Steven Masley MD, LLC Tune up your brain, heart, energy, waistline, and sex life! Sat, 13 Feb 2021 03:46:34 +0000 en-US hourly 1 Steven Masley MD, LLC 32 32 ​Caribbean Fish Ceviche with Coconut Milk Sat, 13 Feb 2021 03:30:50 +0000 The post ​Caribbean Fish Ceviche with Coconut Milk appeared first on Steven Masley MD, LLC.


This dish originates from French Polynesia (Tahiti) where the fish is served nearly raw with perhaps 15-20 minutes of marinating time in lime juice—which is easier to do when you catch the fish (typically tuna) the same day and keep it on ice. From my restaurant experience in the French Antilles, the fish seems to have been marinated a bit longer, perhaps 30-60 minutes. If the fish you will use was caught during the last few days (not few hours) and is not super fresh from the sea, better to marinate it in lime juice a bit longer, for 1 hour and up to 2 hours, the longer it marinates the more cooked it will be and the stronger the lime flavor.

Prep Time: 20 Minutes

Marinating Time: Varies from 30 minutes to 1 hour

Serves: 2 as a meal, 4 as an appetizer.


1 pound fresh snapper (or ahi tuna, or other sushi-grade fish), diced into ½-inch cubes

4 limes juiced (barely enough juice to cover most of the fish in a bowl)

¼ medium red onion, minced

½ red bell pepper, seeds and membranes removed, diced finely

½ teaspoon sea salt

¼ teaspoon freshly ground black pepper

1 medium Haas avocado, sliced into ½-inch cubes

4-6 ounces coconut milk (chilled in the refrigerator)

2 tablespoons cilantro (or parsley), chopped

4-8 fresh lettuce leaves (or encircle the plate with endive leaves)

Optional garnish, dash of cayenne (less than 1/8 of a teaspoon), or use paprika


Marinate cubed fish in a bowl with lime juice in the refrigerator for 30 minutes with an occasional stir and up to 1 hour as desired to your taste. Add onion, red bell pepper, salt and black pepper and return to the refrigerator, and marinate another 10 minutes.

Add avocado, coconut milk, and cilantro, stir gently and serve on a bed of lettuce. Garnish with a dash of cayenne, or if you prefer less heat use paprika.


Steven Masley, MD

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For 2021, What Is the Best Diet on the Planet? Wed, 03 Feb 2021 18:03:23 +0000 The post For 2021, What Is the Best Diet on the Planet? appeared first on Steven Masley MD, LLC.


For 2021, The US News and World Report rated the Mediterranean diet as:

  • The best diet overall
  • Tied for 1st as:
    • The best heart-healthy diet
    • The best diabetes diet
    • The best diet for healthy eating
    • The best plant-based diet
  • And importantly, it is also rated as the easiest diet to follow

Let alone that the Mediterranean Diet provides delicious food that is fairly easy to prepare.

The Mediterranean Diet is based upon the eating habits of people living around the Mediterranean Sea: Spain, France, Italy, Greece, and Turkey, as well as middle eastern and northern African countries. It provides a huge variety of foods to eat.

What these cuisines have in common is the consumption of fresh, whole foods featuring vegetables, fruits, beans, nuts, herbs and spices; the predominate use of extra-virgin olive oil instead of butter, margarine, or vegetable oils; moderate amounts of seafood and poultry; and the moderate consumption of red wine. What the Mediterranean diet specifically has avoided is processed foods, sugar, and artificial flavors. Red meats are rarely on the menu or are used sparingly to flavor a dish.

These accolades should not be too surprising, as Mediterranean countries have some of the longest life spans on the planet, despite that they have higher rates of tobacco use, and they have lower rates of heart disease, memory loss, cancer, and obesity. The people of Spain, who follow the

Mediterranean diet closely, have the longest lifespan and the best health of any country in the Western world, and are anticipated to surpass Japan soon as the longest-lived country on the planet.

In light of all these benefits, I wrote a book to share how easy it can be to follow and benefit from the Mediterranean eating plan, The Mediterranean Method.

Preventing Heart Disease

Heart disease remains the #1 killer for men and women, even though studies have shown we can prevent 90 percent of heart disease with the right lifestyle changes—our biggest challenge is finding a diet and lifestyle that people are willing to follow long-term.

Back in the 1950s, the physiologist, Ancel Keys, became a vocal advocate for the Mediterranean diet, especially to prevent heart disease, which he expanded upon with his Seven Countries Study. A turning point for proof of the cardiac benefits of a Mediterranean diet was the Lyon Diet Heart Study, published in 1994, which showed that in a randomized clinical trial, compared to the more standard, low-fat, American Heart Association diet, a Mediterranean diet was more effective at preventing heart disease.

In 2003, the Greek EPIC trial showed that the closer subjects followed a Mediterranean eating plan, the lower their rate of cardiovascular events. Subsequent studies have shown that the closer people living outside the Mediterranean follow this same diet, the less heart disease and longer life they enjoy.

Then in 2018, the large-scale landmark PREDIMED study with over 7,000 subjects published in The New England Journal of Medicine affirmed the CVD-fighting reputation of the Mediterranean Diet; those who followed a Mediterranean diet and added extra nuts or olive oil had 30% fewer events than those following a low-fat diet.

Data published from my own clinic has shown that in patients who follow a low-glycemic version of a Mediterranean diet, the average person shows a regression of carotid intimal media thickness (IMT) scores, and hundreds of our patients had more than a 10% regression in their arterial plaque load.

Enhancing Cognition and Preventing Memory Loss

The most expensive disease in the U.S. is dementia; recent estimates are that the total bill to treat it exceeds $215,000 billion per year. More startling is that the rates of memory loss and Alzheimer’s disease are predicted to double over the next 15 years.

Yet, just as we can prevent most cases or heart disease, there is now growing evidence that we can also prevent dementia and cognitive decline with the right lifestyle changes. PREDIMED researchers tracked the impact on cognition of the dietary interventions over 6.5 years on over 500 participants and controlled for multiple lifestyle and health factors. Those randomized to a low-fat diet had lower overall cognitive scores and more progression to dementia than those in the Mediterranean diet group, plus the Mediterranean group showed greater compliance following the diet recommendations.

Other studies have also shown cognitive improvement and/or reduced cognitive impairment with following a Mediterranean diet, including the FINGER trial, Three-City study in France, the Chicago Health and Aging Project (CHAP), and in a group of more than 1,200 Puerto Rican adults living in the U.S.

Data published from my own clinic confirmed that the closer a person follows these dietary recommendations, the better their brain processing speed and cognitive scores, results which have continued over 12 years of follow up.

Better Weight Control

In 2016, Dr. Joseph Mancini and his colleagues evaluated five randomized weight-loss trials with more than 1,000 subjects on various dietary regimens including low-fat, low-carb, and Mediterranean. These subjects were followed for at least 12 months, a meaningful length of time given most people lose weight in only the short term and regain it later. The research found that the Mediterranean Diet was more effective than the low-fat diet, and equally as effective as a low-carb diet over the long-term. What’s more, they concluded that those following the Mediterranean Diet not only lost weight, but they had the best improvements in lipid and metabolic profile. The typical weight loss ranged from 10 to 22 pounds lost throughout the 12-months.

In a separate meta-analysis of nine randomized dietary trials with over 1,000 patients in subjects with Type 2 diabetes, again researchers concluded that a Mediterranean diet was the best compared to other diets for weight loss and improvements in metabolic markers long-term.

Adapting the Mediterranean Diet to the 21st Century

Despite all these clear health benefits, there are some limitations and myths related to the Mediterranean diet that should be applied to living in the 21st century.

For instance, some think that the Mediterranean diet promotes large portions of pasta, bread, and pizza—and that adding olive oil, marinara sauce, and red wine will render any food healthy. These are truly myths.

First and foremost, the original Mediterranean diet was followed by farmers, fisherman, and herders–men and women who were physically active for 6 to 10 hours per day. Very few can achieve this much activity today. We, therefore, need to modify an eating plan with a lower sugar and grain flour intake (glycemic load) to match our activity level.

Second, studies that have evaluated the Mediterranean diet have also assessed what components of the traditional eating plan had the most and least benefit. Results from the EPIC trial showed that consuming vegetables, fruit, beans, nuts, and olive oil provided the greatest benefit, and eating whole grains provided the least—likely related to their glycemic load.

A more recent study, The EPIC Greek Cohort study, published in 2012, analyzed adherence to a Mediterranean Diet, and glycemic load intake. It concluded that those who adhered to a Mediterranean Diet and had the lowest glycemic load intake had the best health benefits of all. And if the subjects were overweight, the benefits of following a low-glycemic load version of a Mediterranean Diet were even greater.

This low-glycemic version has the added advantage of appealing to many people who have already shifted towards a low-carb and/or Paleo eating plan.

Beyond Food

Though there are many proven benefits to following a low-glycemic version of a Mediterranean diet, the health benefits of the Mediterranean lifestyle are not solely limited to food intake. Mediterranean people are more active than we are in the U.S., they spend more time walking and cycling to work and for daily shopping, and they spend more time outdoors and with nature.

How they eat is important as well. They enjoy long, leisurely meals typically with friends and family, which fosters close social connections, which is perhaps related to the fact that they have lower rates of anxiety and depression than are found in the U.S.

In summary, let me share my version of the food and lifestyle pyramid of a low-glycemic Mediterranean diet, adapted from my book, The Mediterranean Method.

The pyramid’s foundation is the lifestyle, which features activity, social interaction, cooking, and mindful-leisurely eating. Foods and beverages that are consumed daily include vegetables, fruits, beans, nuts, olive oil, herbs and spices, yogurt, dark chocolate, and water, with moderate intake of red wine and coffee or tea. Seafood, poultry, eggs, and other probiotic-rich dairy products are on the menu several times a week, as are whole grains though in small portions (and gluten-free as needed). My pyramid limits but does not eliminate red meat, sweets, and potatoes.

The Mediterranean Diet is not just a short-term eating plan. It has been followed for centuries and tested in numerous long-term clinical studies and been found to be the best diet on the planet for long-term adherence and for healthy eating. The food is delicious, generally simple, easy to prepare, and the ingredients can be found at your local grocery store. This is an eating plan that truly combines proven health benefits with delicious food—no other diet can embrace the saying as well.

If you have not yet purchased your own copy of The Mediterranean Method, containing 50-plus awesome recipes and many photos, now is your chance, click here.

To Your Health & Bon Appétit!

Steven Masley, MD, FAHA, FACN, CNS







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Can You Reverse Thyroid Disease? Wed, 20 Jan 2021 16:45:29 +0000 The post Can You Reverse Thyroid Disease? appeared first on Steven Masley MD, LLC.


Thyroid disease is common for women and men—20 million Americans have some form of thyroid disease. Many people struggle with thyroid symptoms without knowing that there is a potential dietary solution to reverse it.

Symptoms like brain fog, fatigue, hair loss, cold intolerance, and weight gain are not only bothersome, but too often these symptoms persist even after starting medication for thyroid conditions, and even after your doctor says that with thyroid therapy your levels are normal.

Low thyroid function (hypothyroidism) is related to excess iodine intake. Overactive thyroid function (hyperthyroidism) is also related to iodine intake.

My good friend and medical colleague that I highly respect, Alan Christianson ND, has recently written a book about the relationship between iodine intake, thyroid function, and thyroid disease. His book is called The Thyroid Reset Diet and is the first nutrition plan that has been clinically shown to reverse thyroid disease and/or improve thyroid symptoms for two-thirds of people who suffer from thyroid problems.

How does it work? The key is to eat foods that are low in iodine because you may be exceeding your iodine requirements through the food you eat (in addition to products you might be applying to your skin). In his book, The Thyroid Reset Diet, Dr. Christianson provides a detailed and easy-to-follow plan to overcome excess iodine intake and to help restore thyroid function and symptoms.

The book provides useful information, 65 delicious recipes, weekly meal plans, and long-term maintenance information. I highly recommend that anyone with hypothyroidism, Hashimoto’s disease, or hyperthyroidism read this book and that you share it with your loved ones if they suffer from thyroid disease.

Recently Dr. Christianson and I talked about iodine, thyroid disease, and his new book. If you would like to view my interview with Dr. Christianson, click here.

To simply buy his book, click here.

I wish you the best of health,

Steven Masley, MD, FAHA, FACN, CNS

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Apple Pie with a Gluten Free Crust Sat, 16 Jan 2021 03:04:31 +0000 The post Apple Pie with a Gluten Free Crust appeared first on Steven Masley MD, LLC.


Pre-baked pie crust

For a special occasion, I enjoy baking an apple pie and sharing with friends and family. This crust is much healthier without the inflammatory gluten compounds and it has a lower glycemic load than you would find with a traditional wheat flour crust. Yet for me this crust is still flaky and flavorful. You can substitute the apple with other fruit options in the pie as desired.

Prep Time: 50 Minutes

Refrigeration Time: 1 Hour

Baking Time: 30 Minutes


1.5 cups almond flour (blanched, super finely ground almond meal)

½ cup oat flour

½ cup organic rolled oats

½ teaspoon sea salt

1 cage-free organic-raised egg, whisked

¾ cup organic, unsalted, cold butter, cut into ½-inch cubes


4 medium apples, sliced thinly

1 tablespoon lemon juice

2 tablespoons salted butter

2 tablespoons water

½ cup maple syrup

1 teaspoon ground cinnamon

¼ teaspoon ground nutmeg (freshly grated is best)

¼ teaspoon sea salt

6 tablespoons water

2 tablespoons Kuzu powder (or 1 tablespoon cornstarch)

Optional garnish, organic whipped cream


In a food processor, pulse almond flour, oat flour, rolled oats, and salt until well mixed. Whisk the egg in a bowl, then pulse the egg with the dried ingredients. Next, add cubed butter and pulse until pea-size pieces of butter and dough form. Press the dough into a ball and refrigerator for 45-60 minutes (or up to 3 days covered).

Preheat the oven to 325 degrees F.

Line a 9-inch pie plate with parchment paper. Flatten dough in the pie plate, press into the bottom, and up along the sides. Indent the edges if desired. Poke holes in the bottom and sides using a fork to prevent bubbling. Trim any lose edges of the parchment paper.

Bake in the oven on a middle rack for 15 minutes.

Meanwhile, combine sliced apples and lemon juice together in a bowl and mix well until apple is coated with juice.

Add butter, water, maple syrup, cinnamon, ground nutmeg, and salt in a medium saucepan over medium heat, until the butter melts. Add apples and lemon juice and stir. Heat for about 8-10 minutes with an occasional stir, until apples begin to soften.

Combine remaining 6 tablespoons of water with kuzu (or cornstarch) and stir until mixed. Stir into the apple mixture and heat another 2 minutes.

When pie crust has baked for 15 minutes, remove from the oven.

Preheat the oven to 375 degrees F.

Pour hot apple mixture into the crust. Place pie plate on a middle rack in the oven and bake for 25-30 minutes. Let cool on a wire rack for 5 minutes before serving. Optionally garnish with organic whipped cream and a dash of ground cinnamon.


Steven Masley, MD

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Quiche with Mushrooms, Onion, and Spinach—Gluten Free Sat, 02 Jan 2021 00:32:30 +0000 The post Quiche with Mushrooms, Onion, and Spinach—Gluten Free appeared first on Steven Masley MD, LLC.


​People have been making quiche for hundreds of years. You can enjoy it for breakfast, lunch, or dinner. It is served for take-out, in fine restaurants, and with a little time is relatively easy to make at home. It is loaded with dairy, so please choose organic dairy options. The biggest health concern with traditional quiche is the crust, loaded with white wheat flour—full of sugar and inflammatory compounds. In this recipe, the egg provides a hint of protein, normally provided by the gluten protein, to hold the flour together. And this flour combination manages to provide a flaky crust—I have used this same pie crust to make dessert pies, too.



Prep Time: 50 Minutes

Refrigeration Time: 1 Hour 

Baking Time: 30 Minutes


1.5 cups almond flour (blanched, super finely ground almond meal)

½ cup oat flour

½ cup organic rolled oats

½ teaspoon sea salt

1 cage-free organic-raised egg, whisked

¾ cup organic, unsalted, cold butter, cut into ½-inch cubes


2 tablespoons extra-virgin olive oil

1 medium-large white onion, chopped finely

2 cups cremini mushrooms, chopped

½ teaspoon sea salt

¼ teaspoon ground black pepper

1 teaspoon dried thyme

3 ounces fresh baby spinach

1 tablespoon almond flour

4 large organically-fed, free-range chicken eggs

½ cup half and half

4 ounces Conté cheese, grated (or grated Gruyère), divided


In a food processor, pulse almond flour, oat flour, rolled oats, and salt until well mixed. Whisk the egg in a bowl, then pulse egg with the dried ingredients. Next, add cubed butter and pulse until pea-size pieces of butter and dough form. Press the dough into a ball and refrigerator for 45-60 minutes (or up to 3 days covered).

Preheat the oven to 325 degrees F.

Line a 9-inch pie plate with parchment paper. Flatten dough in the pie plate, press into the bottom, and up along the sides. Indent the edges if desired. Poke holes in the bottom and sides using a fork to prevent bubbling. Trim any lose edges of the parchment paper.

Bake in the oven on a middle shelf for 15 minutes.

Meanwhile, heat a large sauté pan to medium heat, add olive oil, then onions and sauté for 3-4 minutes with an occasional stir until onions soften. (Don’t let the onions brown, reduce heat to low if needed.) Add mushrooms, salt, black pepper, thyme and heat at medium to low heat with an occasional stir for 5-6 minutes, until mushrooms have softened. Add spinach, stir, and heat until the spinach wilts, about 2-3 minutes. Stir in almond flour, reduce heat to simmer, and heat for an additional 5 minutes with an occasional stir. Remove from heat and set aside.

Meanwhile, in a large bowl whisk eggs, half and half, and half the grated cheese. Combine with sauteed onions and mushroom mixture.

When pie crust has baked for 15 minutes, remove from the oven.

Preheat the oven to 375 degrees F.

Next pour onion, mushroom, egg, and half and half contents into the pie crust, then sprinkle the remaining half of the grated cheese on top.

Place pie plate on a middle shelf in the oven and bake for 25-30 minutes until a toothpick inserts and comes out clean. Let cool on a wire rack for 5 minutes before serving.


Steven Masley, MD

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Who Should Get the New Vaccine? Who Should Wait? Tue, 15 Dec 2020 02:36:24 +0000 The post Who Should Get the New Vaccine? Who Should Wait? appeared first on Steven Masley MD, LLC.


The Covid-19 virus continues to ravage communities and spread around the world, especially in countries that have been unwilling or unable to follow common sense and effective public health measures. Despite being one of the wealthiest nations on the planet, the United States has led the world in new cases and deaths since April 2020, with rapidly increasing infections and death rates in recent weeks. After all that we have learned about the virus, right now there are more new cases, hospitalizations, and deaths than ever over the past year.

The rare, good news has been that several vaccines are on the way, and because the infection and death rates have been so exceedingly high, the clinical trials using the vaccines have yielded positive results in an extremely short period of time.

Over the last 12 months, we have learned that Covid-19 infections have hit the elderly and those with heart and lung disease the hardest, yet it has also killed young people, people who are healthy, and those who have chronic disease in often unpredictable ways. With improvements in therapy for hospitalized patients over the last 6-9 months, death rates have decreased from 3-4% of new reported cases to 1.5-2% of cases, an important but limited improvement, making a vaccine essential.

The Pfizer Covid-19 vaccine, called BNT162b2, as well as Moderna’s Covid-19 vaccine, called mRNA-1273, have made front-page news for the last few weeks as they represent a bright light at the end of what has been a long dark tunnel.

These new vaccines are made of a piece of modified RNA (virus genetic material) that encodes a version of the SARS-CoV-2 spike protein, a novel concept in vaccine development. As a protein, the vaccine cannot cause an infection, but can boost immunity and protect us from becoming sick.

Experience with previous coronaviruses (SARS in 2002 and the more deadly MERS in 2012) failed to produce an effective vaccine. This makes the recent publicity about the latest vaccine studies welcome news.

Just this week, the actual Pfizer vaccine results have been published in the New England Journal of Medicine for all to review, and December 12th the FDA advisors recommended authorization of the vaccine for emergency use. Although this remains an ongoing study with results that are not yet final, the data thus far is highly encouraging. You can read the article for free with this link: The Moderna study results will likely be published and available very soon.

Highlights of Pfizer Vaccine Study Results

From the results published to date, findings show that the vaccine reduces infection rates by about 95%–truly amazing! In the primary analysis with over 40,000 subjects, only 8 cases of Covid-19 were seen in the vaccine group, as compared with 162 in the placebo group. These same results appear to be true for both the Pfizer and the Moderna vaccines, with both vaccines produced in a similar way. Thus far, subjects who were either young or old, black or white, healthy or with chronic health problems have shown similar reductions in infection rates—more good news.

In the clinical trial published this week, 21,720 participants received the BNT162b2 vaccine and 21,728 received a placebo. The Moderna study will also share results from a similar large sample size, helping to reveal any safety concerns associated with the vaccine use. Both Pfizer vaccine groups received two injections spaced 21 days apart, the Moderna vaccine also used two injections 4 weeks apart. Persons with obesity or other coexisting conditions were well represented, as well as many different ethnic communities, and more than 40% of participants were older than 55 years of age.

One important limitation of this study is that to date, the Pfizer vaccine findings represent only 2 months of safety data after the second vaccine was given. Important to know is that the results presented are only initial findings and part of an ongoing study.

To me, two months does not initially sound like much time for a clinical study to determine safety, yet fortunately, from hundreds of previous vaccine studies, we know that most serious side effects (such as a heart attack or neurological injury) occur within the first couple of months. Reassuring is that in this study so far, the vaccine subjects have had less serious events occur than the placebo subjects. However, out of 21,000 vaccinated subjects so far with published results, there were 4 cases of Bell’s palsy reported, which is often a temporary weakness in a facial nerve, which represents 1 event per 5,000 people vaccinated, A 0.02% risk.

The common side effects reported have been a reaction to the vaccine at the local injection site with soreness and redness, fatigue, and headache over the first 24-48 hours, and more rarely fever, which is typical for many vaccines. After the second vaccine, about 25% more vaccine subjects had these reported common side effects compared to the placebo group. These side effects were more frequent after the second dosage than the first.

If you think about it, I believe a 25% increased chance of mild arm soreness and cold symptoms for 1-2 days is well worth the 95% protection I would get from a potentially life-threatening Covid-19 infection that could impact me or someone dear that I love!

Does the Vaccine Prevent Severe Infections?

The critical and most important question, “Does this new vaccine prevent severe infections?” has not been fully answered yet. Thus far, the data again is reassuring. Ten severe Covid infections have occurred in both Pfizer study groups thus far, 1 in the vaccine group and 9 in the placebo group, which appears to be a nearly 90% reduction in severe cases with the vaccine.

Yet, this is not enough information to draw any final conclusions on severe infection rates and researchers will have to continue to collect data to answer this critical question. The Moderna results have not yet been published, but their severe infection rate has been reported to show similar dramatic reductions in the vaccinated group.

Who Should Get the Vaccine Now?

The vaccine is already being offered to people in the United Kingdom and in Canada.

The FDA has approved the Pfizer vaccine for emergency use, and assuming approval for the Moderna vaccine as well next week, in December 2020, 20 million doses from Pfizer and 20 million doses from Moderna will be available almost immediately, and as two shots are needed for each person, this will provide a vaccination for 20 million people in the US. Other countries will follow soon.

The CDC has recommended that the following two groups should be the first to get vaccinated:

  1. Health care workers (people at high risk for exposure and who are essential to treating new cases which are skyrocketing)
  2. The elderly with co-existing health disease (especially those living in nursing homes and those who receive medical assistance in retirement homes) that make them high risk for severe infections and death if they become infected.

Health care works and the elderly with co-existing health problems will likely use up the 40 million doses that are available initially.

In January 2021, another 50-100 million doses will be available for those the CDC believes are at high risk of infection, high risk of severe infections, and/or are essential workers, including:

  • School teachers and staff
  • Police and other emergency workers (fire departments, medics, etc)
  • Public transport drivers
  • Daycare workers
  • People over age 65-75 (age cut off to be determined)
  • People who are not elderly but have health conditions that increase their risk for severe complications if they become infected, including people with diabetes and heart disease.

Based upon the information available at this time, I am hopeful and optimistic that by the time the vaccine is available to the general public in February or March 2021, far more data will confirm its safety.

The bottom line is that the new Covid-19 vaccines being produced by Pfizer (as well as a similar vaccine created by Moderna) appear to have more benefit than risk!

Who Should Wait a Few Months or Longer Before Getting the Vaccine?

Children, pregnant women, and immunocompromised people have not been included in studies thus far and should wait until the vaccine is proven to be safe for them. I anticipate a vaccine will be studied in children within the next year, and pregnant women and immunocompromised people will likely be included in future studies as well.

For now, everyone, but especially children, pregnant women, and immunocompromised people should practice public health prevention measures (mask-wearing and social distancing) and hope that as many people as possible are vaccinated as soon as possible to protect them via herd immunity. If you fall into one of these unstudied groups, your unique situation will determine your risk and benefit with the vaccine and the best advice would be to talk to your physician who knows you personally.

Initial experience from the ongoing vaccination program in the United Kingdom with people who have a history of severe anaphylactic reactions (Anaphylaxis, which is a severe and rapidly progressive allergic reaction; people with this condition use an Epi-Pen when they have a life-threatening reaction to bee stings, peanut allergies, shellfish allergies, etc) suggests that they are at increased risk for a severe allergic reaction to the vaccine as well. If you have a history of anaphylactic reactions, check with your physician before getting the vaccine.

What Else Do We Need to Do Besides Get the Vaccine?

Until 80-90% of the population has developed immunity to Covid-19, infections will continue to ravage our economy and to kill people on a large scale. Likely 10% of people have already been infected and have developed some immunity, so until at least 70% of us have been vaccinated, the new infection rates will remain uncontrolled.

For the near future, we still need to:

  1. Wear masks whenever we leave our homes,
  2. Social distance,
  3. Avoid crowds and social gatherings (especially indoors), and
  4. Practice common sense measures like washing hands and using hand sanitizer when we touch anything in a public setting.

If we want to avoid unnecessary deaths and suffering, prevent shutdowns that harm our economy, and help get people back to work, following each of these four steps remains essential.

What Unknown Information Do We Need to Watch For?

Thus far, only about 20,000 people have received the Pfizer vaccine, and about another 20,000 people have received the Moderna vaccine, with only 2 months of safety information on the vaccine, yet what rare but serious side effects might occur long term? The truth is that we do not yet know.

As an example, the influenza vaccine appears to cause Guillain Barré Syndrome once in every 500,000 people vaccinated, with clearly more benefit than harm, yet while there should be more benefit than risk, there are always rare hazards to any vaccination program. Similar rare side effects are likely to occur with this new Covid-19 vaccine as well.

We also do not know how effective 1 injection instead of 2 injections 3-4 weeks apart will be. For now, everyone who gets the first shot should plan to get the second injection, unless they develop a rare adverse reaction to the first shot.

Will the vaccine prevent asymptomatic infections and reduce the spread of infections? We do not yet know the answer to this question, but studies will collect antibody response data soon and this information will become available. The risk is that the vaccine reduces all symptoms and leaves people contagious to spread the disease. Until this is clear, everyone who gets the vaccine needs to wear a mask and practice social distancing!  I am optimistic that the vaccine will prevent asymptomatic carriers, but this needs to be confirmed, not just assumed.

How Long will the Vaccine Be Effective?

Many scientists expect the Covid-19 virus to mutate over time and predict that we may need annual Covid-19 vaccines, like we do with the annual new influenza vaccine. For now, we hope that this vaccine is effective for at least 1 year, hopefully longer. Time will tell.

What Am I Going to Do?

I am in my mid-60’s, so I plan to get this vaccine as soon as it becomes available to me.

I hope this blog gives you the information you need to decide what to do as the vaccine becomes available.

Please be safe and follow all the public health guidelines for at least the next several months.


I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS


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Cauliflower, Cheese, and Burger Casserole Sat, 12 Dec 2020 03:00:26 +0000 The post Cauliflower, Cheese, and Burger Casserole appeared first on Steven Masley MD, LLC.


Casseroles are inviting, especially on a cold day. The oven warms the kitchen, sending a delicious aroma through the house, and the rich food is deeply satisfying for the whole family, plus this dish is easy to prepare. Traditionally this type of casserole would use potatoes or macaroni as a filler; here the cauliflower and Brussel Sprouts provide the added texture with a lovely flavor and a powerful load of nutrients without any gluten and without a huge load of sugar from the potatoes or pasta.

For burger options, you can use a plant-based burger (vegetarian), ground organic turkey, or free-range ground sirloin—please avoid ground hamburger as it is loaded with junk ingredients. Recently, I have been using plant-based burger products from Beyond Burger and Impossible Burger and I have been pleasantly surprised by how good these products taste. Both make amazing burgers, although I like the ingredients in Beyond Burger the best.

Prep Time: 30 Minutes

Baking Time: 30 Minutes

Serves: Six


6 cups cauliflower florets, chopped into bite sized pieces (1 medium-large head cauliflower)

2 cups Brussel Sprouts, stem removed and sliced in half lengthwise

2 tablespoons extra-virgin olive oil


1 tablespoon avocado oil

1 medium onion, chopped

2 cups button mushrooms, chopped

½ teaspoon sea salt

¼ teaspoon ground black pepper

½ teaspoon paprika

1 teaspoon Italian herb seasoning

1-pound burger (choose from plant-based, organic ground turkey, or free-range sirloin)

4 medium garlic cloves, finely chopped


3 organic-fed, free-range chicken eggs

1 cup organic full cream (or for a lower dairy fat option, organic low-fat milk)

10 ounces grated organic cheese, divided (For organic cheese options, I prefer Conte, Gruyere, or Sharp-Aged Cheddar, or use a blend of your favorite options that melt well.)



Preheat oven to 400° F.

Prep cauliflower and Brussel Sprouts, add to a cookie sheet with sides, toss with olive oil. Place in the oven on a middle shelf and bake for 25-30 minutes, until veggies are tender but still al dente. After the initial 15 minutes of roasting, pull the tray out of the oven and stir to mix the veggies, then return to the oven to continue roasting.

While veggies are baking, heat a large sauté pan to medium-high heat, add avocado oil, then onion, and sauté for 1 minute with an occasional stir, then add mushrooms, salt, black pepper, paprika, and Italian seasoning and heat with an occasional stir for another 2 minutes. Next, add the burger to the pan (plant-based, turkey, or sirloin), and with a wooden spoon break into small pieces. Continue to heat with occasional stirring until burger is lightly browned, reduce heat to low, stir in garlic and heat another 1 minute. Remove from heat.

Next whisk eggs in a bowl, add cream (or milk), and whisk again, then stir in half the grated cheese.

When the cauliflower and Brussel Sprouts have been roasted, reduce oven heat to 375°. Grease an oven-proof casserole dish, 9” x 13”, with extra-virgin olive oil. Add cooked burger, onion, and mushrooms to the bottom of the dish. Next, add cauliflower and Brussel Sprouts over the burger, then pour the mixture of egg, cream, and half the grated cheese over the pan contents. Sprinkle remaining half of grated cheese over the top.

Place dish in the oven on a middle shelf and bake for 25-30 minutes, until the top is lightly browned. If need be, switch from bake to broil for the final 4-5 minutes. Let stand on the counter for 5 minutes before serving.


Steven Masley, MD

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Gluten-Free Crab Cakes Sat, 28 Nov 2020 00:36:33 +0000 The post Gluten-Free Crab Cakes appeared first on Steven Masley MD, LLC.


I have always liked crab cakes but have felt that the traditional use of breadcrumbs or cracker crumbs has ruined them by adding gluten and a large sugar load. In contrast, here is a lovely recipe, easy-to-make, delicious, and both gluten-free and low in refined carbs.

Prep Time: 25-30 Minutes

Serves: Four (Makes 8 cakes)


2 large, organic-fed, cage-free eggs lightly beaten

1 pound fresh lump crabmeat

1 tablespoon Dijon mustard

2 tablespoons extra-virgin olive oil

½ medium sweet onion, chopped finely

½ teaspoon sea salt

¼ teaspoon ground black pepper

½ teaspoon Italian herb seasoning

4 medium garlic cloves, chopped finely

¼ cup Italian parsley, chopped finely

¾ cup blanched finely ground almond flour

2 tablespoons ghee

2 tablespoons extra-virgin olive oil


In a medium bowl, lightly whisk the egg. Mix in the crabmeat. Mix well with a fork, breaking up any large pieces, but be sure to leave small chunks of crab meat so that you can taste the crab. Mix in the mustard and set aside.

Heat a large sauté pan (or skillet) to medium heat. Add olive oil, then onion, and heat for 2-3 minutes with an occasional stir. Add salt, black pepper, Italian seasoning, and garlic, heat another 2 minutes, then set aside.

Add parsley to the crabmeat mixture. Then add sautéed onion mixture. Add flour and stir until well mixed.

Use a 1/4 cup scoop to portion out portions of the mixture. Use your hands to form the portions into eight 1/2-inch-thick patties and place on wax paper.

Reheat the large sauté pan to medium heat, add 1 tablespoon of ghee and 1 tablespoon of olive oil.  Next, add 4 of the crab cakes. Heat them for about 4 minutes without moving, until the edges on the bottom are lightly browned.

Carefully, flip the crab cakes, use a second spatula if needed. Cook on the other side, about 3-4 minutes, until lightly browned.

Then cook the other 4 crab cakes in a second pan, or repeat and cook in the same pan using remaining ghee and olive oil.


Steven Masley, MD



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Are artificial sweeteners worse than sugar? Tue, 24 Nov 2020 19:00:06 +0000 The post Are artificial sweeteners worse than sugar? appeared first on Steven Masley MD, LLC.


For decades, we have known that consuming sugar increases your risk for heart disease, diabetes, memory loss, cancer, and weight gain.

A recent study published in Circulation showed that women who had sugary beverages less than once per month, compared to those who had more than two servings a day — defined as a standard glass, bottle, or can — had a 63% increased risk of premature death. And those who only had 1 serving per day showed less risk than those with 2 or more servings per day, but much more than those who had none.

This risk has led many people and even many doctors to use diet drinks with artificial sweeteners and other food products instead of products with sugar.

Have diet products helped with weight loss? The reality is not much, and many would say long term that there is no sustained weight loss from choosing artificially sweetened products.

Now the latest study assessing the safety of artificially sweetened drinks was published in October 2020 in the Journal of the American College of Cardiology.

French researchers published their initial results after following 105,000 people over the last 6.6 years in a prospective observational study that is still ongoing. Study subjects completed dietary records every six months. The results were assessed sugar intake with non-calorie sweetener intake. Their aim was to assess how sugar intake and sweetener intake affect the risk for cardiovascular events, such as heart attack, stroke, or sudden cardiac death.

In this study, sugary drinks consisted of all beverages containing at least 5% sugar (i.e., soft drinks, syrups, 100% juice, fruit drinks).

For sugar, they compared:

  • Non-consumers (less than 1 serving per month)
  • Occasional users (less than 2 servings per day)
  • High consumers (2 or more servings per day)

For non-caloric sweeteners, they compared:

  • Non-consumers (less than 1 serving per month)
  • Occasional users (less than 2 servings per day)
  • High consumers (2 or more servings per day)

For sugar, the results showed that occasional sugar users showed a 5% increased risk for cardiovascular events and high consumers had a 20% increased risk.

For sweetener use, the results showed that occasional sweetener users showed a 15% increased risk for cardiovascular events and high consumers had a 32% increased risk. The most common sweeteners used in this study appear to be the artificial sweeteners, aspartame (sold as Equal and NutraSweet) and Sucralose (sold as Splenda).

This initial data from an ongoing study shows that drinking beverages with artificial sweeteners are equally harmful to drinking beverages with sugar, and artificial sweeteners may be even worse for you.

It was not a surprise to anyone that drinking beverages with sugar increased the risk for serious cardiovascular events. Yet, the results showing harm from diet drinks should be eye-opening and a major wake-up call for people who use artificial sweeteners regularly.

The most likely mechanism for the harm caused by artificial sweeteners is that they have been shown to kill good bacteria in the gut and promote the growth of bad microbes, causing gut microbiome chaos and disorder.

We know that healthy gut microbes help us in many important ways:

  • They help us lose weight
  • Improve blood pressure levels
  • Reduce LDL and total cholesterol levels to normal
  • Improve blood sugar control
  • Decrease inflammation
  • Reduce levels of TMAO, a compound produced by gut bacteria that is associated with increasing cardiovascular events by 62%.

The bad gut microbes show the opposite harmful effects.

The reality is that artificial sweeteners kill the healthy gut microbes that protect us from nearly all the risk factors for cardiovascular events. With this in mind, we should not be surprised that consuming artificial sweeteners increase our risk for heart disease.

A previous study was published in Nature, showing that the most commonly used artificial sweeteners saccharin, sucralose, or aspartame all adversely impacted the gut microbiome and worsened blood sugar control.

One limitation of this ongoing French study is that researchers combined natural sweeteners, such as stevia, with artificial sweeteners such as Aspartame (sold as NutraSweet and Equal) and Sucralose (sold as Splenda). It would be far better if they were looking at them separately.

To date, there is no evidence that natural sweeteners (Stevia) harm the gut microbiome, or cause any other significant harm, yet this will require further observation over time. There is some limited information that stevia and other natural sweeteners (like Xylitol) may block the growth of some beneficial bacterial species, limiting their proliferation. Even though they do not appear to kill large numbers of good bacteria, they may inhibit some good bacteria from growing.

For now, I strongly recommend that all of us avoid the use of sugar and artificial sweeteners—including aspartame (blue packs), saccharin (pink packs), and sucralose (yellow packs). It is ironic that these artificial sweeteners were initially created to help prevent diabetes and weight gain, but that they may actually cause the same problem that they were intended to prevent.

Our best choice is to enjoy food that is unsweetened, natural, and unprocessed! Food can still taste delicious without overwhelming our taste buds with sweetness.

For an occasional treat when you want to celebrate a special occasion, stick with a natural ingredient, such as a small quantity of honey. If you use natural sweeteners, do so only occasionally.

Although not as sweet as sugar or artificial sweeteners, fresh fruit offers our palate some sweetness, without a jump in blood sugar levels and it nourishes our healthy gut microbes. Fresh fruit is good for us, and we should eat 2-3 servings daily.

HOLIDAY: We will celebrate Thanksgiving this Thursday and if you are as well, I hope you have a wonderful holiday.  If you are looking for some Thanksgiving day recipes, click here!

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS


  1. Jotham Suez et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. NATURE 9 October 2014;514:181-86. doi:10.1038/nature13793
  2. Affect of stevia on Lactobacillus reuteri. Letters in Applied Microbiology, 2014;58.3: 278-284.

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Roasted Chicken with Wild Mushroom-Saffron Sauce Fri, 13 Nov 2020 18:16:44 +0000 The post Roasted Chicken with Wild Mushroom-Saffron Sauce appeared first on Steven Masley MD, LLC.


This recipe has been adapted from a delightful dish that Nicole and I enjoyed on the Atlantic Coast of Spain, which was made with quail and a mushroom-saffron sauce.  It is easy to prepare and has a lovely and delicate flavor. I am assuming that most people would have trouble finding quail or pheasant for this recipe, so I chose chicken, and you can use chicken breast or chicken thighs as you prefer. For a vegetarian option, you could even substitute tofu for the chicken, and cover it with the mushroom-saffron sauce, using vegetable broth instead of chicken stock. I recommend serving this dish with a steamed green vegetable on the side to compliment the flavor and provide a splash of color.

Prep Time: 30 Minutes

Oven Baking Time: 30 minutes

Serves: 2


12 ounces chicken breast, cut into 1-inch wide strips

2 tablespoons extra-virgin olive oil

¼ teaspoon sea salt

¼ teaspoon ground black pepper

½ teaspoon dried thyme


1 cup low-sodium chicken stock

1 pinch saffron (1/4 teaspoon)


2 tablespoons ghee

½ medium white onion, chopped finely

4 cups wild mushrooms, sliced (chanterelles, shiitake, porcini, or oyster mushrooms)

¼ teaspoon sea salt

4 tablespoons almond flour (or almond meal)



Preheat oven to 325°(F).

Meanwhile, in a baking dish, combine chicken, olive oil, salt, black pepper, and thyme. Bake for 30 minutes until internal chicken temperature reaches 165-170°, about 30 minutes.

While chicken is baking, heat chicken stock in a saucepan until gently bubbling. Smash saffron stamens between your fingers and drop them into the stock and simmer for 15 minutes. Then remove the pan from heat and set aside.

Next, prep onion and mushrooms, then heat a sauté pan to medium-high heat, add ghee, onion and heat with an occasional stir for two minutes. Next, add mushrooms and salt and cook with an occasional stir for 3 minutes until mushrooms have softened.

Reduce heat to medium, add flour and stir occasionally with mushrooms for about 4 minutes.

Pour chicken stock with saffron from the saucepan into the sauté pan and reduce to a low simmer for about 10 minutes with a rare stir and continue to heat until chicken is cooked. You want the liquid to thicken into a sauce, but if it becomes a bit dry, add a few tablespoons of water or white wine to maintain a medium-thick sauce.

Lastly, add chicken to a serving dish, pour the mushroom-saffron sauce into the serving dish mixing with the chicken, and serve.



Steven Masley, MD



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Shrimp and Avocado Cocktail Fri, 30 Oct 2020 22:48:01 +0000 The post Shrimp and Avocado Cocktail appeared first on Steven Masley MD, LLC.


Avocados are in season in Florida, and I am looking for ways to use these delicious and super healthy fruits. This is a variation of a recipe that we enjoyed in Spain, easy to prepare and terrific to eat.

Prep Time: 15 Minutes

Serves: 4 as an appetizer


2 tablespoons extra-virgin olive oil

1 medium white onion, chopped finely

¼ teaspoon sea salt

¼ teaspoon ground black pepper

½ teaspoon dried thyme

½ pound shrimp, peeled, deveined, and chopped

2 tablespoons fresh cilantro, chopped

1 tablespoon lime juice

Optional, 1/8 teaspoon dried cayenne powder

1 Haas avocado, diced into ½-inch pieces


Heat a sauté pan to medium heat, add olive oil, then onion and heat for 3 minutes with an occasional stir until the onion softens, add salt, black pepper, thyme, and shrimp, and heat another 3 minutes with occasional stirring until shrimp are cooked.

Transfer to a bowl and toss with cilantro and lime juice. If you enjoy spicy heat, add the optional cayenne powder. Stir in avocado.

To serve, spoon mixture into small bowls and gently pack contents to the bottom. Invert bowls over a salad plate.

Garnish with a sprig of cilantro and/or a whole shrimp. Serve immediately.

If serving later, drizzle lemon juice over the mound, then cover and refrigerate.


Steven Masley, MD



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New Tips to Prevent and Reverse Memory Loss Mon, 26 Oct 2020 19:23:06 +0000 The post New Tips to Prevent and Reverse Memory Loss appeared first on Steven Masley MD, LLC.


Evidence is growing that we can prevent and even reverse memory loss, and the earlier we start, the greater our success.

This is an extremely important issue, as cognitive decline is the most expensive and debilitating disease in the US and the western world.

What makes this even more alarming is that the rates for memory loss are projected to double between now and 2030, just a decade away.

Memory loss is also the disease that people dread the most, even more than cancer, as nobody wants to lose their independence and become a long-term burden on their loved ones.

Sugar (and flour) consumption with consequential abnormal blood sugar control remains the #1 cause for memory loss and taking steps to improve insulin sensitivity seems fundamental to prevent this rapidly growing problem. Even mild elevations in blood sugar levels result in a dramatic increase in your risk for cognitive decline. However, blood sugar control is not the only cause and at least two dozen other factors contribute to cognitive decline.

Here are tips from my book, The Better Brain Solution, that will help improve your brain performance and decrease your risk for memory loss:

  1. Avoid consuming sugar and flour, such as sweets, bread, cereals, and crackers.
  2. Add daily activity, with a mixture of strength training and aerobic movement.
  3. Follow a Mediterranean diet, eating more vegetables, fruits, nuts, seafood, olive oil, beans, spices and herbs.
  4. Meet your brain nutrient needs, especially for long-chain omega-fats, vitamin B12 and natural folate, magnesium, vitamin D, and probiotics.
  5. Manage your stress proactively, adding meditation daily and a good night’s sleep.
  6. Avoid brain toxins, like tobacco, mercury, nitrosamines, and inorganic copper.

There are brand new tips to help you prevent and reverse memory decline in the latest book, The End of Alzheimer’s Program, by my colleague Dr. Dale Bredesen, MD. For people with early memory loss, it will help to restore brain function and quality of life. Dr. Bredesen has even helped some people reverse Alzheimer’s disease, something that was previously thought impossible.

Fasting is one of Dr. Bredesen’s simple to follow steps. Fast for at least 12 hours (and up to 15 hours) either every day or most days of the week. Basically, you avoid eating or drinking food and beverages starting at 8 pm at night and do not consume any calories until 8 am the following day. The time you chose to fast is up to you. Fasting helps prevent you from forming beta-amyloid, the protein that is associated with Alzheimer’s disease. Fasting also appears to help improve insulin sensitivity and blood sugar control.

Below you will find the interview I did with Dr. Dale Bredesen discussing his NEW book The End of Alzheimer’s Program.  

The bottom line is that there are many steps that will improve your cognitive function and potentially prevent memory loss.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS




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Chili Fri, 16 Oct 2020 23:26:14 +0000 The post Chili appeared first on Steven Masley MD, LLC.


As the heat of summer abates, I look forward to making a pot of chili. This recipe is healthy and flavorful, and you have the option to make it with organic ground turkey; using grass-fed, pasture-raised ground sirloin; or make it vegetarian.

There is some debate as to whether the original recipe for chili had beans or was made with chili powder and meat, yet including beans makes it super healthy as beans are loaded with fiber, the most powerful antioxidants on the planet, plus many other nutrients. You can make it with cooked pinto beans or dark red kidney beans or a mixture of both. Adding organic corn provides a splash of color and flavor, plus if making a vegetarian version, the beans help balance the amino acids to form a complete protein. Whichever bean you choose, avoid canned beans with a BPA or BPS lining. The best option is to soak dried beans for 8-12 hours and cook them until they are just right—see instructions below.

How much chili powder (heat) to add is up to you; chili powder spice varies greatly as does people’s tolerance for it, so add it gradually as you assess how much spicy heat you want to provide. I like to use mild chili powder for flavor and adjust the heat level with cayenne.

Chef’s Note on Soaking and Cooking Beans

Pour your beans onto a cookie sheet and discard any that are shriveled or discolored (also discard any small rocks).

Rinse beans in a strainer. In a bowl, soak for 8-12 hours, as the beans will absorb the soaking water be sure they are covered in a couple of inches of water to start.

Soaking beans has four important benefits:

  • It shortens the cooking time.
  • They cook more evenly.
  • They are easier to digest and they will cause less gas and bloating when you eat them.
  • When you soak your own beans, you avoid canned beans that may be contaminated with toxins—BPA and BPS.

Rinse and drain the soaked beans (further reducing the compounds that cause bloating and gas formation). Add to a pot, cover with an inch of water and bring to a boil. Reduce heat to low and simmer for 1 hour. Add a teaspoon of salt to the liquid and test the beans about every 15 minutes to see if they are fully cooked. You want beans that are completely smooth, tender, and soft; if the beans are even a little “crunchy,” they aren’t done, but you also do not want to overcook them until they become mushy. Soaked beans typically take 75 to 100 minutes to cook, unsoaked beans take 2-3 hours to cook.

1 cup of dried beans will typically make 3 cups cooked, or 1 1/3 cup of dried beans to make 4 cups of cooked beans.


Prep Time: 25-30 Minutes, plus the time to prepare the beans.

Makes: 6 Servings (which make great leftovers)


4 cups cooked beans (pinto or dark red kidney beans), rinsed and drained

2 tablespoons avocado oil

1 medium white onion, chopped

½ teaspoon sea salt

¼ teaspoon ground black pepper

2 medium celery stalks, chopped

1 teaspoon dried oregano

½ teaspoon ground cumin

1 pound organic ground turkey (or organic, grass-fed sirloin; or vegetarian crumbled burger)

4 medium garlic cloves, chopped

2 cups chopped tomatoes

1 red bell pepper, seeds and stem removed, chopped

2 cups organic corn (frozen, jarred, or fresh)

1-4 teaspoons chili powder (add to taste)

¼-½ teaspoon cayenne pepper to taste (optional)

½ cup low-sodium broth (vegetarian broth or chicken stock)

¼ cup chopped cilantro

Optional Garnish: 1 avocado cubed and/or ¼ cup organic sour cream


Rinse and drain cooked beans and set aside.

Heat a large pot to medium-high heat, add avocado oil, then onion, salt, and black pepper, stirring occasionally for 2-3 minutes until the onion softens. Add celery, oregano, and cumin and heat for another 2 minutes with an occasional stir. Add ground turkey, (ground sirloin, or vegetarian crumbles, stir frequently to break up the big clumps and heat until lightly browned.

Reduce to medium heat, add garlic, tomatoes, bell pepper, and corn. Heat another 5 minutes with an occasional stir. Add chili powder and/or cayenne pepper to taste, then stir in broth, cover, and simmer for 5 minutes.

Just prior to serving, stir in cilantro. To serve, garnish individual bowls with cubed avocado and/or sour cream.


Steven Masley, MD

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Healthy Southwest Avocado Bean Salad Fri, 02 Oct 2020 14:05:48 +0000 The post Healthy Southwest Avocado Bean Salad appeared first on Steven Masley MD, LLC.


This recipe is from The Fitchen, a great place for healthy, simple recipes that help you stay fit in the kitchen. There you’ll find mostly plant-based and gluten-free recipes.

If you have a delicious and healthy recipe that you would like to share please send a recipe to: 

This recipe is a perfect side dish for bringing to gatherings. It is easy to make, with minimal clean-up, and full of mouthwatering southwest flavors. Much safer and easier than potato or egg salad!

Photo by Jordan Cord © TheFitchen

Prep Time: 10 mins

Yield: 4 servings


1 – 15 oz. can of black beans (use BPA/BPS free cans, or better, soak them in advance and make from scratch)

1 – 15 oz. can of pinto beans (use BPA/BPS free cans, or better, soak them in advance and make from scratch)

2 tomatoes, on the vine or roma

2 ripe avocados

1/3 cup frozen or fresh corn

1 tablespoon lemon juice

1/2 cup red onion

1 teaspoon sea salt

1/2 teaspoon black pepper

1/4 teaspoon chili powder

1/4 teaspoon paprika

1/4 teaspoon garlic powder

1/4 teaspoon onion powder

1/4 teaspoon cayenne pepper

1/8 teaspoon oregano

a pinch of allspice

garnish with cilantro


Drain beans and pour into a large bowl, preferably one that’s portable and has a lid!

Add sea salt and mix with beans.

Dice the onion and add to the bowl.

Chop tomatoes into ½-inch pieces and toss into the bowl.

Dice the avocados into ½-inch pieces and toss into the bowl.

Add 1 tablespoon of lemon juice to the bowl.

Add seasonings and mix everything together until well combined.

garnish with cilantro


P.S. If you want to learn how to grow your own avocado tree or other great information on plants and gardening please check out The Gardener’s Path, here.




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What is the best source of water to drink? Tue, 29 Sep 2020 00:33:49 +0000 The post What is the best source of water to drink? appeared first on Steven Masley MD, LLC.


Water is essential to life. About 70 percent of the human body is made up of water and, coincidentally, more than 70 percent of Earth is covered in water.

You can survive for 30-45 days without food, but you will only live for 3-4 days unless you consume water.

It is recommended you consume 4-8 cups of water per day; how much of that you need depends on your activity, temperature, and the quantity of vegetables and fruits you consume—fresh produce is an excellent source of hydration.

The best indication of hydration is NOT how much you drink, but the color of your urine. Ideally, your urine should be clear, not light yellow, and not dark yellow. (Although some supplements with extra riboflavin make the urine bright florescent yellow, so you may need to skip your supplement for a day to assess your hydration status.) The darker the color of your urine, the more dehydrated you are.

Waiting until you feel thirsty is too late, as thirst is a delayed sign of dehydration. The body functions best when you are fully hydrated. Notice how diligently athletes hydrate to ensure maximum physical performance.

Hydration is especially important for people with a history of kidney stones as concentrated urine has crystals that may produce stones, and keeping the urine diluted is the best way to avoid future stones.

Consuming some fluids such as alcohol, sodas, coffee, and tea, only provides limited net hydration because they increase urination— sadly, this is all some people drink. Drinking pure water is the best way to hydrate. Herbal infusions are another excellent source of hydration.

Obtaining pure water has become more complicated. Public water supplies are treated to kill microbes that can make us sick, which is not a bad thing, but water contamination and bad city plumbing can cause major problems. As we have heard from Flint, Michigan, some public water systems are also contaminated with harmful chemical compounds. Sadly, Flint was not a unique situation and many public water systems nationwide are contaminated.

Drinking water from plastic bottles is highly problematic. Plastic bottles leak phthalates into the water—a toxic compound that is an endocrine disrupter. In the past few years, researchers have linked phthalates to asthma, attention-deficit hyperactivity disorder, breast cancer, obesity, type II diabetes, low IQ, neurodevelopmental issues, behavioral issues, autism spectrum disorders, altered reproductive development, and male fertility issues.

Let alone that all that plastic ends up polluting the environment!

I am not worried if someone on occasion drinks water from a plastic bottle, but some people drink several plastic bottles every day, which would provide very high levels of phthalates.

If you buy water in a bottle, it should come in glass. The challenge is that drinking bottled water in glass is more expensive, and is rarely available.

At home, the most economical and healthy source of drinking water comes from reverse osmosis. The public water supply can be pumped under pressure through a membrane, producing very pure water (chemical-free). At our home and sailboat, we have a Reverse Osmosis water maker to produce water. It tastes much better than tap water too.

Filling a stainless steel water bottle (preferably not a plastic bottle) provides a useful way to carry water from home when you are out and about.

There are a variety of other filtration devices using carbon and ceramic filters, but clearly, the best source of home water is produced using reverse osmosis. A reverse osmosis unit can be installed under your kitchen sink and provide drinking and cooking water for your home. There are even countertop models that are now available. The cost to install a reverse osmosis unit in your home may vary from $200-$500, which is expensive upfront, but actually cheaper than drinking bottled water long term.

I recently received an article discussing reverse osmosis water production. The source of the article, had nothing to sell but had very detailed information on reverse osmosis systems, which I thought was refreshing. Please click here to see more information on reverse osmosis.

I highly recommend that you hydrate with pure water daily, either drinking water from a glass bottle or from water produced through reverse osmosis.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS


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Sicilian Orange Salad Thu, 17 Sep 2020 02:31:33 +0000 The post Sicilian Orange Salad appeared first on Steven Masley MD, LLC.


We were served this delightful salad multiple times in Sicily. It is very refreshing on a hot day. Depending upon who is making it, fennel is optional, sometimes the onion is white and sometimes red, but it always has the orange wedges, parsley, and olive oil. Some serve it with a dusting of breadcrumbs—although I like it better with pistachio crumbs instead of breadcrumbs, both for the flavor and the lower glycemic load.

Prep Time: 20 Minutes

Serves: Four


4 medium-large oranges, peel and cut into bite-sized wedges

1 small red onion, sliced thinly

1 medium-small fennel bulb, chopped into small pieces

2 tablespoons Italian parsley, chopped finely


4 tablespoons extra-virgin olive oil

¼ teaspoon sea salt

1 teaspoon honey


1 teaspoon pistachio crumbs (finely chopped pistachios)


 Add salad ingredients to a serving salad bowl.

Wisk vinaigrette dressing ingredients and toss with the salad.

Add salad to serving plates.

Garnish with pistachio crumbs.

Enjoy! 😊

Steven Masley, MD



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Can Eating Canned Food Kill You? Mon, 14 Sep 2020 17:30:17 +0000 The post Can Eating Canned Food Kill You? appeared first on Steven Masley MD, LLC.


​Yes, eating out of cans that have a BPA lining can actually kill you! A study published last month in JAMA showed that people over age 20 with high levels of BPA in their urine have about a 50% greater risk of death than people with low levels. Bisphenol A (BPA) is a chemical produced in vast quantities and used as the inner lining on food containers; BPA is part of the family of compounds that come from polycarbonate plastics and epoxy resins.

Researchers tested nearly 4,000 adults for BPA levels in their urine and followed them for more than 9 years and noted that there was a 49% higher rate for all-cause mortality and was 46% higher for deaths related to heart disease. (JAMA Netw Open. 2020;3(8):e2011620. doi:10.1001/jamanetworkopen.2020.11620).

The population studied comes from one of the most reliable databases in the United States. The National Health and Nutrition Examination Survey (NHANES) is a nationally representative health survey program of the resident population in the United States. It is administered by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC).

Past studies on BPA have shown that consuming it increases your risk for weight gain, diabetes, hypertension, and heart disease, but this is the first solid evidence that consuming BPA can kill you. The basic action of BPA is to disrupt hormone activity and blood sugar control, so it should not surprise you that it leads to diabetes, hypertension, and heart disease.

The authors controlled for multiple risk factors in this population, including age, sex, race/ethnicity, educational level, family income, smoking status, alcohol drinking, physical activity, and dietary intake; and even after factoring in all these variables, it remains clearly a toxic compound.

BPA has been banned in France, Canada, Belgium, and Sweden, yet it is still commonly used in most of the USA and is consumed daily by millions of people.

Where is BPA found?

Bisphenol A is a polycarbonate plastic coating. BPA is used extensively in food and drink packaging, including water and infant bottles and medical devices. Epoxy resins are used as lacquers to coat metal products such as food cans, bottle tops, and water supply pipes. Some dental sealants and composites may also contribute to BPA exposure. Thermal paper in the form of sales receipts also contains these polycarbonate compounds.

If you are concerned about your level of BPA, you can ask your doctor to measure it with a urine test, although this type of testing will not likely be covered by your insurance. More important than testing your level would be to avoid future BPA consumption, as once you stop ingesting it, your body will remove the BPA you have stored over time.

What about other chemical liners used in cans as a BPA substitute?

Unfortunately, a can may be labeled BPA free, but still use other toxic compounds as a liner. An example is a compound called BPS. BPS is an analog of BPA with a similar structure of 2 phenol groups on each side of a sulfonyl group. Polymers made of repeating BPS units are called polyethersulfone (PES).

The original reason used to substitute BPS for BPA has been that BPS is considered less likely to leach into food and drink. However, as BPS has become more common in society and is being used in BPA-free products, there have been reports that as many as 81% of people in the United States and Asia are testing positive for BPS exposure in their urine samples, so the bottom line is that we do absorb BPS, not just BPA.

BPS has been shown to be associated with a variety of similar serious health issues (including weight gain, obesity, abnormal blood sugar control, and cancer). BPA, BPS, and PES are all biochemically very similar so it would be best to avoid all of these plastic liners. Thoene M, Dzika E, Gonkowski S, Wojtkiewicz J. Bisphenol S in Food Causes Hormonal and Obesogenic Effects Comparable to or Worse than Bisphenol A: A Literature Review. Nutrients 2020 Feb; 12(2): 532.

What Should You Do to Avoid Toxic Compounds in Food Packaging and Containers?

  • Avoid canned foods (look for products stored in glass, porcelain, or stainless steel).
    • Yes, some cans are BPA free and it is stated on the can label, but you also need to confirm that they do not use other toxic liners made of other compounds such as BPS and PES. It takes serious research to be sure that cans are toxin-free.
  • Don’t heat your food in a plastic container; polycarbonate plastic food containers often contain BPA or other similar polycarbonate plastics and they will be released into the food with heating.
  • Avoid drinking or eating out of products stored in plastics. Plastic containers have recycle codes on the bottom. Some, but not all, plastics that are marked with recycle codes 3 or 7 may be made with BPA, and other plastics may contain BPS. In particular, do not drink out of plastic bottles with codes 3 or 7.
  • Use baby bottles that are BPA free. (Many but not all places have banned BPA in baby bottles.)
  • When having dental work, confirm with your dentist that they are not using any products that contain BPA, BPS, PES, or other polycarbonate compounds.
  • Avoid touching thermal sales receipts as the ink contains polycarbonate compounds. Cashiers that handle them often should wear gloves.

It may sound depressing to have to worry about the toxicity associated with processed foods, but the good news is that real food does not have plastic liners that can poison you. Learn to enjoy eating foods that are made from scratch with vegetables, fruits, beans, nuts, spices, herbs, oils from glass bottles, and clean protein sources—they taste better that way too!

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS



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Provençal Ratatouille Fri, 04 Sep 2020 01:16:38 +0000 The post Provençal Ratatouille appeared first on Steven Masley MD, LLC.


​By Foodie in Provence

“I can hardly imagine Provençal summer without ratatouille. Not the movie, of course, although we could consider it as ‘how to’. The dish is an ode to summer vegetables and in fact, cannot be cooked outside of the summer season. The word “ratatouille” comes from the Occitan ratatolha and is related to the French ratouiller and tatouiller, expressive forms of the verb touiller, meaning “to stir up”. Originally, the word “ratatouille” means stew of cooked vegetables, especially eggplant, onions, zucchini, peppers and tomatoes, and garlic. There is no ‘real’ recipe for ratatouille and you can change the basic recipe to your liking.”

This recipe was submitted for our community from “Foodie in Provence”—aka Hana, Provence is a department in SE France along the Mediterranean Sea and into the southern French Alpes. As the author of this lovely recipe suggests, take advantage of these summer vegetables when they have their peak flavor. I personally would skip serving this with bread, but included this suggestion as written. The original recipe did not include a quantity for olive oil or herbs, nor salt and pepper; I added some amounts of each as a basic reference but feel free to use more or less to taste. As most of the nutrients in tomatoes are in the skin and seeds, I would chop the tomatoes and use the whole tomato, but in the true French tradition, you will see that the author prefers them without.

Hope you enjoy this delicious recipe! I am sending it to you from the island of Ibiza in Spain. Over this summer, Nicole and I have made a variation of ratatouille several times per month as the markets in the Mediterranean region are packed with these summer vegetables and this is one of our favorite dishes.

If you have recipes that you would like to share with our community, please submit them to


1 eggplant

2 zucchinis

1 onion

2 cloves garlic

1 red pepper

1 green pepper (optional)

2 medium tomatoes or 1 cup chopped tomatoes

2-3 tablespoons extra-virgin olive oil

¼ to ½ teaspoon sea salt

¼ teaspoon ground black pepper

2 teaspoons dried or 2 tablespoons fresh mixture of Provencal herbs: oregano, thyme, tarragon, and rosemary. Plus 1 tablespoon fresh basil


Wash vegetables and herbs.

Dice onion, chop garlic. Chop remaining vegetables and herbs.

Preheat your pan to medium heat, pour in olive oil and sauté onion for a few minutes.

Add diced eggplant, cook for a couple of minutes, then add garlic, zucchini, and peppers.

Meanwhile, prepare your tomatoes: pour boiling water over the tomatoes and let stand for 5 minutes. Peel the skin and dice the pulp. Discard the seeds. Add to the stew.

Add all herbs except basil.

Let cook until the vegetables are slightly cooked, but don’t overcook otherwise they’ll become mushy.

Let stand for a few minutes, add basil. Serve immediately with sourdough bread, as a side dish or with gluten-free pasta.

Bon Appetit and wishing you the best of health!

Steven Masley, MD




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Tips to Decrease Arthritis Pain-Part 2 Tue, 25 Aug 2020 00:46:42 +0000 The post Tips to Decrease Arthritis Pain-Part 2 appeared first on Steven Masley MD, LLC.


As I discussed last week, arthritis symptoms are common. Fortunately, lifestyle choices make a big difference in your level of symptoms and your ability to stay active. The combination of an anti-inflammatory diet, daily activity, and joint supporting supplements can make a dramatic difference in staying pain-free and active.

Please click here to view Part One of Tips to Decrease Arthritis Pain, which focuses on lifestyle choices and clarifies how arthritis drugs often cause more harm than benefit.

If diet, activity, and supplements do not fully cover your pain, joint injections can be very helpful to decrease inflammation and provide pain and swelling relief for 3-12 months. Yet the surprising truth is that the most common treatment offered by physicians may be the worse option available.

Steroid (cortisone) joint injections are commonly used by doctors and they do provide arthritis joint relief for up to 3 months, but not only do they lower inflammation short-term, but they also damage the remaining cartilage and accelerate the destruction of the joint over time. If you are trying to postpone a joint replacement surgery, then it is not such a big deal to have a cortisone injection in a joint that you plan to replace in the near future, but people who hope to avoid a future joint replacement should absolutely avoid cortisone joint injections. And with the newer treatments available, many people who thought they needed a joint replacement may not really need a new joint and all the rehab that goes with it after all.

Better options for arthritic joint relief are joint injections with either PRP or hyaluronic acid injections.

Hyaluronic acid is a substance that is naturally present in the human body. It is found in the highest concentrations in fluids in the eyes and joints. The hyaluronic acid that is used in joint injections is extracted from rooster combs.

Over a decade ago, I tired a series of 3 hyaluronic acid joint injections for my right knee and noticed some modest relief, not enough that I wanted to repeat it when they offered to repeat the injections six months later.

A far better choice is PRP. Platelet Rich Plasma (PRP) is a fluid loaded with platelets that promotes healing for joints, tendons, and other tissues. Up until recently, this was a treatment limited to professional athletes who needed to heal quickly and protect their joints for the future, but more recently this treatment has been offered to anyone with arthritis. Although, the irony is that while insurance companies may cover treatment for NSAID drugs and cortisone injections, they may refuse to cover what appears to be a safer and more effective treatment with PRP.

Let me clarify how PRP works. Inside an artery when there is bleeding, platelets help form a clot to stop the bleeding. In a joint with inflammation, platelets help promote healing and normal joint fluid production. Platelets help restore health and healing wherever they are found in the body.

In a doctor’s office, a technician will draw your blood (typically anywhere from 6 to 20 tubes are collected), the blood is spun to concentrate the platelets, and then a few hours later the PRP solution can be injected back into the same person’s body. Injecting one person’s platelets into another person’s body is thereby avoided.

Within 2-12 hours of a PRP injection, the injected site will often be tender for up to 24 hours and some providers offer a pain medicine prescription to cover any discomfort during the first 24 hours—something I have learned to accept and take after an injection. (I declined to use any pain meds the first time I had my thumbs injected and I was very sorry for 12 hours).

The benefits of joint pain reduction are usually noted within a few days to a week and can last for months and sometimes even a year or more. I have tried this for several joints and noticed a 70-80% reduction in joint pain for up to one year or longer.

A recent study published in the Journal of Arthroscopy compared the effectiveness of PRP versus Hyaluronic Acid injections for subjects with knee osteoarthritis. (Jixiang Tan, Hong Chen et al. Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: a Meta-Analysis of 26 randomized controlled trials. Arthroscopy, July 14, 2020.)

They reviewed 26 randomized controlled trials involving a total of 2,430 patients. Those receiving PRP injections had significantly greater improvement in pain, joint stiffness, and activity levels than those receiving hyaluronic acid injections. There was no significant difference in adverse events between the two groups. The bottom line, similar to my own experience, is that PRP is far more effective in managing advanced osteoarthritis pain than hyaluronic acid.

There are some theories (and some physicians who like to claim) that annual PRP injections may slow the progression of future arthritis joint degeneration, but for now this is only speculation and remains unproven.

My hope would be that if you are one of the many people who have arthritis by following an anti-inflammatory diet, staying physically active, and taking omega-3 oil and curcumin supplements would be enough to manage your symptoms, avoid joint pain, and help you to stay active. With my arthritis, I have given up running, but thanks to following these steps, I have otherwise been able to do just about everything I want to do. When I have had a flare in my symptoms, especially related to my knee after 5 surgeries, it is nice to have a PRP joint injection as another option. It is reassuring to know that relatively safe and effective therapy options are effective for arthritis symptoms.

For more details on PRP and stem cell therapies, watch my recording with Dr. James Leiber, an expert in the field of PRP and stem cell therapy. 

Not only is a healthy lifestyle good for your heart and brain, but it is also great for your joints.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS

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Tips to Decrease Arthritis Pain- Part 1 Mon, 17 Aug 2020 19:11:20 +0000 The post Tips to Decrease Arthritis Pain- Part 1 appeared first on Steven Masley MD, LLC.


The most common form of arthritis is osteoarthritis, typically caused by wear and tear or trauma. If your parents have had arthritis, you are more likely to get it as well.

Less common arthritis forms are caused by auto-immune diseases (such as Rheumatoid or Psoriatic Arthritis). These systemic inflammatory diseases can cause dramatic damage to joints unless managed appropriately. I am going to focus on the more common osteoarthritis form in this blog, but all the steps that help osteoarthritis are also helpful for auto-immune induced arthritis as well. I highly recommend that if you have an auto-immune form of arthritis that you should seek help from a functional medicine focused physician as well.

Both my parents have had osteoarthritis, so not surprisingly I have it too—a bit in my spine, more in my thumbs, and especially my right knee. 25 years ago, I fell while downhill skiing in heavy powder and tore the ACL ligament and medial meniscus in my right knee. I had an initial surgery to repair the ACL but have also had four other surgeries to trim subsequent tears in the medial meniscus, leaving my right knee with bone rubbing on bone.

30-40 million people suffer from osteoarthritis and by age 65 nearly 50% of Americans report arthritis pain.

Your food choices do make a difference in your symptoms. An inflammatory diet makes your pain worse and an anti-inflammatory diet will make it better. This means eating sugar, refined and processed food will increase your inflammation levels and increase your level of arthritis pain. In contrast, eating a Mediterranean diet with more fruit, vegetables, beans, nuts, olive oil, herbs and spices, as well as seafood will decrease inflammation and arthritis symptoms.

Activity also improves joint pain. Walking, cycling, exercise on an elliptical machine, strength training, and other forms of non-pounding movement enhance joint function and symptoms. If you have arthritis in your knees, ankles, or back, running on hard surfaces such as concrete should be avoided if it causes pain, but otherwise, most movement is surprisingly good for your joints.

You can measure your level of inflammation with a simple hs-CRP test (high sensitivity C-reactive Protein, not to be confused with the basic, not high sensitivity CRP test which is far less sensitive). The hs-CRP test is fairly inexpensive, $20-$30 per test, and the doctor ordering it typically gets the results back within one day. A normal level is less than 1.0, high-risk for high levels of inflammation is a level of more than 3.0, and excellent inflammation control gives you a hs-CRP level less than 0.5.

This lab measurement does not need to be done fasting, but please do not measure your hs-CRP level within 3-4 weeks of when you have an acute injury or illness as your levels will jump initially and provide a false high reading—the test is intended to be done to measure your baseline level of inflammation.

Not only do your food choices make a big difference, but anti-inflammatory supplements can also lower inflammation and your hs-CRP level nicely. Some of my preferred options are long-chain omega-3 oils (commonly called fish oil) and Turmeric (Curcumin is the active agent in turmeric and comes in a concentrated form). Both omega-3 oil and Curcumin extract have been shown to lower hs-CRP levels and to reduce joint pain in clinical studies. Other anti-inflammatory herbs that I feel are not as effective as fish oil and Curcumin but that could be considered include:

  • Green tea
  • Ginger
  • Willow bark
  • Pycnogenol (pine tree extract)
  • Capsaisin (chili pepper concentrate)
  • Boswellia (Frankincense)

Other supplements used to manage arthritis include glucosamine sulfate and chondroitin, despite that they do not provide any anti-inflammatory benefit, both provide ingredients are believed to nourish cartilage cells. Chondroitin has very limited absorption (less than 10% of the compound is actually absorbed) and when combined with glucosamine sulfate, it has not been shown to be more effective than glucosamine sulfate alone (chondroitin thus adds a significant unnecessary expense). Initial studies suggested that glucosamine sulfate, which is very well absorbed, may slow degeneration of cartilage over time and it was used widely in the past 20 years, although it has not been clearly effective at reducing arthritis pain. There has also been some controversy as to whether taking glucosamine sulfate may adversely impact insulin resistance and worsen blood sugar control in diabetics, although it does not appear to raise blood sugar levels. Due to the controversies regarding its effectiveness, its use has decreased over time. The typical dosage for glucosamine sulfate in clinical studies is 500 mg taken three times per day.

The quality of fish oil and curcumin, likely these most effective agents used to treat arthritis, are critical issues.  Many forms of fish oil are rancid and can actually increase inflammation. Most types of turmeric are very poorly absorbed (you absorb at most 2% of what you consume) and poorly absorbed forms can cause gastrointestinal distress, so the quality of the product you take really does matter.

Nearly a decade ago, I created a supplement pack for myself and patients at my clinic, which included a high-quality multivitamin, 1,000 mg of EPA and DHA fish oil, 1000 mg of highly absorbed curcumin, extra vitamin D and vitamin K, plus magnesium. I have noticed that when I take it daily my joints feel dramatically better, so I have continued it as have many of my patients for the last decade. Initially, I included glucosamine sulfate in the packets, but have more recently dropped it.

For details regarding this Joint Support pack, please click here.

Drugs used for arthritis are problematic. Highly-marketed NSAIDs (non-steroidal anti-inflammatory drugs, such as Advil, Naprosyn, Ibuprofen, Celebrex, Indomethacin, Diclofenac, etc) do reduce pain and swelling if used regularly over a 5-7 day period, yet they have many side effects, including that they accelerate long term damage to the cartilage in your joints—they actually accelerate arthritis damage! They also cause GI bleeding, kidney damage, serious bleed problems, and other major side effects. These drugs should be avoided and clearly not used more than 5-7 days once or twice per year.

The most commonly recommended drug for arthritis is Tylenol (acetaminophen), yet it does not reduce inflammation and can adversely impact your liver. There are also concerns that regular use of high-dose acetaminophen might accelerate memory loss and dementia as acetaminophen metabolism depletes systemic glutathione levels, an essential anti-oxidant and essential source of protection for the brain and every cell in your body.

I would much rather you use high quality long-chain omega-3 oil and curcumin instead of either of these medications. Randomized clinical studies that lasted 30-60 days, suggest that curcumin can be as effective as NSAID drugs for treating arthritis symptoms, although it takes longer to notice a decrease in pain than from taking NSAID medications.

However, if diet, activity, and supplements do not cover your pain, joint injections can be helpful to decrease inflammation, pain, and swelling for 3-12 months.

I will dive into a discussion and a comparison of joint injections using cortisone (steroids), hyaluronic acid, and PRP next, so please stay tuned for Part Two to this discussion.

Not all joint injections are the same. As you will discover, the most commonly used therapy might even be harmful long-term to your joints. Yet there are effective and safe options available that I will discuss in detail.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS



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Ahi Tuna with Olives, Capers, and Cherry Tomatoes Fri, 07 Aug 2020 21:03:41 +0000 The post Ahi Tuna with Olives, Capers, and Cherry Tomatoes appeared first on Steven Masley MD, LLC.


I usually avoid ahi tuna due to its high mercury content, but occasionally I will splurge. Obviously fresh, sushi-grade tuna is a plus if you are going to partake—although “sushi grade” is only a marketing term that suggests fresh enough to be eaten raw. Recently, I happened to catch an ahi tuna while sailing so it was clearly super fresh. If you would like a vegetarian version of this dish, substitute the tuna steaks with seitan.




Prep Time: 25 Minutes 

Serves: Two 


2 tablespoons extra virgin olive oil 

1 small white onion, thinly sliced 

1 cup button mushrooms, thinly sliced 

1 small red bell pepper, thinly sliced 

¼ teaspoon sea salt 

¼ teaspoon ground black pepper 

1 teaspoon fresh thyme (or ½ teaspoon dried) 

4 large garlic cloves, crushed and chopped 

12 olives (un-pitted) 

2 tablespoons capers, drained 

12 cherry tomatoes, cut in half 

1 tablespoon avocado oil            

½ pound ahi tuna steaks (1-inch thick)

¼ teaspoon sea salt

¼ teaspoon ground black pepper


Heat a sauté pan to medium heat. Add olive oil, then onion and stir occasionally for 2 minutes. Add mushroom and sauté another 2 minutes. Add red bell pepper, salt, black pepper, and thyme and heat another two minutes with an occasional stir. 

Meanwhile, combine avocado oil, tuna steaks, salt, and black pepper in a bowl.  

Once red pepper and seasoning has been added, heat a separate pan to medium-high heat and add seasoned tuna steaks and oil after the pan is hot. Cook for 60-120 seconds on each side until steak surface is lightly browned. If using high heat, after 60-90 seconds on the first side, the second side may only take 60-90 seconds. (See details in the Chef’s Note below regarding cooking times.)  

As you add the tuna to the pan, add garlic, olives, capers, and cherry tomatoes to the vegetable sauté pan and heat for 3-4 minutes with an occasional stir.  

Place tuna steaks on a plate and spoon sautéed vegetables over the tuna and serve immediately. 


How much to cook tuna is controversial.  

Ahi tuna are large predatory fish, capable of swimming up to 40 miles per hour. These high speeds require lots of muscle and an oxygen-carrying protein called myoglobin, which provides that deep red color. Cooking breaks down the myoglobin and changes the color in tuna from deep red to a whitish brown and changes the texture of the muscle tissue and the flavor of the tuna as well.  

When you cut into a cooked tuna steak and look at the center, from a flavor perspective it should be pink or even red in the center and not completely cooked through. That is why most restaurants aim to serve ahi tuna still either pink or red in the center. 

The controversy is that health officials normally recommend that you cook the fish until at least an internal temperature of 140 (F), but by then all the pink has turned whitish-brown and the texture and flavor has changed.  

Yet, ahi tuna is a partial exception to this 140-degree internal temperature cooking rule and it has been deemed “relatively safe” and in restaurants is commonly served raw—typically with a warning about eating raw seafood. This allowance is based upon how often it is eaten and the rare risk of illness related to eating ahi tuna raw.  

The key to avoid illness with eating ahi tuna is keeping it properly chilled until it is cooked, which is more important than how long it was cooked. If ahi tuna has not been properly refrigerated (freezing is also effective), there is the rare risk of scombroid poisoning, resulting in very bothersome food poisoning symptoms (vomiting, diarrhea, chills, body aches) that can last for 1-2 days.  

Scombroid poisoning occurs from eating fish high in histamine. Tuna and mackerel (as well as sardines, herring, and amberjack) do not normally contain histamine but they do have high levels of histidine, and without proper refrigeration, bacteria can convert histidine into histamine. Cooking, smoking, or freezing does not eliminate the histamine once it has formed. (See Wikipedia for details.) You can treat scombroid poisoning and reduce some of the symptoms by taking an anti-histamine medication, such as diphenhydramine or ranitidine, but better would be to prevent this illness. 

What is critical is that the fish has been properly refrigerated from the moment it was caught until it is cooked. So if you buy ahi tuna in the store, be sure to put it on ice in a cooler and transfer it immediately to your refrigerator and keep it refrigerated until you either eat it raw or cook it. Do not give it any chance to warm up. (This also means that you have to trust the seller to have kept the tuna properly chilled from the time it was caught. For this reason, some people prefer out of caution to buy frozen ahi tuna steaks and thaw them in the refrigerator prior to cooking. 

If you have medical problems and especially if you have a compromised immune system, always discuss this with your medical provider and ask about your risks for eating undercooked seafood.

Rare Tuna

To cook a 1- to 1.5-inch thick tuna steak and have a rare, deep-red center, (either on the grill or in a sauté pan) sear on one side for 60 seconds at high heat. Turn on the second side and when the internal temperature reaches 90-95 degrees (about 60 seconds), remove it; it will continue cooking in the center and increase by 5-10 degrees on its own (larger steaks will heat more, smaller steaks will heat less), and be 95-100 degrees in the center when eaten.

To cook tuna and have a medium-rare, pink center, sear on one side for 90 seconds at medium-high heat. Flip and when the temperature reaches 110 degrees in the center, about 90 seconds, remove from heat and the center will continue to cook to 115-120 degrees.

Medium-Rare Tuna, Pink Center






If you prefer to fully cook your tuna steak, remove it at 130-135 degrees, the center will heat to 140 degrees and the steak will turn brownish-white in the center.

Fully Cooked Tuna







Bon Appetite!

I wish you the best of health and dining,

Steven Masley, MD






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Tamam Salad Tue, 21 Jul 2020 14:33:31 +0000 The post Tamam Salad appeared first on Steven Masley MD, LLC.


Chef’s Note:

Nicole and I had a fantastic time sailing west along the north coast of Crete. The coastline was lovely, the towns had amazing architecture, the food was the best we had in Greece, and the people were friendly. Of course, we were some of the very first tourists that Greece had seen since the Covid-19 lockdown began. As a tourist destination, I highly recommend it, especially Hania, of course, once travel is possible again.

Crete is reported to not having any cases of Covid-19 so far—making it a fantastic and safe vacation destination if you can get there. (Greece has been one of the most successful countries in the world at controlling the virus.) Yet, in Crete, their employees still wear masks in restaurants and public buildings, and everyone wears one in museums and any time you venture inside a building. (You are not allowed to enter a public building or store without a mask and use of hand sanitizer.) I appreciate that they are being cautious and hoping to stay COVID-free. I think they got it right—they practice social distancing and use masks to prevent COVID infections—they are not waiting to have rampant levels of new cases every day that need to be controlled.

Many of the Greek islands import their food from the mainland, limiting the quality of the food that they can create. Crete is an exception as they are large enough to produce their own food, and export food for other parts of the country. They have a tradition of excellent food ingredients, making eating and shopping there a total pleasure.  Enjoy the recipe below!

Tamam Salad

I had this delightful salad in a restaurant in Hania (Chania), Crete. It is a lovely combo on a hot day, easy to prepare, and not only delicious but loaded with heart and brain-healthy nutrients. Recipe adapted with permission from the Taman Restaurant in Hania, Crete.

Prep Time: 25 Minutes

Serves: Four

Ingredients for the Salad:

1 cup white cabbage finely chopped

½ cup red cabbage, finely chopped

1 cup carrots, grated

2 cups romaine lettuce, chopped

½ cup arugula, finely chopped (rocket salad)

½ cup parsley, finely chopped

½ cup fresh dill weed, finely chopped

½ cup fresh mint, finely chopped

8 cherry tomatoes, sliced in half

Ingredients for the Vinaigrette Dressing:

2 tablespoons extra-virgin olive oil

1 tablespoon fresh lemon juice

2 teaspoons Dijon mustard

1 teaspoon soy sauce

1 teaspoon honey

Ingredients for the Avocado Sauce:

1 Haas avocado, skin and pit removed

1 tablespoon fresh lemon juice

1 tablespoon extra-virgin olive oil

2 tablespoons Greek yogurt (low-fat or full fat)

¼ teaspoon sea salt


2 ounces walnuts, chopped and toasted lightly


Add salad ingredients to a large salad bowl and mix well.

Wisk vinaigrette dressing ingredients and toss with the salad.

Combine avocado sauce ingredients in a blender and blend until smooth.

Add salad to serving plates.

Pour avocado sauce over the top of the salad, then garnish with toasted walnuts. Enjoy! 😊


Steven Masley, MD


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Lump Crab and Mango-Avocado Salsa Thu, 02 Jul 2020 18:35:36 +0000 The post Lump Crab and Mango-Avocado Salsa appeared first on Steven Masley MD, LLC.


This elegant, flavorful salsa makes a super appetizer or light meal. As with the crab recipe below, using good-quality crab meat—the freshest tasting you can find—is essential! Freshly caught and cracked crab is obviously the best, but refrigerated crab sold in many stores can be excellent. Be sure to check the expiration date if using refrigerated crab.

Prep Time: 20–30 minutes

Serves: 4

Crab Mixture Ingredients:

½ pound lump crab meat, drained

½ medium red bell pepper, finely diced

2 medium green onions, finely diced

½ medium lemon, juiced

Mango-Avocado Salsa Ingredients:

1 medium mango, peeled and diced

1 medium ripe (but firm) avocado, diced

½ medium lemon, juiced

⅛ teaspoon sea salt

⅛ teaspoon ground cayenne pepper

¼ cup chopped cilantro

1 large seedless cucumber, sliced into ⅛-inch slices


Combine crab meat with bell pepper, green onion, and lemon juice.

In a separate bowl, combine mango, avocado, lemon juice, salt, cayenne pepper, and cilantro.

Spread cucumber slices over a serving platter and top each with 1 tablespoon crab mixture, then 1 tablespoon mango-avocado salsa.

Serve immediately.


Steven Masley, MD




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Steps to Decrease COVID-19 Risk with Air Travel Mon, 22 Jun 2020 22:14:16 +0000 The post Steps to Decrease COVID-19 Risk with Air Travel appeared first on Steven Masley MD, LLC.


​COVID-19 has financially crushed the passenger aviation industry over recent months. According to the US Bureau of Travel Statistics, passenger flights were down 95% in April 2020 compared to April 2019. Yet, with all the new safety cautions put in place by the industry, the risk of infection has been reduced dramatically and made flying more comfortable.

Having recently traveled from Florida to Greece, I want to share what it was like to travel domestically and internationally in this new COVID era and give you tips on how to make flying safer.

I used to fly 2-3 times per month across the country to attend medical meetings and to speak at events, plus a few international trips per year as well. (My experience could be a bit limited, as most of my flights have been with a single airline, Delta.) Yet until this recent trip, I had not flown on an airplane in six months. Like most people, I took the lock-down instructions seriously, canceling several trips, and staying home.

What I noticed during this recent trip from our home in Florida to our sailboat in Greece is that the planes and airports have changed dramatically to keep us COVID-19 safer and many of the changes have actually made it more comfortable to travel.

The information in this blog assumes that you want to avoid a COVID-19 infection. There are some people out there who are not worried about catching this virus and they will likely ignore these recommendations, but I hope you take them seriously. In the USA so far, we have had 2.2 million cases and 120,230 deaths; globally, we have had 8.5 million cases and 450,000 deaths (all these numbers are likely underestimated). Despite the lock-down and our attempt at social distancing, we continue to see 20,000 new cases every day and we have seen 5 times more COVID deaths than we typically see from the flu each year, and this may be just the beginning for us.

While I aim to avoid political comments in my blogs, I cannot help sharing my frustration that the USA has done a terrible job of controlling this virus—one of the worst scenarios in the world. If we had done a better job, we may not have needed to shut down our economy in a dramatic way and suffered such a large loss of life. (South Korea and Germany are 2 examples of better success stories.) We still have the opportunity to turn this around, stop the ongoing first wave, and stop a second wave by adhering to the steps recommended at the end of this blog.

Although it has been less common, even 30 and 40-year olds have been hospitalized, put on ventilators, and tragically died. People with underlying risk factors (age greater than 70, diabetes, hypertension, heart disease, lung disease, and those who are immune-compromised) have had the worst outcomes. Perhaps the scariest part has been how contagious and unpredictable this disease can be.

The good news related to travel is that planes now have filters that remove small air particles, including virus particles. The recirculated air is now usually passed through HEPA (high-efficiency particulate air) filters, of the type used in hospital operating theatres and intensive care units, which trap dust particles, bacteria, fungi, and viruses. They may not remove 100% of particles, but the best science suggests that they remove 99.9%. While on a plane, you can catch COVID-19 from someone coughing on you or speaking to you if you are close enough, less likely although still possible, from surfaces you may touch, but likely not from the air you breathe on a plane.

What differences did I see during my recent plane flight? (Keep in mind I flew with Delta, KLM, and Aegean Air to get to Greece. I suspect that things would be similar on other airlines):

  • With the most common 3/3 seating, middle seats are all empty. Your only choice is a window or an aisle seat. No more being packed in like sardines.
  • On planes with 2/4/2 seating, they only put 1 person in the 2 seats, and 2 people in four seats—there is really a great deal more room. Nicole and I had a four-seat section to ourselves, which made it much easier to get in a little sleep.
  • Food and beverage service are safer (from an infectious disease perspective, but from a nutritional perspective it is worse) but with less choice. Assuming your flight is long enough to warrant giving you something, they hand you a paper bag prepared in advance with a water bottle, an unhealthy snack, and disinfectant wipes. This way the flight attendant has minimal contact with the items you end up touching yourself.
  • Everyone wore masks on the plane: I noticed that a few passengers took off their masks when they got on the plane, but the flight attendants asked them to put them back on.
  • The magazines and items in the pockets are gone preventing you from being exposed to other people’s germs. Only the emesis bag has persisted in the pockets, and obviously people are not going to reuse those.

These flight changes appear to be straight from the CDC manual and will continue at least through September, and perhaps longer.

Things were also different in the airports we transited in:

  • There is a repeated public service message on the intercom every 10-15 minutes saying, “You must wear a mask at all times and stay at least six feet distance from other people.” Most people stayed more than six feet apart, and seats have tape so that every other seat is not available to sit in. In the US airports we passed through, Tampa and Detroit, at least 50% of people were not wearing masks unless they were going through security or boarding the plane, so mask-wearing is not being enforced at the terminals as it is during plane travel.
  • The airports are mostly empty. With flights down significantly, it was easy to stay six feet apart from others
  • Most of the lounges, restaurants, and shops were still closed.
  • Boarding was from the back of the plane to the front.
  • There was so little volume of passenger traffic that priority security and regular security were combined.
  • In the restaurants (if they were open), employees we required to wear masks. Food was served on disposable plates, cups, and utensils. At least in the US airport restaurants that we saw, the challenge is that the servers pass you plates and glasses that they have touched. This appeared to be the biggest infection risk from the whole trip.

European airports are following these guidelines more strictly. When I compare the US airports with the three European airports we transited through, social distancing and mask-wearing were being followed by everyone, while less than half of people in American airports were compliant.

How Can You Make Flying COVID-Safer?

  1. Do not travel if you are sick or if you think you may have been exposed. All of us need to follow this advice every day.
  2. Wash your hands for at least 20 seconds with soap whenever feasible, especially before you eat or touch your face; and do your best to avoid touching your face. Keeping your mask on is a good reminder.
  3. Bring your own food and since you cannot bring beverages through security, buy a drink for the flight (or carry your own refillable bottle), and wipe the outer surface of the container with a disinfectant wipe. My impression was that the biggest risk from traveling through multiple airports and planes was buying food in the airport.
  4. Bring extra disinfectant wipes with you and wipe down surfaces that you contact.
    • Clean your tray in your seat if you are going to use it.
    • Wipe down your seatbelt and the armrests with disinfectant wipe.
    • If you use the bathroom, use the disinfectant wipe to open the door, flush the toilet, turn the nobs to wash your hands, and exit the room, then discard it in the trash without touching the room.
  5. Any time you touch a surface that does not belong to you, use a hand sanitizer, and/or wash your hands.
  6. Wear your mask, unless it is an N95 mask it will not protect you, but it will help you prevent spreading this disease to others (it is a simple act of courtesy for the people around you) and if everyone did this, we would be better off.
  7. If you check a bag, use hand sanitizer after you gather your bag from the carousel, then wipe down the handles of the bag with a disinfectant wipe before you handle it yourself.
  8. Avoid touching counters, either when checking in for your flight, buying food, or at any counter.
  9. Bring your own reading material and avoid picking up any public magazines.
  10. Stay at least 6 feet away from other people all the time in the airport.
  11. Keep in mind that the biggest risk for acquiring COVID-19 is being too close to somebody when they cough, sneeze or talk. If somebody is coughing within 6-9 feet from you, move. If you are on a plane, ask the flight attendant to move you. Honestly, nobody with a cough should be out in public in this era.
  12. This is a good time to mind your own business and avoid as much as possible talking and visiting with strangers.

After five flight segments from Florida to Leros, Greece, I felt pretty safe following these recommendations. I hope that these suggestions will be helpful for you too.

Once we got to Athens, we were tested at the airport for COVID-19, spent the night confined to our hotel room, and the authorities had our results in 24 hours. The process was quick and organized and fortunately for us, we did not receive a call the following day telling us we had tested positive. (I find it amazing that the testing system in the US continues to be so slow!) Then we flew to our boat and put ourselves into self-isolation for 6 more days as was requested.

After the 7 days of isolation and with a negative test, the Greek government gave us the green light to go out in society. Although we continue to be cautious, especially as foreigners visiting a hosting country; we wear masks when in crowded public places and stores, keep our social 2-meter (six-foot) distance from others, avoid touching public surfaces, and use hand sanitizer before and after shopping and paying for goods. We noticed that every store (even the fruit stands) has hand sanitizer within reach of the customers. Living on a sailboat helps to maintain our social distance in many other ways, as typically unless shopping for food and supplies or eating in a restaurant, we stay away from everyone.

We are back on our sailboat Mariposa, researching Mediterranean recipes, and hoping to sail from Greece to Spain this summer without further COVID delays.

I plan to keep sending you blogs, sharing delicious and healthy recipes from this trip, and health tips as I have done for years.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS




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Shrimp Curry Fri, 29 May 2020 16:00:17 +0000 The post Shrimp Curry appeared first on Steven Masley MD, LLC.


Curry dishes are easy to make, delicious, and loaded with anti-inflammatory benefits. Traditionally rice is included with a curry dish, as I did here, yet you could easily skip the rice and feel content without it in this meal.  To make this vegetarian, substitute 1.5 cups of cooked garbanzo beans instead of the shrimp. (For my own personal blend of curry spices instead of 2 tablespoons of curry powder, I typically use 2 teaspoons of ground cumin, coriander, and turmeric, ½ teaspoon of cinnamon, ¼ teaspoon of ground clove and red curry powder, plus the salt, black pepper, fresh ginger, and garlic listed below.)

Prep Time: 40 Minutes

Rice Cooking Time: 45-50 Minutes

Serves: Two


¾ cup brown rice

1 ½ cups water

¼ teaspoon sea salt

2 tablespoons macadamia nut oil (or almond or avocado oil)

1 medium onion, chopped

½ teaspoon sea salt

½ teaspoon ground black pepper

2 medium carrots, chopped

2 tablespoons curry powder (for a personalized curry spice blend, see the intro above)

1 ½ tablespoons fresh ginger root, diced finely

½ medium head of cauliflower, chopped

¼ cup water

1 pound large shrimp, peeled and deveined

1 medium red bell pepper, chopped

4 medium garlic cloves, chopped

½ cup organic plain low-fat yogurt (or plain coconut yogurt if you prefer non-dairy)

Garnish with 2 tablespoons fresh herbs, chopped (mint, cilantro, parsley)


In a saucepan, bring rice, water, and ¼ teaspoon sea salt to a boil, then reduce to medium-low heat and simmer until rice is al dente, about 45 minutes.

Meanwhile, heat a large skillet or sauté pan to medium-high heat, add oil, then onion, ½ teaspoon salt and black pepper and heat with an occasional stir for 2 minutes. Add carrots and curry powder blend and heat another 2 minutes with an occasional stir. Stir in ginger root, cauliflower, plus a ¼ cup of water, cover, and heat for 4 minutes. Then remove the pan from heat.

Check the rice and when it is nearly cooked, resume heating the curry pan to medium-high heat, it may take 1-2 minutes to reheat the pan. Then stir in shrimp and bell pepper, cover, reduce to medium, and heat for 3-4 minutes with an occasional stir until shrimp turns pink and curls. Then add garlic, cover, and heat a final 2 minutes.

Turn off heat and stir in the yogurt. Garnish with fresh herbs and serve over rice.


Steven Masley, MD




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