Neuroscientists have found that food and recreational drugs have a common target in the “reward circuit” of the brain, and that the brains of humans and other animals who are stressed undergo biological changes that can make them more susceptible to addiction.

Consider the opioid epidemic. Last month, this newspaper estimated that more than 59,000 Americans had died of drug overdoses in 2016, which represents the largest year-over-year increase ever recorded. The Princeton economists Anne Case and Angus Deaton reported in a 2015 study that middle-class whites in particular have experienced an alarming increase in midlife mortality since the 1990s, driven largely by “deaths of despair” involving suicide, alcohol and drugs. These addicts did not suddenly lose their moral fiber. Instead, they faced poor job prospects, a steady erosion in their social status and, consequently, mounting stress.

In a 2010 study, Diana Martinez and colleagues at Columbia scanned the brains of a group of healthy controls and found that lower social status and a lower degree of perceived social support — both presumed to be proxies for stress — were correlated with fewer dopamine receptors, called D2s, in the brain’s reward circuit.

All rewards — sex, food, money and drugs — cause a release of dopamine, which conveys a sense of pleasure and tells the brain something like: “This is an important experience. Don’t forget it!” The reward circuit evolved to help us survive by driving us to locate food or sex in our environment. Today, the more D2 receptors you have, the higher your natural level of stimulation and pleasure — and the less likely you are to seek out recreational drugs or comfort food to compensate.

Dr. Nora Volkow, the director of the National Institute on Drug Abuse, and colleagues demonstrated this in a study of Ritalin. Healthy, non-drug-abusing subjects with fewer D2 receptors experienced the stimulant drug as pleasurable, while those with more found it aversive.

The number of receptors don’t just predict drug usage; they are also affected by it. In that same study, Dr. Volkow discovered that people addicted to cocaine, heroin, alcohol and methamphetamines experience a significant reduction in their D2 receptor levels that persists long after drug use has stopped. These people are far less sensitive to rewards, are less motivated and may find the world dull, once again making them prone to seek a chemical means to enhance their everyday life.

Drug exposure also contributes to a loss of self-control. Dr. Volkow found that low D2 was linked with lower activity in the prefrontal cortex, which would impair one’s ability to think critically and exercise restraint.

The same neuroscience helps us understand compulsive overeating. Food, like drugs, stimulates the brain’s reward circuit. Chronic exposure to high-fat and sugary foods is similarly linked with lower D2 levels, and people with lower D2 levels are also more likely to crave such foods. It’s a vicious cycle in which more exposure begets more craving.

Dr. Volkow and colleagues showed that morbidly obese individuals had reductions in their D2 receptors and that the reduction was proportional to their body mass index. The implication of this blunted reward circuit is that they find normal food consumption insufficiently rewarding. At the same time, when exposed to pictures or smells that predict a food reward, they experience more intense cravings than non-obese people. And just like drug addicts, obese people with fewer D2 receptors also show decreased activity in their prefrontal cortex, making it harder to exert self-control.

At this point you may be wondering: What controls the reward circuit in the first place? Some of it is genetic. We know that certain gene variations elevate the risk of addiction to various drugs. But studies of monkeys suggest that our environment can trump genetics and rewire the brain. The good news is that while we can’t change our genetics, we can change our environment.

Michael Nader at the Wake Forest School of Medicine showed this in a study of monkeys and cocaine. When monkeys are moved from an individual cage and housed in a group, some become dominant and others assume a submissive role. For those that become dominant — meaning they get more attention, more grooming and more access to food and treats — this is a positive change. They now have more D2 dopamine receptors and are less interested in self-administering cocaine. But for submissive animals, the group setting is a stressful change, and they respond by increasing their use of cocaine.

Strikingly, the effect of environment is easily reversible: Stress the dominant monkey by returning it to a solo cage and its D2 receptors will drop — and its taste for cocaine will increase. In other words, simply by changing the environment, you can increase or decrease the likelihood of an animal becoming a drug addict.

The same appears true for humans. Even people who are not hard-wired for addiction can be made dependent on drugs if they are stressed. Is it any wonder, then, that the economically frightening situation that so many Americans experience could make them into addicts? You will literally have a different brain depending on your ZIP code, social circumstances and stress level.

The last important component of addiction is access. No matter how stressed you are, you obviously won’t become a drug addict unless you’re exposed to drugs. The same goes for compulsive overeating.

Humans have been consuming food for rather a long time without the modern affliction of widespread obesity. In 1990, no state in our country had an adult obesity rate above 15 percent; by 2015, 44 states had obesity rates of 25 percent or higher. What changed?

Contemporary humans did not experience a sudden collapse in self-control. What happened is that cheap, calorie-dense foods that are highly rewarding to your brain are now ubiquitous. Once you’ve had a glass of orange juice, you are not likely to be as satisfied with a healthier and less caloric orange that you have to peel.

For most of history, food was scarce, so there was a great survival advantage in scarfing down as many calories as you could when they were available. There was no flourless chocolate cake on the savanna.

Nothing in our evolution has prepared us for the double whammy of caloric modern food and potent recreational drugs. Their power to activate our reward circuit, rewire our brain and nudge us in the direction of compulsive consumption is unprecedented.

The processed food industry has transformed our food into a quasi-drug, while the drug industry has synthesized ever more powerful drugs that have been diverted for recreational use. We extracted opium from the poppy and quickly discovered how to make opiates that are a thousandfold more potent and addicting. Not content with just smoking cannabis, we bred super-potent strains of the plant, extracted the active cannabinoids and moved on to dangerous synthetic versions. The list goes on.

Finally, the advertising industry may play a role. Dr. Volkow says that she and her colleagues are now “testing how the brain responds to subliminal messages” about food and drugs. Her hypothesis is that drug-addicted and obese individuals are more susceptible to such messages.

Fortunately, our brains are remarkably plastic and sensitive to experience. Although it’s far easier said than done, just limiting exposure to high-calorie foods and recreational drugs would naturally reset our brains to find pleasure in healthier foods and life without drugs.

In the meantime it’s worth remembering that we can’t control our genes or the misfortunes that befall us, much less their impact on our brains. Even the most self-disciplined can fall prey to a food or drug addiction under the right mix of adversity and stress.

Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, and a contributing opinion writer.

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Wednesday, June 28, 2017

Rotary Club of Des Moines scholarships

“Children must be taught how to think, not what to think.” ― Margaret Mead, American cultural anthropologist and author of the bestseller, Coming of Age in Samoa

I'M A LONG-TIME member of the Rotary Club of Des Moines. In addition to all the other service my club contributes locally, nationally and internationally, every year we award six $8,000 scholarships, one each to a student chosen from each of Des Moines' six high schools. It's been my pleasure to serve on the selection committee for East High for five years. 

East's able school counselors narrow the pool of applicants to four, and my co-evaluators, Mark Lyons and Rob Tucker, and I never fail to be impressed with the calibre of the candidates, not just in academic achievement alone — often while holding down more than part-time jobs, and participating in athletics, music, drama, debate and other specific interest groups — but also their commitment to giving back to the community through volunteer work.

Every year it's an extremely difficult choice, and each time we want to award scholarships to them all. This year was no exception. One applicant's goal is to be a geneticist, and even before reaching graduation, she has interned in a genetics lab at Iowa State University. Two aspire to work in healthcare, one with her eye on becoming a nurse, the other a pediatrician. The fourth dreams of a business career in filmmaking.

But choose we must, and this year our winner was Robbi Boggess. Robbi will be attending the University of Iowa in pre-med with a goal of specializing in pediatric medicine.

The other scholarship winners were Jared Baker from Hoover, Giovanni Tenikat from Lincoln, Kaine Burch from North, Hope Stone from Roosevelt and Michaela Pratt from Scavo. Congratulations to them all!

Mark Lyons, Robbi Boggess, Rob Tucker and me
I attended East High's Awards Night to present Robbi her scholarship
Of course I wore East's school colors

Monday, June 26, 2017

The lying liar leading us to ruin

“A lie can travel half way around the world while the truth is putting on its shoes.” — Charles Haddon Spurgeon, English Particular Baptist preacher often called the Prince of Preachers

THIS IS the country we live in now. Last week The New York Times felt compelled to make the unprecedented move of using a full page to print all of the lies SCROTUS* has told publicly since taking office. (Here's a link that will take you to the full list of lies and the entire article.)

*So called ruler of the United States

Trumps' Lies
By David Leonhardt
June 23, 2017

Many Americans have become accustomed to President Trump’s lies. But as regular as they have become, the country should not allow itself to become numb to them. So we have catalogued nearly every outright lie he has told publicly since taking the oath of office.

All the President’s Lies

President Trump’s political rise was built on a lie (about Barack Obama's birthplace). His lack of truthfulness has also become central to the Russia investigation, with James Comey, the former director of the F.B.I., testifying under oath about Trump's “lies, plain and simple.”

There is simply no precedent for an American president to spend so much time telling untruths. Every president has shaded the truth or told occasional whoppers. No other president — of either party — has behaved as Trump is behaving. He is trying to create an atmosphere in which reality is irrelevant.

We have set a conservative standard here, leaving out many dubious statements (like the claim that his travel ban is “similar” to Obama administration policy). Some people may still take issue with this standard, arguing that the president wasn't speaking literally. But we believe his long pattern of using untruths to serve his purposes, as a businessman and politician, means that his statements are not simply careless errors.

We are using the word “lie” deliberately. Not every falsehood is deliberate on Trump's part. But it would be the height of naïveté to imagine he is merely making honest mistakes. He is lying.

Trump Told Public Lies or Falsehoods Every Day for His First 40 Days

The list above uses the conservative standard of demonstrably false statements. By that standard, Trump told a public lie on at least 20 of his first 40 days as president. But based on a broader standard — one that includes his many misleading statements (like exaggerating military spending in the Middle East) — Trump achieved something remarkable: He said something untrue, in public, every day for the first 40 days of his presidency. The streak didn’t end until March 1.

Since then, he has said something untrue on at least 74 of 113 days. On days without an untrue statement, he is often absent from Twitter, vacationing at Mar-a-Lago in Florida, or busy golfing.

The end of May was another period of relative public veracity — or at least public quiet — for the president. He seems to have been otherwise occupied, dealing with internal discussions about the Russia investigation and then embarking on a trip through the Middle East and Europe.

Trump’s Public Lies Sometimes Changed With Repetition

Sometimes, Trump can’t even keep his untruths straight. After he reversed a campaign pledge and declined to label China a currency manipulator, he kept changing his description of when China had stopped the bad behavior. Initially, he said it stopped once he took office. He then changed the turning point to the election, then to since he started talking about it, and then to some uncertain point in the distant past.

The Public’s Mistrust of Trump Grows

Trump has retained the support of most of his voters as well as the Republican leadership in Congress. But he has still paid some price for his lies. Nearly 60 percent of Americans say the president is not honest, polls show, up from about 53 percent when he took office.

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Friday, June 23, 2017

Fake democracy

“What difference does it make to the dead, the orphans and the homeless, whether the mad destruction is wrought under the name of totalitarianism or in the holy name of liberty or democracy?” ― Mahatma Gandhi

ACCORDING to the US Code of Laws, Title 36, U.S.C., Chapter 10 as amended by P.L. 344, 94th Congress, flying the American flag upside down in an official signal of distress. I honestly wonder whether our nation can be saved; please consider my virtual United Stated flag flown upside down.

Attached is a breathtaking opinion piece in today's New York Times.

Our Fake Democracy

By Timothy Egan 

June 23, 2017

We tell ourselves stories in order to live, as Joan Didion said. We do this as a nation, as individuals, as families — even when that construct is demonstrably false. For the United States, the biggest institutional lie of the moment is that we have a government of the people, responding to majority will.

On almost every single concern, Congress — whether it’s the misnamed People’s House, or the Senate, laughably mischaracterized as the world’s greatest deliberative body — is going against what most of the country wants. And Congress is doing this because there will be no consequences.

We have a fake democracy, growing less responsive and less representative by the day.

The biggest example of this is the monstrosity of a health care bill, which a cartel of Republicans finally allowed us to peek at on Thursday. The lobbyists have seen it; of course. But for the rest us, our first look at a radical overhaul of one-sixth of the economy, something that touches every American, comes too late to make our voices heard.

Crafted in total darkness, the bill may pass by a slim majority of people who have not read it. Inevitably, with something that deprives upward of 23 million Americans of health care, people will die because of this bill. States will be making life and death decisions as they drop the mandated benefits of Obamacare and cut vital care for the poor, the elderly, the sick and the drug-addicted through Medicaid. The sunset of Obamacare is the dawn of death panels.

It would be understandable if Republicans were doing this because it’s what most Americans want them to do. But it’s not. Only about 25 percent of Americans approved of a similar version of this bill, the one passed by the House. By a nearly 2 to 1 margin, people would prefer that the Affordable Care Act be kept in place and fixed, rather than junked for this cruel alternative.

The Senate bill is “by far, the most harmful piece of legislation I have seen in my lifetime,” said Senator Bernie Sanders. At age 75, he’s seen a lot.

Remember when Republicans used to pretend to care about crafting the people’s business in sunlight? “It’s simply wrong for legislation that will affect 100 percent of the American people to be negotiated behind closed doors.” That was Mike Pence in 2010.

Why are they doing it? Why would the people’s representatives choose to hurt their own people? The answer is further evidence of our failed democracy. About 75 million Americans depend on Medicaid. This bill will make their lives more miserable and perilous in order to give the top 2 percent of wealthiest Americans a tax cut.

And where are the 75 million now? They are nowhere. The sad fact is, the poor don’t vote. Up to 80 percent of low earners do not show up at the polls, and it’s even worse in midterm congressional elections. The Republicans can screw the poor, whose population is disproportionately large in red states, because those citizens will not fight back.

So, little surprise that Republicans are also working to make it even harder for the poor to vote. They can seek to disenfranchise one class of Americans, and get away with it from the safety of gerrymandered seats.

The symptoms of democratic collapse — from the opioid crises of people who long ago checked out of active citizenship to the stagnation of class mobility — cry for immediate action.

It takes the median worker twice as many hours a month to pay rent in a big city today than it did in the early years of the baby boomer era, as Edward Luce notes in his new book, “The Retreat of Western Liberalism.” Add towering increases in health care and college costs to that and you’ve got an unclimbable wall between low-income limbo and a chance at the middle class. The United States, once known for our American Dream, now has the lowest class mobility of any Western democracy, according to Luce.

What is Congress doing? Nothing on wages. Nothing on college tuition. And the health care bill will most surely force many people to choose between buying groceries and being able to visit a doctor.

Our fake democracy reveals itself daily. Less than a third of Americans support President Trump’s decision to withdraw from the Paris Climate Agreement. In a truly representative government, you would see the other two-thirds, the common-sense majority, howling from the halls of Congress.

Most Americans are also against building a wall along the Mexican border. They would prefer putting taxpayers’ billions into roads, bridges, schools and airports. But the wall remains a key part of President Trump’s agenda.

Trump is president, of course, despite losing the popular vote by nearly 3 million people. Almost 60 percent of the public is against him now. In a parliamentary system, he’d be thrown out in a no-confidence vote. In our system, he’s primed to change life for every citizen, against the wishes of a majority of Americans. Try calling that a democracy while keeping a straight face.

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Wednesday, June 21, 2017

The benefits of extra-virgin olive oil

“Let food be thy medicine and medicine be thy food.” — Hippocrates

WE'VE ONLY cooked with olive oil at our house for years. Extra-virgin appears to have extra advantages. Below are the main points from three articles from USA TODAY to help you keep your heart and brain ticking along.

FYI: Coconut oil has more saturated fat than lard. Yikes!

Extra virgin olive oil staves off Alzheimer's, preserves memory, new study shows

By Sean Rossman

June 21, 2017

Temple University research shows extra-virgin olive oil protects against memory loss, preserves the ability to learn and reduces conditions associated with Alzheimer's disease.

Researchers at the college's Lewis Katz School of Medicine found mice with EVOO-enriched diets had better memories and learning abilities compared to the rodents who didn't eat the oil.

The real effect of EVOO appeared in the inner-workings of the mice's brains. Neuron connections in the brain were better preserved in those on an EVOO diet.

Also, olive oil reduces brain inflammation and activates the autophagy process, whereby intracellular debris and toxins are removed. Such debris and toxins are firm markers of Alzheimer's disease. A reduction in autophagy, researchers claim, is suspected to be the beginning of Alzheimer's disease.

"The thinking is that extra-virgin olive oil is better than fruits and vegetables alone," said senior investigator Domenico Pratico, a professor at the Lewis Klein School of Medicine. "As a monounsaturated vegetable fat, it is healthier than saturated animal fats."

Alzheimer's cases are on the rise. In 2013, 5 million Americans had the disease. That number is expected to triple to 14 million by 2050.

Pratico said the "exciting" finding sets researchers up for another experiment. The next step is to introduce EVOO later in the aging process.

"Thanks to the autophagy activation, memory and synaptic integrity were preserved, and the pathological effects in animals otherwise destined to develop Alzheimer's disease were significantly reduced," Pratico said. "We want to know whether olive oil added at a later time point in the diet can stop or reverse the disease."

Coconut oil is out. These are the oils you should be using, experts say

By Ashley May

June 20, 2017 

Last week, the American Heart Association said coconut oil is unhealthy, reigniting a conversation about saturated fat and leaving some confused about what is healthy. 

When shopping for a healthy oil, 
Donald Hensrud, medical director of the Mayo Clinic Healthy Living Program, said to go for one with high levels of monounsaturated or polyunsaturated fats. Both are considered healthy fats that lower cholesterol. Also, avoid partially hydrogenated oils — that's the source of trans fat, which raises bad cholesterol.

Here are some of the healthiest oils, as recommended by doctors and researchers: 

High in monounsaturated fats: Olive oil is the shining star of healthy oils in this group. Many experts point to a study in The New England Journal of Medicine that enrolled 7,447 people ages 55 to 80-years-old and showed eating olive oil (or nuts) greatly reduced the risk of cardiovascular disease. Research also suggests olive oil could help reduce the chance of breast cancer.

The type of olive oil can matter. Extra virgin olive oil has slightly more nutrients, Hensrud said. Sediment in the bottle could actually translate to vitamin E. 

Avocado oil, which contains 71% monounsaturated fatty acids, has become a popular choice, and experts say for good reason. It has some of the same properties as olive oil, plus it has a high smoke point — meaning, it's safe to cook at high temperatures. Oils with low smoke points create toxic compounds when overheated (think: frying). Safflower and sunflower oils also contain high amounts of monounsaturated fats and have high smoke points (above 400 degrees). 

High in polyunsaturated fats: The American Heart Association's Dietary Fats and Cardiovascular Disease advisory showed corn oil, soybean oil, peanut oil and canola oil all contain high amounts of polyunsaturated fats. Canola oil and peanut oil are high in both monounsaturated and polyunsaturated fats. Canola is best for baking because it's largely tasteless and peanut oil is good for frying because of its high smoke point.

Coconut oil isn't healthy. It's never been healthy.

By Ashley May

June 16, 2017

The American Heart Association recently released a report advising against the use of coconut oil. 

The Dietary Fats and Cardiovascular Disease advisory reviewed existing data on saturated fat, showing coconut oil increased LDL ("bad") cholesterol in seven out of seven controlled trials. Researchers didn't see a difference between coconut oil and other oils high in saturated fat, like butter, beef fat and palm oil. In fact, 82% of the fat in coconut oil is saturated, according to the data — far beyond butter (63%), beef fat (50%) and pork lard (39%).

"Because coconut oil increases LDL cholesterol, a cause of CVD [cardiovascular disease], and has no known offsetting favorable effects, we advise against the use of coconut oil," the American Heart Association said in the Dietary Fats and Cardiovascular Disease advisory. 

Tuesday, June 20, 2017

The Emoluments Clause

“If what’s going on is somebody is buying something from The Trump Organization to buy favor, there’s no way you’d ever figure out who that person is or what favor they’re trying to buy.” — Jack Blum, Washington attorney specializing in offshore tax evasion and financial crime and former staff lawyer for two U.S. Senate committees

I'M DESPERATELY hoping that one of the current lawsuits suing SCROTUS* for violating the Emoluments Clause of the US Constitution succeeds. That's the provision that bars federal officials from accepting foreign payments and gifts without congressional approval. 

Below is an article from USA Today detailing some of SCROTUS' recent real estate transactions. How blatant does it have to get?! Remember, although the trust is run by his sons, HWSNBN** is the sole beneficiary of the trust and can withdraw money any time.

* So called ruler of the United States
** He who shall not be named 

Most Trump real estate now sold to secretive buyers

By Nick Penzenstadler, Steve Reilly and John Kelly 

June 13, 2017

Since President Trump won the Republican nomination, the majority of his companies’ real estate sales are to secretive shell companies that obscure the buyers’ identities, a USA TODAY investigation has found.

Over the last 12 months, about 70% of buyers of Trump properties were limited liability companies – corporate entities that allow people to purchase property without revealing all of the owners’ names. That compares with about 4% of buyers in the two years before.

USA TODAY journalists have spent six months cataloging every condo, penthouse or other property that Trump and his companies own – and tracking the buyers behind every transaction. The investigation found Trump’s companies owned more than 430 individual properties worth well over $250 million.

Since Election Day, Trump’s businesses have sold 28 of those U.S. properties for $33 million. The sales include luxury condos and penthouses in Las Vegas and New York and oceanfront lots near Los Angeles. The value of his companies' inventory of available real estate remains above a quarter-billion dollars.

Profits from sales of those properties flow through a trust run by Trump’s sons. The president is the sole beneficiary of the trust and can withdraw cash any time.

The increasing share of opaque buyers comes at a time when federal investigators, members of Congress and ethics watchdogs are asking questions about Trump's sales and customers in the U.S. and around the world. Some Congressional Democrats have been asking for more detail about buyers of Trump’s domestic real estate since USA TODAY’s initial report.

Their concern is that the secretive sales create an extraordinary and unprecedented potential for people, corporations or foreign interests to try to influence a President.  Anyone who wanted to court favor with the President could snap up multiple properties or purposefully overpay, without revealing their identity publicly.

The real estate cache, which Trump has never fully revealed and is not required by law to disclose, offers unique opportunity for anyone to steer money to a sitting President. The increase in purchasers shielded by LLCs makes it far more difficult to track who is paying the President and his companies for properties ranging in price from $220,000 to $10 million – or more.

The clear post-nomination shift since last year to more shell-company purchases is unique to sales by Trump’s companies, even in his own towers and neighborhoods. Condos owned by others in the same buildings, and sold during the same time period, were bought by LLCs in no more than 20% of the transactions. In some areas, the share was far less.

“If what’s going on is somebody is buying something from The Trump Organization to buy favor, there’s no way you’d ever figure out who that person is or what favor they’re trying to buy,” said Jack Blum, a Washington attorney specializing in offshore tax evasion and financial crime and former staff lawyer for two U.S. Senate committees.

The reason for the shift is unclear. The White House refers all questions about Trump's businesses to The Trump Organization, which would not answer questions about the sales.

Experts in real estate and corporate law say there are many reasons to create an LLC and use it to buy property. Some buyers, including celebrities, foreign political dissidents and even police officers, may use them to protect privacy. Investment groups use them to purchase properties in partnership.

The method is more common among the wealthy or famous in the buying of multimillion-dollar properties. For instance, President Obama and his wife are behind Homefront Holdings LLC, a corporation registered in Delaware which in May purchased the family’s home in the Kalorama neighborhood of Washington D.C. for $8.1 million, according to district property records.

There are more nefarious reasons to use LLCs, including to illegally hide assets, shield profits from taxation and launder drug money or funds embezzled from a foreign company or government. Even when LLCs are used legally, they can hide the identities of the buyers.

USA TODAY found no sales by Trump's companies that were obviously above the market rate, based on analysis of comparable properties in the same buildings and neighborhoods.

In Las Vegas, condos sold by Trump’s companies sold within a few dollars per square foot of other resellers’ units in the building. Prices were near flat, moving up $6 per square foot since Trump took office compared to before he announced he was running.

In New York, the tiny number of sales and uniqueness of each skews comparisons. Two were below-market sales by Trump to his son, Eric. The two since the election are at opposite ends of the spectrum. One $16 million deal was a short sale of a penthouse at Trump Park Avenue. At $3,800 per square foot, it sold in the low end of the range of a dozen comparable units in its Manhattan neighborhood. A smaller $2.5 million condo at Trump Parc East, at $3,085 per square foot, was at the high end of the range for 47 recent sales of comparable condos in the area.

The Trump Organization announced in January that a new corporate ethics officer would screen all real estate deals to prevent conflicts of interest. Neither the company, nor the ethics lawyer, would discuss on the record its screening process, specific deals or buyers' identities.

Sen. Sheldon Whitehouse, a Rhode Island Democrat on the Senate Judiciary Committee investigating the Trump campaign’s contacts with Russians during the 2016 election, raised concerns about the source of funds, considering Trump’s history with foreign investors in his development projects.

“Once you know—as we do – that corrupting influence by Russia is a matter of Russian practice through shell corporations, that puts a particular spotlight on transactions in which the President of the United States through his direct business interests is involved,” said Whitehouse, who is pushing legislation that would force more disclosure about the owners of all LLCs in real-estate transactions. “It’s easy: simply disclose who the party of interest is on the other side so we know it’s an ordinary business transaction and it’s not influence peddling.”

USA TODAY used corporate, financial and other records to track down 18 officers and other people related to 17 LLCs that bought Trump properties since last May. Six spoke to reporters; 10 did not respond to calls or other attempts to reach them. One who responded did not want to discuss his purchase and another hung up on a reporter asking questions about a recent purchase.

Tracking down the people behind 2 L Nevada LLC shows how difficult it can be to determine who is paying Trump.

The LLC paid a half-million dollars for two condos in the President’s shimmering golden tower near the Las Vegas strip in April. The only person identified for the buyer in public real estate records is the lawyer for the company.

In incorporation papers, 2 L Nevada lists one officer -- another LLC with an address at a Vancouver mail drop being used by as many as a dozen Canadian companies.

USA TODAY reporters scoured public records to identify the names of every company and person using the mail drop address in Canada, and eventually found the buyer.

Brian Lovig of Kelowna, British Columbia, the conservative blogger behind 2 L Nevada LLC, said he had nothing to hide. It's an investment, and he said his family used an LLC on the advice of their trust’s manager. He said he didn’t think any buyer could influence the President via real estate purchases.

“Buying a few units in a hotel isn’t going to make the President jump circles,” Lovig said.

In fact, Trump attorneys have argued that same point, saying profits from individual real-estate sales route through a maze of subsidiaries and eventually become mixed in a large pool of undifferentiated money in the trust. That, they say, makes a conflict from an individual sale difficult to imagine.

Another entity using LLCs to deal in luxury Trump real estate is the Black Tulip Organization, a French-owned investment firm with offices in New York and Miami. Records show Black Tulip provided the money behind the purchase of two of Trump’s Vegas condos during the election, and three more since Election Day – using five different LLCs.

Public records tie the $1.3 million worth of purchases to Benoit Pous Bertran, a French national, who said he was not trying to hide his firm’s identity with shell company names like “JOYP Holdings” and “Galiz Holdings.” Rather, Black Tulip was using the routine protections of a LLC. He said the purchases are not aimed at gaining attention or influence from Trump.

“This is one of the few buildings in Las Vegas where you can buy hotel condominium units, which is why we purchased there. I’m not too into politics and I’m not even a citizen. I’m French,” Pous Bertran said.

Black Tulip, which Pous Bertran said has invested in other Trump projects, runs a real estate investment fund it has said is bankrolled by investors around the world, including Brazil and Russia.

At Trump National Golf Course near Los Angeles, the President’s company sold a pair of oceanfront lots to LAT Homes LLC and Author Homes LLC in April. The two companies trace to one address, a house on the same street. The LLCs are incorporated in Michigan by a Bangladesh-born author and investor who owns a mansion adjacent to the lots.

Subir Chowdhury said his deal was motivated by a desire to develop the oceanfront properties, not politics.

 “My experience, not only with Mr. Trump but the Trump Organization, is stunning — literally stunning experience. Brilliant. Because of the professionalism,” he said.

Chowdhury, a management expert who has written 15 books including several bestsellers, buys high-end lots and develops luxury houses, negotiated an earlier land buy in the Rancho Palos Verdes neighborhood with Trump over Twitter back in 2013. He says he likes working with The Trump Organization.

Chowdhury’s companies paid Trump $3.8 million and $2.4 million for two lots this year. Per square foot of ground, that is about twice what others paid for lots on the same street. He said the premium reflects the lots’ much-better views of the Pacific Ocean.

Even though he tweeted a picture of Eric Trump, thanking him for visiting his family's home, weeks before the sale, Chowdhury repeatedly asked a reporter not to reveal his purchase.

“Because these are all LLC owners," he said, "and I don’t want the rest of the world (to) know, hey, I’m the owner of these properties.”

Chowdhury buys high-end lots and develops luxury houses, and he says he likes working with The Trump Organization. “My experience, not only with Mr. Trump but the Trump Organization, is stunning — literally stunning experience. Brilliant. Because of the professionalism,” he said.

Chowdhury, a management expert who has written 15 books including several bestsellers, negotiated an earlier land buy in the Rancho Palos Verdes neighborhood with Trump over Twitter back in 2013.

Chowdhury’s companies paid Trump $3.8 million and $2.4 million for two lots this year. Per square foot of ground, that is about twice what others paid for lots on the same street. He said the premium reflects the lots’ much-better views of the Pacific Ocean.

Even though he tweeted a picture of Eric Trump, thanking him for visiting his family's home, weeks before the sale, Chowdhury repeatedly asked a reporter not to reveal his purchase.

Sunday, June 18, 2017

Diagnosis: a medical mystery

"The good physician treats the disease; the great physician treats the patient who has the disease." — William Osler, Canadian physician and one of the four founding professors of Johns Hopkins Hospital

WE'RE fans of The New York Times, as you already know. Periodically (little publishing pun) the NYT Magazine that comes with the Sunday paper runs a feature called Diagnosis. Essentially each one is an account of a baffling medical case that a doctor or team of doctors was finally able to solve, although not always soon enough to save the patient. This one has a happy ending. And thank goodness for doctors who take the time to really observe and listen.

Illustration by Andreas Samuelsson

She Had Never Suffered From Anxiety. Was She Having Her First Panic Attack?

By Lisa Sanders, M.D.

June 7, 2017

She didn’t have any urgent medical problems, the woman told Dr. Lori Bigi. She was there because she had moved to Pittsburgh and needed a primary-care doctor.

Bigi, an internist at the University of Pittsburgh Medical Center, quickly eyed her new patient. She was 31 and petite, just over five feet tall and barely 100 pounds. And she looked just as she described herself, pretty healthy. Doctors often rely on patients’ sense of their well-being, especially when their assessment matches their appearance. But as Dr. Bigi was reminded that day, patients aren’t always right.

The patient did say that she had seen her old doctor for awful headaches she got occasionally. They felt like an ice pick through the top of her head, the patient explained, which, at least initially, usually came on while she was going to the bathroom. The headache didn’t last long, but it was intensely painful. Her previous doctor thought it was a type of migraine. He prescribed medication, but it didn’t help. Now her main problem was anxiety, and she saw a psychiatrist for that.

Sudden Panic

Anxiety is common enough, and because the patient was seeing a specialist, Bigi wasn’t planning to spend much time discussing it. But then the doctor saw that in addition to taking an antidepressant — a recommended treatment for anxiety — the patient was on a sedating medication called clonazepam. It wasn’t a first-line medication for anxiety, and this tiny woman was taking a huge dose of it.

The young woman explained that for most of her life, she was not a particularly anxious person. Then, two years earlier, she started experiencing episodes of total panic for seemingly no reason. At the time she chalked it up to a new job — she worked in a research lab — and the pressures associated with a project they had recently started. But the anxiety never let up.

Her first full-fledged attack had come early one fall morning. She was on the subway going to work when she suddenly had a stabbing pain in her head, similar to the headaches she experienced in the past. Then her heart began to pound as if she were running a race. She was drenched in sweat. Her stomach heaved. At her stop, she lurched out of the car and braced herself against the wall of the station. The feeling eased a bit as she took deep breaths. Within an hour she felt fine and forgot about it.

But then the following week, she was driving to the mall when her heart started to race again, and she thought she might throw up. She pulled off the road and called her husband. He had a history of anxiety and suggested it might be a panic attack. He tried to reassure her, but even as the symptoms receded, she was scared they would return. She turned the car around and drove home.

After that, she would have these attacks maybe once a week — then, over time, they became more frequent, often daily. She felt a kind of constant low-level anxiety, knowing the terror could come at any time. She avoided taking public transportation or driving. Her parents often gave her a ride to and from work. She did cognitive-behavioral therapy for nearly a year. She started exercising daily. Nothing seemed to help. Antidepressants had side effects at levels higher than a baby dose. Finally, a psychiatrist started her on the clonazepam three times a day as needed. Now she took a high dose — every eight hours — and it helped. The medication made her feel a little stupid, mentally not nearly as sharp. But it did tamp down her anxiety.


It seemed obvious to the patient that her symptoms were a response to anxiety. At least two specialists confirmed the diagnosis, and she was being treated for it. And yet to Bigi, the story seemed atypical. Most patients with anxiety had experienced it their whole lives, or at least since adolescence. And the fact that she was taking two medicines for anxiety — one at a very high dose — and still felt anxious was also strange. Bigi wondered if this might be something other than the run-of-the-mill anxiety disorder.

Two possibilities came to mind: a surplus of thyroid hormone or of adrenaline. The thyroid gland acts as a kind of carburetor in the body, adjusting the speed of the body’s metabolism. Set too high, with too much thyroid hormone, everything goes too fast. Adrenaline is produced by the adrenal gland in response to threats, creating the fight-or-flight response. Released inappropriately, it could cause a racing heart. Both were far less common than simple anxiety. But they were worth considering.

During the exam, Bigi looked for any sign of disease. The only abnormality was that the patient’s blood pressure was higher than she would have expected in a slender woman who exercised daily. Other than that, her exam was normal. The patient’s neck might have been enlarged if she had too much thyroid hormone, but it was not. If she had too much adrenaline, her blood pressure might drop drastically when she stood after lying down, a phenomenon known as orthostatic hypotension. But it didn’t.

Bigi figured it probably was anxiety, just as the woman assumed. The doctor reminded herself that an unusual presentation of a common disorder, like anxiety, was much more likely than even a classic presentation of an oddity, like excess hormones. She told the patient to continue to work with her psychiatrist to get her symptoms under control.

Before putting the case to rest, Bigi decided to order a couple of simple blood tests to double check for thyroid or adrenaline abnormalities or clues of any other disorder. Bigi wasn’t surprised when the thyroid test came back completely normal. As many as one in 200 individuals will end up with an overactive thyroid. But when the results of the adrenaline test came back, Bigi was stunned to see that the patient had 30 times the amount of adrenaline normally found in the blood. Individuals can have more adrenaline than normal in times of physical or psychological stress, but levels this high strongly suggested that the patient had an adrenaline-producing tumor known as a pheochromocytoma or pheo. She called the patient and arranged for her to follow up with an endocrinologist.

The subspecialist repeated the blood test, and when it came back just as high, the patient was sent for an M.R.I. of her abdomen and pelvis to look for a tumor. The young woman had a baseball-size mass growing out of her left adrenal gland, a one-to-two-inch pyramid-shaped gland on top of the kidney. These tumors are rare — on the order of three to eight per million. A patient with a pheochromocytoma will usually have high blood pressure, as well as episodes of headaches, sweating and a racing heart — all of which she had. Of course, these symptoms are far more common than the tumor, and most people with episodes like this do not have a pheochromocytoma. But some do.

She had surgery to remove the tumor, and over the next few months all of her symptoms melted away. She hasn’t had to take any medications at all since.

Head vs. Body

Until Bigi suggested that there might be a physiological cause for her racing heart and other strange feelings, the patient assumed that her symptoms were psychological. She had known lots of people who had anxiety and panic attacks, and what they described seemed to match what she was feeling. And her friends, even her brother and sister-in-law, physicians both, all thought it was stress or possibly bipolar disorder. Even Bigi didn’t really think the patient was going to have a physical cause for her anxiety and panic attacks. As we constantly remind ourselves and our patients, when you hear hoofbeats, the chances are good that it’s a horse. The most common diagnosis is usually the correct one. But we must also remember that sometimes the circus is in town.

Lisa Sanders, M.D. is a contributing writer for the magazine and the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.”

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