TIKKUN OLAM. REPAIRING THE UNIVERSE FROM MELBOURNE, AUSTRALIA TO MIAMI FLORIDA AND BEYOND

TIKKUN OLAM 

MELBOURNE AUSTRALIA TO MIAMI FLORIDA 

Yesterday a Jewish friend of mine wanted me to talk to a friend of his and guide his friend with some medical advice.

Since the beginning of the pandemic, every day I have had the pleasure of engaging in medical conversation, to bring the science of medicine to the sceptic minds and usually guiding them to the appropriate treatment. 

I told the person on the other end of the line, as we were finishing the conversation, the Jewish people have a concept of Tikkun Olam, which I interpreted as Healing of the Universe Olam interpreted as Universe.

Talking to my Jewish friend, whom I refer to as the Optimistic Optometrist, I explained to him that my desire to help, in the modest way I can, is the concept of Tikkun Olam.

Things do not happen without a reason, say my indigenous friends, we are not smart enough to understand them when they happen.

Lo and behold, this morning, in the inbox there was an email from My Jewish Learning, explaining TIKKUN OLAM

Brought back memories of learning, in Melbourne, Australia and some learned men at the Chavurah in Miami.

Roots of the Term

The term “mipnei tikkun ha-olam” (perhaps best translated in this context as “in the interest of public policy”) is used in the Mishnah (the body of classical rabbinic teachings codified circa 200 C.E.). There, it refers to social policy legislation providing extra protection to those potentially at a disadvantage — governing, for example, just conditions for the writing of divorce decrees and for the freeing of slaves.

It was the mystical connection to the Lurianic tradition that brought back such pleasant memories of Jewish life in Melbourne.

Every year we were privy to the intellect of a Shaliach (a representative) and of course, we in the distant diaspora were super impressed with the breadth of their intellect. Was it Aharon Megged who introduced us to the elements of the Kabbalah? I still remember him talking about schehinah Light. it is the coming together of this light, in the Lurianic tradition, a created world, to return to the divine light of what was before. To become whole once again.

I remember being very impressed. At the end of the talk, he asked, are there any questions? Not even one of us could muster a question. It took me a lifetime to understand the Kabbalah, and you could understand in one hour? How fantastic!

My own understanding of Tikkun Olam coincided with my becoming a doctor and reading American Jewish Literature. 

I have always felt that my Jewish upbringing has had a fantastic influence in the kind of Medicine and Healing that I have practiced since becoming a Doctor, A shaliach to the Olam, a healer to the Indigenous, a doctor without borders.

Mieux vaut n'penser à rien que n'pas penser du tout. Stacey Kent. Ces Petits Riens. These Little things . Serge Gainsbourg . In Paris. In Love . Full of sound and Fury, signifying Nothing

 I am at a farm just a few miles out of Miami. It is absolutely quiet here, no traffic , no noise, surrounded by parcels of fields cultivating mainly decorative plants attended by migrants from Mexico and Central America, with some very distinct Indian faces. So different is this slow paced life from the aggressive, Cuban dominated, noisy life of Miami, only 25 minutes away by car.

Even in this isolation, wifi is available and Spotify to listen to, and spending this lazy afternoon, listening to songs, old and new, selected for me by the streaming service, whose algorithm seem to know my brain!

Ces Petits Reins

I have had heard this song before 

Stacey Kent 

very good French pronunciation (makes me feel jealous!)(she is American but very popular in France, Germany and other parts of Europe)

I read the lyrics in English, an extraordinary talent of love, luck and desperation should have written these lyrics, I thought

Who wrote the lyrics 

50 years ago 

Serge Gainsbourg

French man of arts..

20 years after his death, he is larger than ever in France. English speaking music lovers in the periphery of the English speaking world (think of us in the Antipodes) heard of him through a song he had recorded with his muse, above, Jane Birkin. 

Ces petits riens

Stacey Kent

Better not to think of anything than not to think at all.
Mieux vaut n'penser à rien que n'pas penser du tout.

Nothing is already, nothing is already a lot.
Rien c'est déjà, rien c'est déjà beaucoup.

We remember nothing, since we forget everything.
On se souvient de rien, puisqu'on oublie tout.

Nothing is much better, nothing is much better than everything.
Rien c'est bien mieux, rien c'est bien mieux que tout.

Better to think of nothing than to think of yourself.
Mieux vaut n'penser à rien que de penser à vous.

It's not worth anything, it's not worth anything to me at all.
Ça ne vaut rien, ça ne m'vaut rien du tout.

As if nothing had happened, I think of all
Comme si de rien n'était, je pense à tous

These little things that came to me from you.
Ces petits riens qui me venaient de vous.

If it was three times nothing, three times nothing between us
Si c'était trois fois rien, trois fois rien entre nous

Obviously, that's not a lot.
Evidemment, ça ne fait pas beaucoup.

These are the little things that I put end to end
Ce sont ces p'tits riens que j'ai mis bout à bout

These little things that came to me from you.
Ces petits riens qui me venaient de vous.

Better to cry at nothing than to laugh at everything.
Mieux vaut pleurer de rien que de rire de tout.

Crying for nothing is already a lot
Pleurer pour un rien, c'est déjà beaucoup

But you, you have nothing in your heart and I confess
Mais vous, vous n'avez rien dans le cœur et j'avoue

I envy you, I hate you a lot.
Je vous envie, je vous en veux beaucoup.

These are the little things that came to me from you.
Ce sont ces p'tits riens qui me venaient de vous.

Do you want them?
Les voulez-vous ?

Hold !
Tenez !

What do you want ?
Que voulez-vous ?

Me, I do not want anything in the world, nothing more from you.
Moi, je n'veux pour rien au monde, plus rien de vous.

To be yours, you have to be half crazy.
Pour être à vous, faut être à moitié fou.

These are the little things that came to me from you.
Ce sont ces p'tits riens qui me venaient de vous.

Do you want them?
Les voulez-vous ?

Hold !
Tenez !

What do you want ?
Que voulez-vous ?

Me, I do not want anything in the world, nothing more from you.
Moi, je n'veux pour rien au monde, plus rien de vous.

To be yours, you have to be half crazy.
Pour être à vous, faut être à moitié fou.

REVERSING TYPE 2 DIABETES: MORE CONTACT, MORE SCIENCE, MORE NUTRITIONAL KNOWLEDGE AND LESS MEDICATIONS.. AND THANKS TO ERAN ELIANAV AND ERAN SIEGEL

 I am always grateful to my Israeli colleagues to provide innovative evidence to collaborate what i observe in my clinical practice among the Indigenous people.

Abstract

OBJECTIVE To compare the clinical effects of a personalized postprandial-targeting (PPT) diet versus a Mediterranean (MED) diet on glycemic control and metabolic health in prediabetes.

RESEARCH DESIGN AND METHODS We randomly assigned adults with prediabetes (n = 225) to follow a MED diet or a PPT diet for a 6-month dietary intervention and additional 6-month follow-up. The PPT diet relies on a machine learning algorithm that integrates clinical and microbiome features to predict personal postprandial glucose responses. During the intervention, all participants were connected to continuous glucose monitoring (CGM) and self-reported dietary intake using a smartphone application.

RESULTS Among 225 participants randomized (58.7% women, mean ± SD age 50 ± 7 years, BMI 31.3 ± 5.8 kg/m2, HbA1c, 5.9 ± 0.2% [41 ± 2.4 mmol/mol], fasting plasma glucose 114 ± 12 mg/dL [6.33 ± 0.67 mmol/L]), 200 (89%) completed the 6-month intervention. A total of 177 participants also contributed 12-month follow-up data. Both interventions reduced the daily time with glucose levels >140 mg/dL (7.8 mmol/L) and HbA1c levels, but reductions were significantly greater in PPT compared with MED. The mean 6-month change in “time above 140” was −0.3 ± 0.8 h/day and −1.3 ± 1.5 h/day for MED and PPT, respectively (95% CI between-group difference −1.29 to −0.66, P < 0.001). The mean 6-month change in HbA1c was −0.08 ± 0.19% (−0.9 ± 2.1 mmol/mol) and −0.16 ± 0.24% (−1.7 ± 2.6 mmol/mol) for MED and PPT, respectively (95% CI between-group difference −0.14 to −0.02, P = 0.007). The significant between-group differences were maintained at 12-month follow-up. No significant differences were noted between the groups in a CGM-measured oral glucose tolerance test.

CONCLUSIONS In this clinical trial in prediabetes, a PPT diet improved glycemic control significantly more than a MED diet as measured by daily time of glucose levels >140 mg/dL (7.8 mmol/L) and HbA1c. These findings may have implications for dietary advice in clinical practice.

Ben-Yacov O, Godneva A, Rein M, et al. Personalized Postprandial Glucose Response-Targeting Diet Versus Mediterranean Diet for Glycemic Control in Prediabetes. Diabetes Care. 2021 Jul 23. pii: dc21-0162. doi: 10.2337/dc21-0162. (Original study)

What makes the blood sugar goes up after you eat ?

I have my own theories. I work exclusively with Indigenous people so it is easy to make observations (being an anthropologist helps as unlike Medical Doctors, anthropologists tend to be more qualitative)

I give you an example 

A primary care provider made the diagnosis of Type 2 Diabetes on an Indigenous person. The blood sugar was in the range of 200 mg/dl range.  She was not obese. But her nutrition was the General American Diet (which probably caused her Diabetes?)

Three of us work together : The Diabetes Educator who is also a certified Physical Education Teacher and indigenous herself  ; the Nutritionist who is a Professor of Nutrition at a University nearby and open minded and with years of experience working with Indigenous people and my work has been exclusively with Indigenous people.

Six weeks ago, the Nurse Practitioner in the Clinic informed us that a 61 year old Indigenous person has been diagnosed with Type 2 Diabetes.

First Lifestyle history with emphasis on NUTRITION or lack of it.

In a country where majority of the people consume ultra processed food, a history of that consumption makes up the huge chunk of Lifestyle and the ability to manipulate it.

Results Ultra-processed foods comprised 57.9% of energy intake, and contributed 89.7% of the energy intake from added sugars. The content of added sugars in ultra-processed foods (21.1% of calories) was eightfold higher than in processed foods (2.4%) and fivefold higher than in unprocessed or minimally processed foods and processed culinary ingredients grouped together (3.7%). Both in unadjusted and adjusted models, each increase of 5 percentage points in proportional energy intake from ultra-processed foods increased the proportional energy intake from added sugars by 1 percentage point. Consumption of added sugars increased linearly across quintiles of ultra-processed food consumption: from 7.5% of total energy in the lowest quintile to 19.5% in the highest. A total of 82.1% of Americans in the highest quintile exceeded the recommended limit of 10% energy from added sugars, compared with 26.4% in the lowest.

Conclusions Decreasing the consumption of ultra-processed foods could be an effective way of reducing the excessive intake of added sugars in the USA.

Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study.  thanks to Dr Carlos Augusto Monteiro, USP, Brasil.

As expected, our patient's caloric intake was predominantly prepared by others, in take-out restaurants and fast food restaurants.

Education about Malnutrition and Ill health. 

Assess the willingness of the patient for a change in Nutrition. This patient was very willing as she had seen the consequences of uncontrolled diabetes in her tribe.

Continuous Glucose Monitoring. We use Libre 14 days, and with the promise that she would check the machine often and send the results to me.

What is important here is her willingness to make changes to her nutrition.

Within one week her average blood sugar came down from 200 mg/dl to 150 mg/dl. The Primary Care Provider had begun her on two medications and I stopped one and within the next two months, the other medication was also stopped.

Because of the CGM we were able to find out many peculiarities of the effects of Food on her Blood Sugar.

This is what the two ERAN s (Siegel and Elianav) in Israel do with their algorithm , in which Microbiome of each patient is included. 

In a way we were doing a hit and miss Microbiome examination of our own .

In this patient, any Bread or bread products increased the Blood sugar 

But whole grain Pita,  did not. (I joked that she must be my sister, as the same thing happens to be when I eat Pita or the other types of bread. but I do know my microbiome)

On the way over to the clinic one day, she stopped at STARBUCKS and had one of those mixed drinks and her Blood sugar went up by more than 60 mg/dl

One thing to note was the lack of postprandial excursions of blood sugar.

She is now off all medications, and her Blood sugar remains around 100 mg/dl. No change in exercise, typr or intensity or time.

Has she reversed her Diabetes ?

In my opinion, Yes

We now have people trying to reverse their diabetes, and in general the "fresh" they are in the diagnosis, the faster they reverse their Diabetes.

Yet another patient, his story is so astonishing that it deserves to be in the Publications for patients on Diabetes. ( I attend ONLY to Indigenous patients, aunque estoy un medico sin fronteras, bien que je sois un médecin sans frontières)

What have I learned from my indigenous patients?

and the above article from Israel offers scientific credence ?

If you eat the food that is appropriate for you, there will not be a postprandial excursion.

Then, in memory of my teacher Larry Fishman, who said, to make sure that horse does not bolt, close the gate, to give insulin before food, is a vain attempt to teach the  metabolism to change? should you not make sure that the blood sugar does not go up after eating, by eating appropriate food, by knowing your microbiome?

My plans for the indigenous patients with Diabetes (in the USA initially)

when they are seen for newly diagnosed Type 2 Diabetes

Microbiome

CGM

Daily contact 

Education

Educating myself about their social history , especially Nutrition.

The plan and desire would be to REVERSE the diabetes.

SAUDADE. AN UNEXPLAINED NOSTALGIA, ANOTHER PSYCHOLOGICAL BLOW OF THIS PANDEMIC

 It was 4 pm, the mellow sun was about to set over the London skies. I was a student of Anthropology at London.

I made myself a cup of tea.

Pont Street was where the apartment was. Historically, I looked up, there was a bridge and a tariff levied on goods that crossed that bridge in the middle ages in that part of London.

thus the name

(the word tariff also has an interesting history:

From French tarif, from Italian tariffa, from Ottoman Turkish تعرفه‎ (ta'rife), from Persian تعرفه‎ (ta'refe), from Arabic تَعْرِفَة‎ (taʿrifa, “tariff, rate”), from the root ع ر ف‎ (ʿ-r-f). ). Tarif Ibn Malik was also a Berber conquistador of southern Spain.

I remember the moment very clearly. A nice cup of tea (from the world famous store few steps away ?), the mellow sun and the joy of studying Anthropology.

Then a song drifted in, the radio was tuned to a World Music station

My ears perked up

a soft voice, in a language i had never heard of 

Cabo verdian portuguese creole!

The singer was Cesaria Evora.. thus began my long love affair with Cabo Verdian music of mornas and coladeras.. Ildo Lobo Jovinho dos santos. Alex veira Bau many others..

also emphasized the concept of Saudade..

Miss Perfumadu

 

Cape Verdean

Miss Perfumado

Dxam morrê ta sonha

Na sombra di odjo magoado

Duma pequena gentil

Di corpo perfumado

 

Assim dxam morrê ô flor

Na sombra di bo odjinho

Dxam morrê ta sonha

Assim c’ma pomba na sê ninho

 

Si pomba é feliz na sê ninho

A mim também mi é feliz

Na sombra di odjo ma carinho

Let me die as I dream

Under the gaze, dark and lovely,

Of a beautiful girl

With a sweet-scented body.

 

And so, let me die, sweet rose,

Under your eyes so arresting.

Let me die as I dream,

As would a dove happily nesting.

 

If doves are happily nesting,

Then I will be happy too,

With one whose eyes on me are resting:

Sweet Miss Perfumado.

Saudade is a pleasant way to feel sad and in my opinion it brings its own pleasure and most importantly a sense of proportion to your life and being.

The saudade that began last night has continued to this morning. Saudade has a very purifying and more importantly a clarifying effect.

It acts as a prism through which you look at the people close to you, hold them up to a higher expectation of behaviour as if Saudade has made your own heart shine ..

Thank you Cesaria Evora

Cold days in early January 2012

At the Air France Lounge in Boston Airport? a vague recollection, on my way to Paris

My favourite magazine was lying around 

The Economist  dated Jan 7, 2012

As I opened it to the last page, there it was obituary to Cesaria Evora

I was crying holding the magazine in my hand, champagne to the rescue, as I am crying now, my heart full of saudade, for the hours and hours of music that Cesaria Evora brought into my life.

From The Economist 7 january 2012

O mar, mar azul…

When musicologists wondered where the islands' songs came from—those sad, syncopated mornas that blended Portuguese fado, Brazilian modinhas, the laments of Angola and even, some thought, the shanties of British seafarers—she had only one explanation. They were about love, emigration, homesickness, looking for work, waiting for rain, missing people. And with their continual wave-like interlinking of one line into the next, their evenness and endlessness, so that it seemed she could go on singing them for ever in her limpid, lovely voice, they could only have come from the sea.

WELCOME TO INDIAN RELATIVE , KISIKAPACUA... IN THE LONG LINE OF RESISTANCE TO OPPRESSION AND ACCULTURATION

 I have been fortunate to get to know some Native people who are caught in the web of acculturation and their intense desire to maintain their culture. 

So happy was I when my traditional texas kickapoo sister , Mena, sent me a photo of a new addition to the family: Kisikapacua.. Kisi for us.

Her genealogy was explained to me by Mena.

She is the daughter of Peminoicua, who is the daughter of my "niece", but in the indian wasy, Nieces do not exist, only daughters.

Her father is the grandson of Kisikapata or Clan leader.

she then included a picture of the traditional summer houser of the Traditional Kickapoo. Which is constructed in the same fashion as they did long before the europeans arrived without invitation at their borders.

Women collect the reeds and preparing the reeds for the roof bloodies their hands for days and they prepare the raw material for their summer homes and winter homes (which are often completely re constructed).

How do traditional tribes maintain their desire to maintain their culture and identity when the outsiders are telling them to integrate? Integrate in the indians world means, give up what you have and take what we give you ? To call this highly advanced spiritual people, sauvages /salvajes/ savages exhibit the cataract vision painted in their brains of negating or looking down upon whatever group, culture, religion they belong to.

Indians have survived.

how have they survived the cultural aggression of missionaries, greedy land grabbers and politicians?

By maintaining the integrity of their own symbols: tribal, political or cultural

Most traditional tribes reject the efforts of Christian missionaries belonging to the aggressive variety such as the hideouly disguised  Summer Institute of Linguistics SIL , the american missionary enterprise and there is a British Enterprise as well , New Tribes Mission.

They go deeper and deeper into the area of contact and for one "martyred" priest, they usually kill about 500 "savages" by brining infections, inlammation and intolerance.

Traditional Indians will reject wholeheartedly symbols of the oppressors

The first is the Evangelical Christianity of any type

Second are the institutions, such as Army . I would like to know when did the warriors in the Plains region of USA turned from being enemies to the obeisant sepoys of the Military Industrial Complex of the Yanquis?

I did notice that the traditional Kickapoo unlike their relatives up north never joined Armed forces of the USA  which has been demonstrated as a fine way to assimilate into the American Culture.

I was told by an elder of the HoCank tribe that the name St.Cyr was bestowed upon an Indian warrior for his bravery and strategy by the invading French, honouring the well known army officers school near Paris, France.

Missionaries also knew that destruction of language and knowledge was an important way to "assimilate" the "savages"

Just the other day, a sixty year old Navajo Indian told me that he was asked to wash his mouth by the Nuns of his Catholic school whenever he spoke to his fellow Navajo classmates. We know of thousand such stories. 

I have always liked to visit Yucatan and specifically Merida. One can still see in the innocent faces of the Maya who had built Chichen Itza and Tulum and Kabah and Uxmal and Labna.....the tragedy imposed upon them by the Inquisitorial minded Spaniards, in the person of Bishop Landa who burned their libraries (only three books remain).. Mayan libraries were larger than the libraries that Spain had at that time!

Like all the destructive missionaries, he wrote down all that he was destroying..so that we know how they lived before he and his ilk destroyed their lifestyle.

He joins the infamous with names such as Pizarro, Balboa and hundreds of other conquistadores whose actions are still felt in the poverty ridden flesh of South America .

 KISI So welcome to the glorious history of your people and their continued resistance against Americans, Mexicans and Others . You will grow up speaking your language and you will learn to dance the way of your ancestors that a million Bishop Landas were not able to eradicate. Be a proud member of Humanity, but to be a good human being, you have to be a good Kickapoo..

MEDITATION AND BLOOD PRESSURE IF YOU WISH TO BRING DOWN YOUR BLOOD PRESSURE, A MOST ENJOYABLE WAY..

Over the course of the years, they have defined what is normal Blood Pressure for an average human. For years it was accepted that it was 130/80 mm Hg, but lately it is recommended that it better be around 120/70 mm Hg.  Please do not rush into taking medications, some changes in nutrition would help. But my own recommendation is Meditation. Each night I try to do about 15-20 minutes of Anapana Medication of SN Goenka. It always pleases me that after the meditation my Blood Pressure is never in the high range, the range where it used to be a few years ago.

The tranquility in your heart even after a short period of meditation is incredible. I was not open to this practice until quite recently, but everything fell into place.

it also makes you appreciate all that is which is beautiful around you, gives you a capacity to resolve conflicts within yourself and with others..

this photograph taken by me today is a metaphor for the sensation in my heart at this moment.

May you also have the same sensation..

TWO UMONHON INDIAN RELATIVES COME TO VISIT

Two UmonHon Indian relatives dropped in for a lovely short visit!

I had not seen them since November 2018, but for a period of 3 years we saw each other a lot, first as colleagues at the Diabets Programme and then as relatives and then as travellers together to Cambodia, Malaysia, Cuba.

They drove down from Orlando, 200 miles away and I wanted to make sure that our time together was memorable. 

It did turn out that way.

I wanted them to have a taste of my everyday life here. We stopped at the Palacio de los Jugos, where young recent immigrant workers from Cuba, work very diligently, while counting their american dreams. I requested the mother of the owner to make us three Cortadito, not too strong but with piping hot milk.  We sat down and chatted while sipping Cuban Coffee on this hot day in Miami 

 

They were surprised to see the variety of fresh fruit and vegetables available ..Availability and access and desire are all different among the population in this diverse city of spanish and english speakers.

They had been driving the 200 miles from their hotel in Orlando and it is time to treat them to a good Cuban meal and once again to one of my haunts... i remember them when I was a student here!!

To live in Miami or observe it as a visitor is an Anthropologist's dream...One has the leeway of being friendly with the majority of the latin population here, a freedom denied to its euro american and black population, struggling with political correctedness and self confidence etc. I am always friendly with the servers at these restaurants who always tend to be friendly and from a wide variety of backgrounds. Today was no exception.. Anna was from the province of Trujillo and very friendly, almost motherly. Hope I get to see her again.

Driving through South Miami and on to Mathieson Hammock where vestiges of pre contact South Florida is maintained in its well preserved hammocks of mangroves. They were interested in the Indian history of Florida and we had a nice chat, including the contact with the local indians with indians of Cuba.

When a visitor comes to my part of the woods, I begin to see the scenery with a fresh eye and I enjoy showing people around this part of the world where I spend time.

I was happy to show my UmonHon friends, A and M, few years ago : Kuala Lumpur, Malaysia and also Siem Reap, Cambodia. They have been my guests in La Habana, Cuba twice as a part of their study of the excellent Diabetes Care system in Cuba.

I am sure there would be other places in the future.

It is nice to show visitors the skyline of Miami across the bay from Key Biscayne. I remember my own initial sensations visiting Crandon Park during my university days here in Miami. 

Key Biscayne in recent years has been built up and there are strip malls now rather than the quaint shops they used to have. Progress for one person is detrimental to the eyes of another ..

No visit to Cultural Miami is complete without a visit to Cafe Versailles, which is the nest of the anti-cuba hornets, a cupola of subservience to the capitalism and selfishness that denote this particular group of Cubans. I always feel that I am entering a den of vipers, as many of them hold such poisonous views about Cuba which they confuse with the political system there, rather than genuinely wanting a change. 

But the coffee is good. Nice to watch the people. I did notice a few visitors with mayan memories etched on to their face.

As befits their personal politics, majority of the people waiting to enter the restaurant were not wearing masks! ah well.. probably not vaccinated either..

They had visited Cuba twice and of course being the original inhabitants of this land and very tolerant of millions of immigrants, perhaps it baffles them to see this abhorrence of the land of your birth or ancestors. 

The night was falling. They were not hungry. I had wanted to take them to a Food Truck but they said they were not all in the mood to eat. 

They left as the sun was setting for the 200 miles drive back to Orlando. Close to midnight they reached there, having taken four hours to get back.

A lovely day with my UmonHon relatives.