GOING HOME TO HAVANA. FIRST LEG. AMSTERDAM TO LONDON TO MIAMI

I had arrived at Amsterdam Schipol Airport from Corinthia Corentin region of Austria the day before, four hours by train from its capital Klagenfort to Vienna and a short Austrian airlines ride to AMS. I stayed at the very same hotel  Renaissance near the airport as I had ten days before and it turned out to be a lucky choice, which I will explain in another blog 

The day began early enough, the alarm waking me up at 5 AM and by 6 AM I was downstairs ready for the shuttle to take me to the Terminal 3 of AMS airport. this certainly is a huge airport, one of those mega airports, I think it may have been one of the earliest ones, where you could walk for hundreds of steps passing shops, eateries and duty free shops before you reach your assigned gate of departure.

I was flying British Airways, the agent, a Dutch lady was pleasant and efficient and before long through the security and Immigration, was walking and walking not enough time for a stop somewhere certainly I couldnt stop by the British Airways lounge as our gate was on the other side of the airport.

I had a very nice seat assigned to me and there was no one sitting next to me. It was a very short 46 minute flight from Amsterdam to London, much like the Miami to Havana flight that I take often. But unlike the American Airlines, the staff quickly produced a tasty breakfast.

I had a nice view of London as the plane was approaching the LHR airport. How many wonderful years I had spent there as a student of Medicine as well as Anthropology. I felt so good to be able to recognize many of the landmarks of this wonderful city.

On arrival at the British Airways Lounge it was once again Dev at the helm, and this time the First Class Lounge was working and it was nice to rest there for a couple of hours before boarding the 747-400 flight to Miami.

You could sit down and order a breakfast, and I asked for smoked salmon and scrambled eggs from farm raised free range chicken which tasted distinctly different, less chemicals i supposed and coming from less stressed hens!
It was time to board and it was a long walk to our aircraft
I remember flying a 747-400 from LHR to Cape Town just the year when France won the World Cup under Zidane! Beautiful Bird indeed.
BA has three flights a day from LHR to MIA. I see this pattern. The USA based airlines  the three major ones form alliances with European ones while crying foul of the Gulf Airlines flying here and let the European airlines do all the flying while they code share.. Delta is doing it with Virgin Atlantic, American does it with BA and United with Lufthansa.. three flights a day from London to Miami?
on British Airways? and one flight with American Airlines to their major hub in Miami ?

 The first thing you note as you climb up to the separate section 'upstairs' is how spacious it is and that the seats are newer configuration that you find in other more recent BA planes such as the 777.

 The load was light today so I could choose any seat I wanted and I chose an area where there were no one else and i could comfortably sit near the window without being disturbed.

 Unlike the Grandma and Grandpa flight attendants at the American Airlines transatlantic flights Business Class, there were two young FAs, and they were enthusiastic and smiling and friendly. While I missed my QR friends, I was glad that I had chosen BA rather AA for this transatlantic flight.

 Soon after take off, I remember looking for Reading where a close friend of mine was doing MBA at Henley School of Business! Felt a tinge of saudade ..

 Champagne arrived and I had time to nurse it through and asked for another with the appetizer

 Eating smoked salmon was a habit I picked up when I was studying Medicine in London and it is something I truly like. My second taste of Smoked Salmon this morning..

 I chose a pasta with vegetables avoiding the beef that was offered.

 In my life on the ground I am not known to eat desserts but who can resist this chocolate...

 The duration of the flight was 9 hours and it was smooth ride all the way through. sometime during the flight I had chance to speak to one of the pilots and we exchanged some flight stories mainly about the different aircrafts and their comfort to us the passengers.

Afternoon tea was served one hour before arrival to Miami and it was a nice fitting end to a pleasant flight. This is the third time I have crossed the Atlantic with BA just this month and I have to say, the service is good, much better than what you would get on USA based airlines..
But I still miss Qatar Airways for various other reasons, one of them being, I fly QR from Miami to Doha on my way to the Far East and it is the anticipation of the  pleasures of the Far East that brings on this nostalgia for Qatar Airways..

Hurricane Dorian was aiming towards Miami, my luggage arrived smashed and damaged but with the impending rain, I did not stop to file complaint and instead took the Ride Sharing company home, reaching the house of my sister in time for a nice chat and a cup of tea..

LOTS OF VITAMIN D , DOES IT HELP BUILD BONES IN HEALTHY PEOPLE NO NO NO

As an endocrinologist, I believe that we must give hormones or supplements to people who demonstrate a definite deficiency and not on some empirical treatment that more may be better when a need in the body does not exist.
Vitamin D which is a hormone is one such case in point. There has been a plethora of supposed benefits to Vitamin D but on closer examination none of which has proven to be of benefit to non deficient healthy people.
I tell my patients: if you are low in Vitamin D go for a walk for 20 minutes a day, your vitamin D levels would come up. I realized that among the indigenous peoples that I work with not a single person had NORMAL vitamin D levels as proscribed by the scientists. there must be something more to it, I thought. 
If you are a true indigenous person(just card carrying wont do) the chances of you having osteoporosis is small, change of life is accepted as a normal passage of life, so get out in the sun and walk a little..
Here is a recent article on high vitamin D supplementation.

Original Investigation

August 27, 2019

Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone StrengthA Randomized Clinical Trial

Lauren A. Burt, PhD¹; Emma O. Billington, MD, FRCPC¹; Marianne S. Rose, PhD²; et alDuncan A. Raymond, MS¹; David A. Hanley, MD, FRCPC¹; Steven K. Boyd, PhD¹

Author Affiliations Article Information

JAMA. 2019;322(8):736-745. doi:10.1001/jama.2019.11889

visual abs

Key Points

Question  Does higher-dose vitamin D supplementation improve bone mineral density (BMD, measured using high-resolution peripheral quantitative computed tomography) and bone strength (measured as failure load)?

Findings  In this randomized clinical trial that included 311 healthy adults, treatment with vitamin D for 3 years at a dose of 4000 IU per day or 10 000 IU per day, compared with 400 IU per day, resulted in statistically significant lower radial BMD (calcium hydroxyapatite; −3.9 mg HA/cm³ and −7.5 mg HA/cm³, respectively); tibial BMD was significantly lower only with the daily dose of 10 000 IU. There were no significant differences in bone strength at either the radius or tibia.

Meaning  Among healthy adults, supplementation with higher doses of vitamin D did not result in improved bone health; further research would be needed to determine whether it is harmful.

WHAT MAY CAUSE YOUR DEATH IN THE USA APART FROM GUNS AND TRAFFIC ? FOOD OF COURSE

One of the first moments of consternation when trying to understand the philosophy of the Native Indians happened with the People of the Red Earth when my teacher said to me:
The food is killing us .
I remember asking myself the question: How can FOOD kill you.. as usual the Indians were right, FOOD in the USA is the major killer, much more than Guns or Cars or Accidents..this I believe.

A calorie-centric, carbohydrate-protein-fat model of thinking became and still is predominant but not paying attention to the QUALITY of FOOD.. if you are on a low carbohydrate diet with bad Quality of the ingredients, it is still is BAD FOOD.. not a good nutrition.
the reason why food restriction works reasonably well is because with restriction comes the restriction of chemicals, preservatives and all those other things that harm the bodies of human being and not to mention the animals and trees..

From the Literature 2017

Key Points

Question  What is the estimated mortality due to heart disease, stroke, or type 2 diabetes (cardiometabolic deaths) associated with suboptimal intakes of 10 dietary factors in the United States?

Findings  In 2012, suboptimal intake of dietary factors was associated with an estimated 318 656 cardiometabolic deaths, representing 45.4% of cardiometabolic deaths. The highest proportions of cardiometabolic deaths were estimated to be related to excess sodium intake, insufficient intake of nuts/seeds, high intake of processed meats, and low intake of seafood omega-3 fats.

Meaning  Suboptimal intake of specific foods and nutrients was associated with a substantial proportion of deaths due to heart disease, stroke, or type 2 diabetes.

highly processed food which also may contain more sodium and Pizza Hut or McDo does not give you Omega-3 fats which has to arrive in the form of food rather than GNC merchant tablets..

The same teacher who told me about Food killing the Indians also said to me:

We know the answers but the Americans are too arrogant to ask us!

SARAH COHEN OF JEW STREET, JEW TOWN, MATTANCHERRY, COCHIN, KERALA INIDA 30AUG2019

our beloved SARAH is no more!
I received three emails from Cochin today 30.08.2019 informing me that she had passed away.
So many images passed through my mind.

Jew Town will not be the same again. With her coffin, the Paradesi Jewish Community of Cochin is also dead, while the synagogue from 1468 CE will continue to be visited, there would be no actual PRESENCE of Jews along that street visible and accessible as easily as was Sarah.

I had met her on my first visit to the Jew Town area in 1995 with my then travelling companion. He husband Jacob Cohen was still alive and I still have the copy of the newspaper with an interview with him, that he gave to me. Her brother Shalom was with them.

Over the course of years, William passed away and then Shalom. the Jewish presence began disappearing, concreted with the death of Sammy Hallegua, before then the death of Itzhak Hallegua. Kashmiri merchants moved in and began selling irrelevant, incongruous handcrafts from other parts of India and at one time, Jew Town was one of the most visited parts of Kerala. Mrs Salem died soon followed by her husband. The last of the elderly jews migrated to join their families in Israel. It leaves now just two Paradesi Jews (jews of Foreign origin in the local language), an elderly widow whose son is a doctor in LA and a daughter who is a sociologist in NY as well as a reclusive bachelor whom I have met only once. 
Now the street becomes a discotheque of the fake Kashmiri merchants selling fake goods.
Sara always sat by her window, a siddur (prayer book) in her hands and a home made kippah of her design on her head. Many years ago she was lucky to have the presence of a local Muslim family, Taha is the name of the man, in her house and they truly looked after Sarah. May the gratitude be abundantly placed on Taha and his family.
Today is Shabbat and I have been a witness when she lit the shabbat candles in her house, more than once. 
It can be truly said that the shabbat candles have died along with Sarah. May your lights brighten all those of us who had the pleasure of knowing you.

this is the front of her house, as it was today, the day of her death.
RN a good friend of mine, a devout christian and a long term friendly of the family wrote to me expressing his sadness at Sarah's passing.
So this grand old dame of Jew Street symbolised the harmony with which Jews were treated for 500 years(Paradesi Jews arrived at the port of Saudi south of Cochin in early 1600s , 500 years ago) by the local populations: the native Hindus, the oldest christian community east of Israel and also the converted Muslims 

let us be grateful for Sarah's life.
The local newspaper carried her obituary
https://english.manoramaonline.com/news/kerala/2019/08/30/sarah-cohen-oldest-jew-india.html

HOW TO READ A MEDICAL ARTICLE WITH A CRITICAL ANTHROPOLOGICAL EYE?

HOW TO READ A MEDICAL ARTICLE WITH A CRITICAL ANTHROPOLOGICAL EYE?

A total of 41 studies published between 1963 and 2018 were included, of which 40 were classified as safe and effective for inclusion in the primary analysis. Thirteen studies (13/40) were on very-low-CHO diets (<50 13="" 14="" 18="" 26="" a="" according="" ad="" adapted="" amount="" and="" d="" dietary="" diets="" encouraged="" energy="" fat="" g="" high-fat="" included="" intakes.="" libitum="" low-cho="" of="" or="" participant="" prescribed="" prescription="" progress.="" reported="" studies="" tei="" thirty-one="" to="" total="" twenty="" unrestricted="" were="" which="">35% TEI). Twenty-six studies reported a prescribed dietary pro<50 13="" 14="" 18="" 26="" a="" according="" ad="" adapted="" amount="" and="" d="" dietary="" diets="" encouraged="" energy="" fat="" g="" high-fat="" included="" intakes.="" libitum="" low-cho="" of="" or="" participant="" prescribed="" prescription="" progress.="" reported="" studies="" tei="" thirty-one="" to="" total="" twenty="" unrestricted="" were="" which="">tein amount, of which 22 were unrestricted or were high-protein (>25% TEI).  The types of dietary CHO, fat and protein recommended were predominantly whole foods. Common delivery methods reported were dietician and/or physician involvement, moderate to high frequency of contact (=1 session/month) and use of participant self-monitoring.

CONCLUSIONS: Multiple approaches for developing and delivering a low-CHO diet intervention for T2D management are safe and effective. A comprehensive set of core dietary components to consider in the formulation of low-CHO diet protocols were identified for use in clinical practice and to inform evidence-based guidelines for T2D management.

The authors looked at many studied about the effects of Low Carbohydrate Diets along with the composition of other ingredients in the food  FAT PROTEIN . They found out that it did not matter whether it was high or low Fat or Protein but the results were equally good. And their conclusion from these observations was a typical quantitative one: they identified a core dietary components for consideration in a low Carbohydrate diet.

Most medically oriented readers would have stopped there and not paid any further attention. An anthropologist would like to know WHY is that despite various fractions of Fats and Proteins along with low Carbohydrate diet did not make much difference in the outcome ?

You can see it staring at you at the summary:

The types of dietary CHO, fat and protein recommended were predominantly whole foods. Common delivery methods reported were dietician and/or physician involvement, moderate to high frequency of contact (=1 session/month) and use of participant self-monitoring.

All these INGREDIENTS had nothing to do with proportion or size but

DIETICIAN OR PHYSICIAN INVOLVEMENT

HIGHER FREQUENCY OF CONTACT

ENCOURAGING PARTICIPATNS TO SELF MONITOR

WHOLE FOODS RATHER THAN FRAGMENTED PROCESSED AMERICAN DIET

Remember, whatever a patient complains of, Arthritis or Diabetes, if the above qualitative humanistic factors are taken into account, they would get better.

That has been my experience as a Physician Anthropologist.

Get yourself a doctor that you get along with

Eat Food and not fabricated substitute

Have friends and spend time with them.

A lovely trip to Europe

I have just returned to Miami after a 10 day trip to Europe in which I discovered a lovely part of Austria and also ventured into the mountainous parts of Slovenia.
I will go back to Havana soon enough.
Havana to Miami and then to London via Atlanta.
Atlanta airport and Lounge experience was one of the worst in recent memory
BA flight to London with efficient service, a cut above the service you expect from USA based airlines.
Train ride from Amsterdam to Paris CDG and then on to Bretagne. 
Paris CDG to Vienna on Austrian airlines, and I have become fond of this airline for their genuine friendliness and service orientation.
Two exciting days exploring Carinthia Karnten, a surprisingly beautiful mountainous region. Visited Bled in Slovenia as well as Tarvisio in Italy.
Nice flight from London to Miami on a lovely 747-400 upstairs very quiet and good attention from the newly recruited FAs.

A lovely trip
Six Airports
American Arlines British Airways Austrian Airlines
Lounges at Miami Atlanta London Vienna Paris
Train Trips from Amsterdam to Roissy Paris to Quiberon back to Roissy Paris 
Klagenfort to Vienna by train 
USA UK Holland France Austria 

Thanks to friends in Quiberon, Bretagne  and Sankt Mikael in Austria 

where would the winds take me next ?

WHERE IN THE BRAIN ARE THE LONGINGS STORED?

The morning was rather tender, the sun never shone so horridly that one takes refuge, and the day slipped into the afternoon, the tropics which are like hammocks for lovers (Nin) sets forth its languorous afternoon tune, from somewhere or other arrives the downpour, the blue of the sky turned grey.
My first day in Miami and as always thinking of things tender, usually far away
these moments mind turns to longings, not for a person but something much bigger, a sensation, I wonder where in the brain are these sensations stored.
and of course there are triggers
like listening to the music that I have selected and stored in my phone.

What beautiful music (thank you Internet, thank you Youtube and thank you, Iran)
Listening to the above song, I began to think about Iran, a country that I deeply admire, but only from afar as it is a destination prohibited for me as long as the current theocratic regime is in place. It is my choice but it is too risky to travel to Iran at this moment in time.

I thought of all the beautiful iranian people that I had written to, that I have met and especially to NM who had introduced me to Ahmad Shamloo, Jafar Panahi and Nafisi..

why are these wonderful people destined to suffer like this? the most educated and sophisticated of all Islamic peoples, perhaps throughout its history since dispersion from Spain or the ancient Mesopotamia, why these people have to suffer.

I think of you, my dear friends, and as helpless as I am to be any assistance, my heart and mind is with you.

The afternoon is slowly progressing, the trees have put on new green clean clothes and the sky is beginning to be bright again.

I look forward to a nice dinner tonight with my closest friends in Miami.
In homage to my Iranian friends, I would try to dress as much Iranian as possible, and eschew all western clothes and of course wear the silk scarf sewn together by the indigenous people of India..a country that carry a considerable legacy of IRAN.

I AM LISTENING TO FARAMARZ ASLANI HAVING JUST ARRIVED IN MIAMI FROM HAVANA

Here I am in my sisters home in Miami , the evening is mild and I am listening to a new Iranian Singer to me, Faramarz Aslani and enjoying it tremendously with the soulful guitar in the background and his longing voice, lyrics which i am told are wonderful but I do not understand them but that does not matter.

But it does compliment well for the longing for my Little island just south of here. The desire to go back is so strong (I left at just early this afternoon) that I will do all the chores with pleasure and efficiency.

Dinner with my closest Friends in Miami

spend time with the Indigenous people nearby and enjoy time with colleagues

Ah well

I am not longing with attachment but enjoying the pleasure of having spent such lovely days in Havana, that is all.

Time for a glass of wine

LOYALTY PAYS OFF.. IT IS. CONNOR. AGAIN AT HILTON

I have always felt that LOYALTY to a brand matters, when you are on the road constantly. Today I had a flight from Colombo to London Heathrow, a 11 hour flight and when you arrive in London, especially in the morning the place is crowded with flights coming in from all over the world. Fortunately this flight was to arrive at 7 pm. 

I have a connecting flight to Miami tomorrow on BA, and I wanted to rest the night at a hotel at the airport. 

I have status at both HILTON and MARRIOTT hotels. I do not check hotel booking agencies if one of these hotels are aplenty on site. Hilton alone has five or six properties near Heathrow airport and this is a fairly new hotel, and the only one attached to the terminal 2

Most of the workers at the airport had no idea how to get to Hilton Garden Inn as it is fairly new. In the end after much trial and error I found my way to the hotel entrance without having to take HOPPA buses

As I approached the Hilton Honours desk, i had the vague feeling that I had seen the agent before. He looking up from his task, greeted me very warmly and remembered the last time, when I had stayed one night at Hilton Gatwick and we had chance to chat. He gave me a nice room with a view and I was grateful.

Loyalty does pays off, from a convenience point of view but being an anthropologist, the human point of view is so precious to me. What are the chances of meeting a Hilton Employee that you met at another hotel one year ago, at another hotel.. chance here is due to the time we spent talking together the last time. Since then he must have checked in thousands of guests..