Dr. Louis B. Malinow, MDVIP

Dr. Louis B. Malinow, MDVIP A true partner in health who you can reach 24/7 and see same- or next-day. He sees fewer patients, which means more time for each one.

Dr. Malinow, Board Certified Internal Medicine physician, offers a different approach to primary care. Patients appreciate same/next-day appointments that start on time and aren't rushed; plus they can usually reach his 24/7. His practice also offers other services, including comprehensive, advanced health screenings and diagnostic tests, that go far beyond those found in concierge medicine practices. Dr. Malinow develops a personalized wellness plan based on the results of the wellness program. His MDVIP-affiliated practice is open to new patients.

09/20/2025

A bit long but some good advice from Arthur Brooks new book The Happiness Files

Your life is the most important management task you will ever undertake. It is, in fact, like a startup, where you are the founder, entrepreneur, and chief executive.

The right denomination of rewards for the startup life is happiness itself, with a focus on love, enjoyment, satisfaction, and meaning.

It emphasizes that in leadership over your life, YOU are the most important employee.

Humans get satisfaction not from arriving at a destination but rather making tangible progress toward it.

For busy, ambitious people, family and friends are often the relationships that are sacrificed and become desiccated and malnourished.

You need a rhumb line (the direction that ships follow) to see and measure progress toward a goal

Rather than protecting you against future disappointment, a cycle of rumination after failure can set you up for more failure, or at least missed opportunities to succeed. You become fearful, lose confidence, and miss opportunities for new success.

Failure can be crushing when you set a goal of success and prioritize that over learning and improvement.

Walden wrote: “The cost of a thing is the amount of what I will call life which is required to be exchanged for it, immediately or in the long run.” Translation: bad choices can hurt you immediately or in the future.

Time is wasted when you engage in something that crowds our more productive or edifying activities, and when you deliberately engage in something that, on balance, we don’t even like.

We all have the impulsive toddler in our heads who has no concept of tomorrow and dominates our executive function. That leads us to overestimate the value of a little short-term pleasure and underestimate the value of our long-term well-being.

Consider your “non-working” time on the internet in terms of wages. If you earn an average hourly wage of close to 30 dollars an hour and spend the average amount of time on social media (142 minutes per day), you’re spending 71 dollars of your time scrolling.

Workplace burnout can manifest as (1) emotional exhaustion, (2) cynicism or depersonalization, or (3) negative view of personal effectiveness.

One of the most glaring sources of workplace burnout is meeting fatigue. Meetings are too long, unproductive if more than a few people involved, and get in the way of work. Good leaders will minimize meetings and keep them under 30 minutes. Eliminating or minimizing meetings at work is one of the most straightforward ways of improving employee well-being. Cancel all meetings that do not have a clear agenda or purpose if you’re the one scheduling them. Workforce engagement is maximized with 4 meeting free days per week and stress is minimized with zero meetings in the average week.

Zoom fatigue has several causes. When it comes to human interaction, it is like junk food: filling and convenient, but no substitute for a healthy diet. There are 6 common causes (1) asynchronicity of communication (rhythm is impacted by connection), (2) absence of body language, (3) lack of eye contact, (4) increased self-awareness (looking at yourself), (5) interaction with multiple faces, (6) multitasking opportunities (most of are doing other things when in a Zoom meeting….I never do this when Zooming with a patient, but guilty when Zooming on other meetings).

Working at home is often the antithesis of creating space between work and life.

Procrastination is defined as “delaying a task for a maladaptively long time.” It’s typically thought of as a time management issue, but may be more of an emotion management issue. People may avoid a task due to the negative feelings surrounding a particular task. Although usually a negative, sometimes a bit of procrastination can help the right ideas for a project show up than one completed too early. I probably suffer from “precrastination” as I’m always in a hurry to lower my “cognitive load.” Sometimes putting off tasks that require innovation and research in order to mull them over might improve performance. Finishing a task to 90% and then saving the last 10% for the next day can improve the outcome.

The strategic use of NO can save your life. Many people say no to something that becomes a source of regret, but more often than not this isn’t the case.

Be particularly aware of narcissists who have two characteristics…they’re exploitive and entitled. They’re exploitative because they think if you’re willing to be taken advantage of, that’s YOUR problem. They’re entitled because they think they deserve whatever they’re asking for. It’s taken me a long time to learn how to handle the narcissists in my practice. Certain people are VIP’s but are humble and don’t use it unfairly...while others use it excessively. My definition of class is someone who could skip the line, but who waits in line like everyone else. We have an important choice: “Behave with controlled grace, or uncontrolled entitlement.” Most, but not all, of my patients are the former.

Worrying can steal your peace and sucks up valuable time. Worry is a recursive mental attempt to resolve a situation that has an uncertain, potentially negative outcome. It is repetitive and self-focused and features an inability to shift attention from negative thoughts. It harms attention, erodes problem solving, and worsens mood. Worry centers on events that have not yet occurred.

Worry can mute the vividness of our mental picture, interfering with some of the pathways in the brain that could help us devise a real solution. Worriers believe that their worrying will help them to handle a situation better or increase their control of it.

Chronic worrying has a genetic component. In some way, our genetics influence this and this is why there is a “worrier” and a “warrior” genetic profile. I would not have survived 36-hour shifts unless I had the warrior genetics as warriors remain calm under fire.

Chronic worriers deal poorly with uncertainty, are narrowly focused, self-conscious, and tend to have more social anxiety. Worry does correlate with higher performance in many things.

Worrying is not based on reality most of the time. In one study, 91% of the things studied participants worried about never came to pass, meaning chronic worriers suffer 9 out of 10 times needlessly. Writing your worry down makes it more emotionally manageable. Focus on writing down the best, the worst, and the most likely outcome of a problem. Give up the magical thinking that if your torment yourself with enough worry about something it’ll improve the situation. Perseverating on something will not provide unique insight.

Remember that worry robs you of valuable time in your life, and researchers have found that worry induced psychological distress is associated with early mortality.

The biggest predictor of happiness at work is happiness outside of work.

In order to max out the benefits of happiness derived by giving to others, you’ll get deeper, lasting happiness from a good deed no one knows you did. Sure, the admiration, thanks, and praise you get giving a big donation somewhere to help others gives you a hit of pleasure, but those who gifted others and kept their gift unpublicized derived greater happiness from it. Publicized gifts when given from someone with “high moral character” might make a self- reflective donor doubt their own motivations. Volunteer without posting about is what Arthur Brooks suggests we do sometimes.

Money doesn’t buy happiness past a certain level required to meet needs. Spending more time fruitlessly chasing well-being up the income curve often means spending less time on love. Spending money on experiences, buying time, and giving money away does seem to raise happiness, but designer shoes do not. Using money to create memories with friends and family help happiness.

Early in life, success often comes from addition: more money, more responsibility, more relationships, more possessions. Early in life, you’re filling an empty canvas. By midlife, choose subtraction, not addition. The most important impediment to chipping away is a belief that success = more. This is bad math in mid-life. Work to reengineer your life later in life so that you can step away from more responsibility and make more time to think, love, read, and pray.

Prospection means mentally living at the finish line, which subjects you to an “arrival fallacy” which means you expect a specific goal will be the be-all end-all for your happiness.

People unable to accept criticism are those who score low in self-esteem and high in neuroticism, who are fearful of negative evaluation, and who tend to be pessimistic. Many of us tend to analyze the critic more than the criticism, and we tend to consider the criticism a judgement on our inherent abilities rather than our performance. Try moving the focus from emotion to analysis.

If you’re criticizing to help, you’re doing it right. If you’re criticizing to harm, you’re not. Good criticism should have (1) the care of the recipient in mind, (2) respectful delivery, (3) good intentions, (4) a pathway to improvement, and (5) appropriate targeting of the recipients needs.

Praise in public, criticize in private.

The happiest couples had a 5:1 ratio of positive to negative interactions.

An honest compliment is given with nothing asked or expected in return.

Good health practices seem to lower unhappiness rather than raising happiness.

No surprise, parental warmth and affection (slanted toward the fathers behavior a bit more than mom’s) has a large impact on a child’s happiness and psychological adjustment. Make sure your kids know you love them unconditionally, even at their worst and least deserving moments.

Kids pay attention to everything their parents do, rather than what they say. I saw my parents exercising 7 days a week and thought “that’s a part of life.” My kids saw my wife and I doing the same thing, and now they do it and will likely model it for their kids one day.

Real friendships have (1) companionship (like being together), (2) help (help each other when in need), (3) intimacy (can confide without fear of betrayal), (4) reliable alliance (we can count on each other to be there for each other), (5) self-validation (they support and encourage each other, genuinely hoping for success), and (6) emotional security (comfort and reassure each other through tough times).

Top 10 ways to improve happiness:
1. Invest in family and friends
2. Join a club (social capital)
3. Be active physically and mentally
4. Practice your religion
5. Purposeful exercise
6. Act with kindness
7. Be generous
8. Check your health
9. Experience nature
10. Socialize with colleagues out of work

Progress, not goal achievement, is more likely to bring happiness.

“Courage is not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers fear.” Nelson Mandela

If you want success, pursue happiness. Instead of trying to get success and hoping it leads to happiness, work on your happiness and you’ll have a higher likelihood of succeeding at everything in life (work, marriage, friendships, etc…)

09/14/2025

Some good quotes I've modified from social media

Motivation:

You don’t always need to feel good to get going. Sometimes you need to get going to give yourself a chance at feeling good.

You can’t think yourself into a new state of being, but you can act yourself into a new one.

“I’ll do anything for my kids” is a lie parents tell themselves, because when it comes to YOUR healthy, suddenly there are exceptions.

Your children don’t need your sacrifice, they need your example! They need you alive and thriving for decades to come. This is what motivates me to do what I do.

Show your kids how to prioritize health. Demonstrate what self-care actually looks like.

When you choose nutritious food, you teach them to value their bodies. When you make time to exercise, you show them resilience matters. YOUR habits are THEIR future health. Your legacy isn’t what you leave behind, it’s how long you stick around to share it.

Health isn’t something you “get around to.” Don’t treat your body like a disposable resource. Your body keeps score…everything you eat, every workout you skip, and with your body, you have a “no refund” policy. Fixing things later is a big mistake….because later isn’t guaranteed. Life isn’t a dress rehearsal waiting for the real thing to arrive……this is the main event….right now. Nobody is coming to save you. Don’t wait to regret what you’ve done or not done…remove any doubt that at 80 you’ll be able to hike or get up the stairs or walk comfortably in your body. I see too many people that can’t…..and 9/10 times it was avoidable.

Stop spending money on things and start spending it on achieving peak health. This isn’t an expense…..it’s an investment. It’s the investment with the highest ROI. “The healthy person has 1000 worries…but the sick person has only one.”

Think of your new diet/eating strategy or exercise routine as a startup business with you as the CEO. It’s new, but not impossible.

09/06/2025

Good quotes:

1. You don’t always need to feel good to get going….sometimes you need to get going to feel good

2. Muscles don’t build without resistance. Minds don’t grow without challenge. Lives aren’t meaningful without friction. Stress is uncomfortable, but the response is growth.

3. Failure isn’t the opposite of success….it’s the path to it.

4. Going to the gym should be like brushing your teeth….automatic….just do it. “I don’t feel like going to the gym, so I skipped it.” So if you don’t feel like brushing your teeth, do you skip that too?

5. Muscle are damaged in the gym, nourished in the kitchen, and built in bed.

6. A fit body is the ultimate status symptom. Anyone can buy an expensive car….but showing up with a fit body tells you so much more about that person. The body has been created through good habits, years of effort, and years of controlling your eating habits. You can’t buy a fit body, you have to earn it. A fit body opens doors to experiences that no car can. It’s an investment in yourself, that pays dividends in confidence, vitality, and longevity. True health is wealth….prioritize your body over material possessions….it’s the one asset that appreciates with proper care and attention.

7. If you wanna see your kids go through every phase of their lives and eventually see grandkids, you need to take care of yourself like your life depends on it. Lifting weights is a non-negotiable as it’ll enable you to pick up your grandkids.

8. The gym isn’t only about looking better, it’s about finding yourself when you’re lost. The gym can start as an escape, but becomes your return. A journey back to who you were meant to be. Gyms don’t only transform broken bodies, they rebuild broken spirits.

9. A surgeon gets called into an emergency at 2 AM to save someone’s leg. He was tired, his mind was noisy, he was off. He took all of that to the OR…..and nailed the case anyway. One of the most underrated skills in life is performing well when you don’t feel your best. It’s easy to do great work when everything is clicking, but excellence means being able to deliver when it’s not. The greats aren’t great because they always have perfect conditions, they’re great because they show up and give it their best shot even when they don’t.

10. You can silence 50 scholars with one fact, but you can’t silence one idiot with 50 facts.

11. It’s foolish to desire what you’re unwilling to suffer for.

12. A man’s true character is revealed by how he treats those who can do nothing for him.

13. Want a lean body and maybe a 6 pack. Stop drinking. Prioritize sleep. Eat the same thing every day (BORING WORKS!). Don’t snack. Eat dinner very early. Look at food as fuel, not satisfaction. Don’t sabotage efforts during the week by living it up on the weekend (do the same things on the weekend).

14. When people mock your choices, they’re not judging you..they’re protecting themselves from what YOUR discipline reveals about their choices. Early bedtime (“you’re missing out”), skipping drinks (“you’re boring”), tracking nutrition (“that’s obsessive”), daily workouts (“that’s too much”). Discipline isn’t punishment…..it’s the ultimate freedom. Your choices aren’t about restriction….its about creating the life others claim they want without willingness to build it. Embrace the discomfort most people avoid…..choose growth over approval.

Collagen is the most abundant protein in the body. It accounts for 25% of the protein mass in the body.  Collagen exist ...
08/29/2025

Collagen is the most abundant protein in the body. It accounts for 25% of the protein mass in the body.



Collagen exist in a triple helix structure composed of glycine, proline, and hydroxyproline. Hydroxyproline is an amino acid unique to collagen. When collagen peptides first hit the market years ago, I was skeptical that the peptide would be absorbed intact and have any impact. The data suggests otherwise. In fact, digestion doesn’t completely break the tri-peptide into individual amino acids and we see Gly-Pro-Hyp peptides absorbed intact and these tripeptides the accumulate in cartilage, tendons, bone, and skin. There, they trigger extracellular matrix synthesis.

Although there are at least 28 different types of collagen, the three main types are type I, type II, and type III. Type I strengthens bones, tendons, ligaments, and the cornea and is the most abundant subtype. Type II provides cushioning and structure to the vitreous humor and to cartilage. Type III provides elasticity to skin, blood vessels and organs.

Randomized trials indicate that adding collagen peptides to the diet (or gelatin formed when animal collagen is broken down from long strands of these peptides into smaller strands) substantially increases skin quality (elasticity and thickness), strengthens the connective tissue in joints and ligaments, increases bone density, and even boosts strength (not as much as animal proteins) at ALL ages (even after 80).

Using 15 grams of collagen peptides or gelatin one hour before a tendon loading workout amplifies collagen content in the tendons (especially if paired with vitamin C which is a cofactor for the enzyme that turns proline into hydroxyproline) more than just the exercise alone. Using collagen with vitamin C improved tendon collagen synthesis 2-fold over exercise alone.

We often talk about the importance of protein, which is critical to prioritize for muscle health, but muscles connect to bone via tendons, ligaments connect bone to bone, and cartilage cushions the joints. Collagen is integral to the health of all of these tissues. Collagen peptides or gelatin is completely different from animal protein or whey protein which is rich in leucine (the amino acid trigger for muscle synthesis). Collagen peptides have very little or no leucine, but are rich in the amino acids needed for proper soft tissue/tendon improvement.

Tracer studies demonstrate that collagen peptide localize in cartilage, tendons, and skin and act as signaling molecules which stimulate collagen synthesis in cells lining joints (chondrocytes), promote fibroblast proliferation (helps heal skin wounds), and enhance tendon thickening.

A 12-week trial randomized women to placebo or collagen (lower dose than we’d normally use) and found a 28% improvement in skin hydration, a significant improvement in skin elasticity, a 27% reduction in wrinkle depth, and a 24% improvement in dermal density (skin thickness). Benefits were seen as soon as 4 weeks into the trial which used only 2.5 grams of collagen peptides.

A 24-week trial in athletes with joint pain randomized 147 participants to collagen 10 grams or placebo and the collagen group demonstrated a statistically significant reduction in measures of pain.

Collagen 5 grams per day was tested in 131 postmenopausal women with reduced bone density over 12 months vs placebo. Bone density and markers of bone production (blood test) and bone resorption (blood test for bone breakdown) were followed from baseline to 12 months. At 12 months bone density improved 3% in the spine and 7% in the hip in the collagen group and fell 1% in the placebo group. Markers of bone formation were significantly higher in the collagen group.

Several other trials examining the impact on joint pain demonstrate benefit and one study employed MRI which demonstrated an improvement in collagen quality (increase in proteoglycan content of the cartilage based on delayed contrast MRI). One study demonstrated superiority of collagen vs. Glucosamine chondroitin.

The addition of 15 grams of collagen peptides per day gave middle aged and older adults an edge during a 3-month resistance training program. They gained 1.3 kg more lean mass in that time than a placebo group. Whey protein still beats collagen (not really FOR muscle per se…) and essential amino acids beat whey (both topics of prior education).

Collagen has no safety concerns and therefore everyone interested in keeping their tendons, ligaments, and skin healthy should consider this. I personally have used Vital Proteins (there is one with added vitamin C) in coffee daily for years, although gelatin is certainly acceptable and a more cost effective alternative. We should position this as part of nearly everyone’s “longevity” cocktail as preservation of joint function, bone strength, and reduction of pain will help to preserve mobility throughout life.

07/14/2025

Carrying heavy things (rucking for instance) is associated with weight loss, but not the way you think!

Wearing a weight vest or a a rucksack (mine is a 40 lb rucksack from Goruck.com) isn't leading to weight loss via calorie burning......it reduces appetite.....through a very unique mechanism.

One randomized controlled human trial took 72 people with obesity and randomized them to a group that wore a rucksack equivalent to 11% of their weight (a 200 lb person would wear 22 extra lbs, for instance) and the other group 1% extra. The group loaded with extra weight lost close to 4 lbs and gained a tiny bit of muscle over a 3 week time frame.

The second study in 2025 had folks in one group wear a 20 lb rucksack for 6.6 hours a day for six months and compared them to a group without the extra weight. Both groups were calorie restricted as well. At the end of 6 months, both groups had lost about the same amount of weight, but they were followed for another 1.5 years, and the weight regain was 2X as much in the control group vs. the weighted group. In other words, there was some type of legacy or lingering impact.

In a mouse study, mice were loaded with an extra 15% of their weight and were compared to mice that weren't loaded. The weighted animals lost a tremendous amount of weight over two weeks compared to controls. Same thing was found in birds.

The weight loss was NOT explained by additional calorie burning, but rather by DECREASED food intake.........whatever calories were needed to maintain the weight they needed to get around as if they'd not gained weight.

this was the origin of the "gravistat" hypothesis. the bones seem to sense increased gravitational load and signal the brain to curb food intake. The goal is to bring the organism back to a movement friendly body mass.

This had nothing to do with the usual hormones that impact food intake .....GLP1, leptin, alpha MSH, FGF23 (for the nerds out there).....which were measured and didn't change...rather:

It was the bones sending the signal. When researchers "knocked out" osteocytes (cells in the bone that sense load and coordinate bone remodeling)........there was no weight loss. In other words, the signal was coming from the osteocytes in bones.

If weight goes up too much (back in the day when we were hunters and gatherers), mobility and agility suffer. Come hang out in the lobby of our building or go to any Delaware beach these days and you'll see the impact of excess weight on mobility.

Bottom line: Consider a rucksack or a weighted vest for your walks or for part of your day......easy way to improve bone health, muscle health, and lean out!

Believing life should be easy.....makes it even harder! We should all be doing HARD things on a regular basis and if you need motivation, read The Comfort Crisis by Michael Easter.

Above was research posted by Nick Norwitz.

07/07/2025

I read an interesting book called The Next Conversation. In it were several good sound bites. The book is extended version of something my dad told me when I was little about arguing…his message was: “when someone goes red, you go blue.” I never forgot it. A hothead never wins. And the first message in this book is:

“Winning an argument is a losing game. Winning means that you’ve likely lost something far more valuable--- their trust, their respect, or worse, the connection.”

Stop seeing arguments as something to win but as an opportunity to understand the person behind the words. Stop hearing only what’s said and start hearing what’s felt. Build the discipline to connect to the person in front of you.

Have something to learn, not something to prove.

The “next conversation” has the benefit of hindsight and reflection, and understanding of what was missing from the first go-round. There’s a lot you can do in the next conversation to reframe, recognize your mistakes, and laugh over it.

You get blind acceptance of your point of view zero out of 10 times, but you can absolutely get a better understanding of the other person’s point of view 9 out of 10 times.

The question you need to ask is: “who do you want to be seen as after a conversation ends?”

Texting is sometimes tough. You’re not connecting at a level that conveys emotional nuance. You’re living in a world of transmission, not connection. Transmission, such as text and email, focuses on sending and receiving signals in a cold medium…it’s transactional. It’s efficient, but indifferent to understanding and authenticity. Transmission conveys information, but connection breathes life into it. Difficult conversations require connection, a voice….I wish the teens and 20 somethings got this.

Connection is a dressed-up word for understanding and acknowledgement.

In a classic disagreement, it’s almost always the other person you expect to bend their way of thinking….not yourself. When you bother yourself enough to want to know why someone holds a particular belief, rather than simply criticizing the belief because it’s different from yours, only then will you begin to appreciate their point of view. If you possess this ability, you’re empowered to create deep relationships with lasting success.

Confidence:
Doesn’t mean you’re not afraid. You do it scared.
Doesn’t’ mean you’re always right. It means you tell them when you’re wrong.
Doesn’t mean you avoid mistakes. It means you embrace them.

Inside every argument, there’s an ignition phase and a cooling phase. Emotional intelligence, or discernment, gives you a big advantage in a disagreement. Recognizing and understanding your own reactions and triggers leading to conflict helps, and if you can identify those in another person…..it really helps.

Don’t react to win an argument, respond in a way that cools it. If you want to put out someone’s fire, find their trigger.

Don’t look for what will control someone else in a conflict, look for what’s controlling you.

I’ve talked about metacognition….something many of us would benefit from. This is taking a breath before reacting to something. Let your first word be your breath when about to react negatively. I don’t have any conflicts with patients, but a few weeks ago, someone had a challenging time getting on the video that we normally use (not a big deal and we have easy work arounds)….I wasn’t worried or bothered…..but the second we connected it was at least a minute of a barrage of negativity…..and I sat there and took it and apologized……but I think instead of erupting with negativity……a better approach might have been to take a breath, explain you had a bit of difficulty logging in, and move on. The negativity can set the tone for the visit, and wasn’t necessary. Fortunately, the visit was pleasant and productive, and ended up being positively valenced. Metacognition…thinking before speaking usually helps us craft a better response.

Silence may be the absence of sound, but not the absence of communication. Silence can be the most effective tool at your disposal to fix communication problems. Rather than thinking silence shows uncertainty, take the mindset that silence ensures what follows IS certain. The strategic use of silence reflects intention, not hesitation. When well timed, pauses are a sign of confidence and self- control. More often than not, the person who controls the pace of the conversation is the person most in control of themselves. When things start to get heated in a conversation, silence serves as a wet blanket. Silence for several seconds allows words to echo back to the person who said them, allowing them to reflect on a hurtful statement. Silence can never be misquoted…it’s better than saying something hurtful.

Though the book had many other takeaways, the last I’ll leave you with is:

The fewer the words, the clearer the point.

The more words you use, the less we want to listen and the less value your words have. The fewer the words you use, the more I want to pay attention, and the more value each word holds. Flooding the market with excess words creates a deficit of attention. If you want to sound assertive, serve your words neat.

06/11/2025

Great quote:

"It doesn't make sense to continue wanting something if you're not willing to do what it takes to get it. If you don't want to live the lifestyle, then release yourself from the desire. To crave the result, but not the process, is a path to disappointment."

Unfortunately, something I see every day.

Another great quote:

"Doctors should be the embodiment of physical health."

How often do we see this?

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