Sugar and Health

How are Sugar and Health linked? Discover more here! Though I am a plastic surgeon, looking after your whole body is important to me. Here is an email I received from a friend of mine recently:

Dear John!

When I was a medical student, “going viral” was something really bad. If a patient “went viral”, you’d feed them pancakes (because that was the only thing you could slide underneath the door). You didn’t open the door until you sent in the SWAT team in plastic coveralls.
It was that bad.

Nowadays,, “going viral” is regarded as something good. As in “the video clip went viral.” The SA restaurant rage videos currently doing the rounds are one such example of “going viral”. Although they are probably as bad for our minds as the old “going viral” was for our bodies. I truly hope they don’t spur on any further instances of restaurant rage.

As everyone is pointing fingers and moralising about what is happening in these clips, I’d like to step back and look at rage from a biological angle. Few people realise that rage is largely the result of two molecules in a kind of see-saw balance:

Glucose and insulin
If glucose goes up (courtesy of what we eat), insulin follows some time later (courtesy of the pancreas). This nudges glucose out of the blood into the cells. Glucose then drops again. Some time later, insulin drops in response to the lower glucose levels.

Pure harmony.

Fair enough. But how are food and mood linked?

The brain runs mainly on glucose. If blood glucose drops too fast, or too much, the brain gets anxious. A low blood glucose level is a threat to survival. Therefore, all the “fight or flight” responses are activated by low blood glucoe. Anything that gets in the way is pushed out of the way. No explanations. No niceties.

“Hand over that chocolate cake and no one will get hurt.”

If one person behaves rudely, all those around also start behaving rudely in defence. It’s a kind of chain reaction. Not long afterward and it looks like a fight scene from Asterix.

When does blood glucose drop very fast or too much? I’m glad you asked.
From my description above, you may have noticed that there is a lag in insulin response, both when glucose rises, as well as when it drops. It is that lag which causes the problem in a modern society eating modern foods.

But before we get there, a little fact that will change the way you understand sugar.
If I took ALL the glucose from the blood of an adult and purified it, how much glucose would I get? The answer is … one level teaspoon. About 5 g. That’s it. All the fuss about glucose levels fits into one teaspoon.

So… If I add a teaspoon of sugar to my tea or coffee, I basically double my blood sugar in a matter of minutes. This is not good news for the body’s balance.

In the olden days, when food technology was mostly limited to a wood fire, sugars came with plenty of fibre attached. True, you could suck out nectar from flowers, but you’d have to do this for an hour before getting to a teaspoon of sugar. And your fellow cave dwellers would probably give you some strange stares. Honey? Yes, but at a price that stings.

The pancreas liked that mellow life. Up the insulin a little, drop it a little. The range of blood glucose levels was pretty stable most of the time. On the low side (compared to our modern ‘normal’ levels), but stable. And the brain was happy.

Fast forward 150 years. Or a bit more.

Nowadays, it is possible to ingest 8 teaspoons of sugar in less than 10 minutes. By eating a medium sized pizza, nogal. Or by drinking one of the many carbonated drinks on store shelves. Without fibre, the sugar superdose is absorbed in minutes to supercharge the brain. It feels good. You feel like the Top Primate all over again.

It’s a bit like taking our cave dwelling ancestor for a spin in a Ferrari. You’re gonna need some serious soap to clean his seat afterwards.

The pancreas, likewise, is in a flat spin. It does not have the reserves to cope with such a load. It starts up the factory and pushes out all the insulin it can. The smell of burning pancreatic rubber goes mostly unnoticed as we bask in the happiness of a brain stuffed full of glucose. We’re on the nutritional highway to glory. Who cares what is happening below the hood?
But while the glucose rabbit falls asleep at the wheel, the insulin tortoise crawls past secretly. It takes about two hours, give or take a nose hair. At this point, the glucose rabbit gets pipped at the post and has to retreat into the cells. Order is restored. But that pancreatic factory isn’t so easy to stop. It just keeps running at full tilt for some time to come.

What happens next is nicely depicted in Greek mythology. The newly-freed Icarus flies too close to the sun, his waxen wings melt and he plummets to the ground. In our case, insulin does the melting. After that glucose overshoot, there’s an insulin overshoot, followed by a rapid glucose-drop that will make your head spin.

It is at that tipping point when even a tiny irritation can set off a firestorm. Road rage incidents often happen around meal times, when glucose levels are low. Drunkards get abusive when all the sugar has left the building but the alcohol keeps on shouting. But the true triggers happened some hours previously, when too much sugar started the ticking time bomb.
For decades, we’ve been conditioned that sugar gives “energy”. It’s an easy sell. Our cells burn sugar for energy, sugar makes us feel good, so why not boost sugar levels whenever we need a lift? Athletes swear by sugar. Students swear by sugar (and beer and caffeine). So it must be good, right? Wrong!

Moral of the story? Avoid refined sugar like the plague it is. That way, you are much less likely to end up “going viral”.

To your health!
Doc Frank
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The S Curve and Plastic Surgery

It really is all about the curves, there are no flat spots, it’s all curves.

A statue is a statue versus a flat image because it has volume and shape, it is not flat, it is round, curved, and it draws your eye around to see what’s coming next. Is it ALSO as good or interesting as what you’ve just seen, can it be, what’s next, how does it “finish off”, or does it?

The curve is infinite and everywhere, it never ends. Ferrari uses a curve, or at least the classic ones did like the 1969 Dino, Audi’s luxury models are “S-Lines” too, Coca-Cola uses curves everywhere in their advertising, the curved under the logo, the bottle, the Nike swoosh they’re all curves. The more sophisticated ones are subtle, almost subliminal silhouettes of the female curve.

We all relate to this primal curve, even MacDonalds recognized this and put a very provocative double curve in their logo, so if you are one year old or a hundred, it is always a recognizable part of our intimate physical past.

Does your husband / wife / girlfriend / boyfriend support your plastic surgery decision?

Making sure that Hubby or BF/GF are on board with your choice of body modification surgery is more important than you think. I have a patient at the moment whose boyfriend is unfortunately not secure enough to live with her anymore and the way that she looks now because she is pretty amazing beautiful and so they’re unfortunately going through some tough times. Taking some time to talk about it beforehand is important.

Man and woman discussing plastic surgery

Wife and husband discussing plastic surgery

Several patients in my history have made me think about this now, and there have been aggressive violent physical act performed against people like one patient’s boyfriend who heard that she was on the way to the surgery center and drove home and rammed her car from behind injuring her! Some people are prepared to go to jail over these decisions. This was surely not a healthy reaction but it could have had a chance of a better outcome if there had been some dialog beforehand and a mutual decision made.

I have to compare these instances share the very best that I have seen where recently of young couple came in and discuss their goals and aspirations with me, I took a lot of time to sit and listen to them about exactly what they wanted and they got exactly what they wanted. To see their level of exhilaration excitement and gratitude after the case was nothing short of a privilege.

One thing which struck me about the comments from the husband of the patient off the wood was that he was grateful that I had just listened to him about what they wanted and that I had and continually push myself forward as being the best of the best!

Cosmetic Surgery as a lifestyle change stimulus QUALITY OF LIFE

One of my favorite patients is a person I am glad to know, is a motivation for me and my patients. This lady lost 100lbs after her surgery, which removed her excess of abdominal skin, fat, and facial aging. Since then she has exuded nothing but confidence, and is one of the healthiest people I know. At 64 years old she is one of the most amazing lifestyle changes I have ever seen. It is better late than never, life is not about quantity, but quality.

With Linda’s permission I will share a selection of her feedback, and photo’s. To the rest of my patients, I hope with all I can that they choose to use their cosmetic surgery as a stimulus for a life changing lifestyle change. My personal interests in gardening, permaculture, and nutrition, growing your own food, recycling, composting, as well as making good soil transfers to my patients, who learn from it if they show any interest. I put everything I have, know, and have learned into helping my patients affect all the possible lifestyle changes they need.

I look forward to updating this blog post with more details from Linda herself, and possibly even pictures if she doesn’t mind!

Pain is a pain

I have recently had a quite severe, constant hip pain, which has been a real pain. I believe it is after a bicycle accident I had in the mountains where I fell on my hip, and it has never been quite the same since. I spent some hard earned $ on massage therapists, some of the best I have ever met, and I wanted to share this Times article on “Muscle knots”, because this is what I have learned about this problems from my massage therapists, experiences, and insights. The article itself is poor, but the comments on the blog are worth reading (for a change!)

The fascial system is the important thing to understand, and it really does remain relatively poorly understood until today, as there may not be enough $ involved in it. These boundaries of our understanding in medicine interest me, as they are ‘new frontiers’ of medicine, and our curiosity, and research help to expand the current pool of knowledge to better assist our treatments of them in the future.

Modest Lifestyle, Less is more.

I’m sure everyone reading this has moved at least once in their lives, and has gone through the throwing away of extra, unecessary  “stuff”. All through our lives it seems “stuff” attaches itself to us with regular, repetitiveness. Those of us with children have it even worse, accumulating even more stuff.

So what does this have to do with plastic, or cosmetic surgery? Well, it seems to me a lot of my colleagues in the field tend to collect even more, and expensive stuff, often trying to keep up with each other, who has the fanciest car, house, clothes, watches, etc. The reason I have always concentrated on maintaining a modest lifestyle, is so that I can avoid these pitfalls of forever chasing after MORE.

My family and I have concentrated on not “wanting” more, not saying we “need” the latest, greatest, or most expensive “stuff” just to keep up with our neighbors. This lends itself to a very important point: I don’t NEED a lot of money, or a high patient turnover, so I get to spend more time LISTENING and CARING for my patients. Each patient literally becomes my most important patients they move through our office, and is taken care of so that this is what they feel, and this makes a big difference.

There are many high volume practices in Los Angeles, and I have worked in them, but no more. I have made a decision not to be like them, not to run a puppy farm, but to treat each patient with the time, respect, and care they deserve. Each one of my patients has direct access to my cell #, and are told they are welcome to call, or text at any time of the day or night. They do not abuse this privilege, as they know I am THEIR surgeon. Just as people do not abuse THEIR car (unlike a rental), they treat me with respect, and care.

I feel constantly privileged to be able to care for a wonderful group of people, and get to touch so many lives, and always hope it will be in a positive, uplifting, and quality of life improving way.



I frequently, as a liposuction surgeon, get asked to make my patient’s bodies silhouette look like a coke bottle. The ubiquitous famous shape of the curve of that bottle is known to everyone around the globe. There are however several forms, and shapes of humans, and not all of us are able to achieve that desired shape, simply because of our underlying anatomy.

Coca Cola Girls

Coca Cola Girls

More Coca Cola Girls

More Coca Cola Girls

A recent Times article reviewed the preferred silhouette shapes of women from the 17th century until today, and I found this both fascinating and interesting to see through a different set of eyes/subject matter, art and fashion? Or is it different? Is our desired body shape not altered by the media, art, culture, the people we see around us? What other people are doing to modify their bodies, be it corsets, clothing, padding, etc? Do we want to go to this extreme? :

SIlhouette created by extreme Corset on the Waist

SIlhouette created by extreme Corset on the Waist

The best view I have of a woman’s body is when they are lying on their side, so I can see the shape and height difference between their hip height, and the lowest was it hight, and then returning to their bony lower chest diameter. That is the coke bottle, and that is where I can exaggerate the lower curve with fat transfer (addition), and remove waist fat (subtraction), to make the height differences look different and “Coke bottle like”.

The other image that comes to mind is that of famous cars, famous in my mind because of the underlying shape they imitate, or that of a woman lying on her side.


Another interesting take on image and shape:



Liposuction Fat Transfer, “Evolution” of a procedure

I am a scientist by training, but a pragmatist at heart, and when something “aint broke, don’t fix it!”

I have been performing liposuction of the body and fat transfer to the buttocks, in large volumes for just over a decade now, and when I started, nobody was doing the volumes I did, and very few do now either. These days there is a lot of eyewash/quackery around this procedure, with all sorts of new “normals’, or “standards of care”, which is basically what a bunch of surgeons usually far more timid, and less practices, tell the rest of us what we can and cannot do…so we have to “cover our ass” so we don’t give these people the chance to slander us (which they do, and love to do).

When I started doing this there were very few scientific studies to show how effective it was, but there were many surgeons doing it because it did work, it was effective, and also long lasting, with few side effects. I don’t need to tell you where it started, but yes, it was in South America, and yes it was where Shakira came from (in all her glory). So I studied what those Colombian surgeons did, and I still do what they did and do, because it works.

All the fancy shmancy talk about it will not get you a good job. If surgeons sell you something that doesn’t make sense to you, it probably doesn’t make sense period. Stem cell enriched fat transfer to any area does improve the lasting effect of the fat, this has been proved by my friend Alexandra Condé green, at Rutgers University. A consummate scientist, plastic surgeon, and an all round wonderful person, Alexandra performed THE most elegant study to prove this to date, and no doubt will continue to produce the most elegant studies in the future.

There really are people out there who do great work, and these days there are more, but buyer beware of any surgeons badmouthing cosmetic surgeons, and if you think board certification guarantees you a great result, then…think again!


Obliviobesity-when is your child too fat, and you’re not seeing it!?

Downhill from 980 lbs