A few days ago, while getting rid of some "old stuff" in my office, I found an interesting denial letter sent to a patient of mine in 1986 (yes, 23 years ago) from a major health insurance carrier in Connecticut. The letter states that:
"Your contract defines a medical emergency as the sudden and unexpected onset of a condition requiring medical care which the patient obtains immediately after the onset. Heart attacks, cardiovascular accidents, loss of consciousness and convulsions are examples of medical emergencies.
"The information received from the hospital does not indicate that a similarly acute condition existed when services were rendered for ... Therefore, we are unable to provide benefits."
In reality, the patient had acute appendicitis, was admitted to the hospital at 2 AM, and had surgery within an hour. The appendix was about to burst. I guess that's not an emergency. Can you imagine how much energy it took to reverse this denial?
Do you think that things got better in the 23 years since this episode? Unfortunately, things only got worse, and it's going to take a lot of sincere effort and energy to fix them.
Do you have any war stories?
About Me
- Dr Staw
- My practice motto has been "we help you live a longer, healthier life..." I’ve been in private practice 35 years, and in the last 25 years have placed great, and ever increasing, emphasis on prevention. I practice preventive care by first identifying health risk factors (the factors which predispose you to disease) and then developing the best strategy to minimize or eliminate these risks. Special diagnosis and treatment tracks in my office include asthma, COPD, high cholesterol and obesity, and diabetes.I now place special emphasis on the provision of truly affordable health care to all, including patients with HSA's, high co-pays, and high deductibles.
Tuesday, September 29, 2009
Thursday, September 24, 2009
The Better Sweeteners
There’s no question that refined sugars, widely used in the US and hidden in many foods, are a major health hazard and their use should be minimized. But if you like your food to be sweetened, what can you use safely?
Here are some of my favorites:
1. Agave syrup. Agave syrup (also known as agave nectar) is a natural plant product extracted from the agave plant in several states of Mexico. It’s a liquid resembling honey, but less viscous. It is a little less sweet than sugar, and is available in light and darker varieties, depending on the degree of filtering. The darker varieties have more of the plant product in them, and have the additional caramel-like flavor.
Agave syrup is not calorie free. It has the same number of calories as sugar, but it contains much more fructose than sugar, and therefore raises blood sugar levels to a much lower extent than does sugar (table sugar, or sucrose, is made of 50% glucose, 50% fructose; it’s the glucose that causes most of the damage). As a sweetener, agave syrup is considered much safer than sugar, but because it does contain the same amount of calories as sugar, it should be used in moderation.
Agave syrup can be used in cooking. It’s a good substitute for other liquid sweeteners. When used instead of solid sweeteners, the consistency of the baked product will change.
2. Erythritol. Erythritol is a natural sugar-alcohol (not to be confused with regular table sugar or with the ethanol present in alcoholic beverages). Erythitol is produced from glucose, usually derived from corn, by yeast fermentation. It’s available as a powder, is about 2/3 as sweet as table sugar, and can be used in cooking and baking. It is present in many commercial foods, and in chewing gum. Unlike table sugar, erythritol does not cause tooth decay.
Erythritol’s main advantage is that it’s almost calorie free, and does not significantly raise blood sugar or insulin levels. Erythritol is considered very safe, but using it in very large amounts may cause abdominal bloating and discomfort.
3. Xylitol. Xylitol is a natural sugar-alcohol, a powder with some similarities to erythritol. It is present in plants, fruits and vegetables, and also in the human body as part of glucose metabolism. Most xylitol used and sold commercially is extracted and processed for human consumption from birch and corn. Xylitol contains approximately half the calories of table sugar, and causes a significantly smaller increase in blood sugar and insulin levels than does table sugar. It is considered “tooth friendly,” not causing tooth decay. Xylitol is much more likely to cause abdominal bloating than erythritol, which may limit the amount one can use.
Are you a dog lover? Make sure your dog doesn’t get a hold of your xylitol. In dogs, xylitol can cause severe hypoglycemia which can be fatal.
4. Truvia. Truvia is a natural product made from rebiana, a sweetener derived from the sweet leaves of the Stevia plant. It is approximately 200 times sweeter than table sugar, and has essentially zero calories. Stevia is native to South and Central America; its leaves are harvested and dried, and are steeped in fresh water in a process similar to that of tea making. Unlike agave syrup, Truvia is available as a powder. It contains erythritol as its first item on the list, but most of its sweet taste comes from the rebiana. According to the Truvia website, you can cook and even do some baking with Truvia. But I’m not so sure about “traditional” cake baking.
When shopping, read those labels and pay special attention to sugar or sugar-like ingredients like corn syrup and high fructose corn syrup. Frequently, you’ll find more than one sweetener in the ingredient list. In my opinion, this is done mainly to confuse us by shifting these sweeteners to a lower position on the ingredient list, and to make us think we’re consuming less of the bad stuff.
My vote (as table sweetener)? Erythritol, agave, xylitol, Truvia, in that order of preference.
Here are some of my favorites:
1. Agave syrup. Agave syrup (also known as agave nectar) is a natural plant product extracted from the agave plant in several states of Mexico. It’s a liquid resembling honey, but less viscous. It is a little less sweet than sugar, and is available in light and darker varieties, depending on the degree of filtering. The darker varieties have more of the plant product in them, and have the additional caramel-like flavor.
Agave syrup is not calorie free. It has the same number of calories as sugar, but it contains much more fructose than sugar, and therefore raises blood sugar levels to a much lower extent than does sugar (table sugar, or sucrose, is made of 50% glucose, 50% fructose; it’s the glucose that causes most of the damage). As a sweetener, agave syrup is considered much safer than sugar, but because it does contain the same amount of calories as sugar, it should be used in moderation.
Agave syrup can be used in cooking. It’s a good substitute for other liquid sweeteners. When used instead of solid sweeteners, the consistency of the baked product will change.
2. Erythritol. Erythritol is a natural sugar-alcohol (not to be confused with regular table sugar or with the ethanol present in alcoholic beverages). Erythitol is produced from glucose, usually derived from corn, by yeast fermentation. It’s available as a powder, is about 2/3 as sweet as table sugar, and can be used in cooking and baking. It is present in many commercial foods, and in chewing gum. Unlike table sugar, erythritol does not cause tooth decay.
Erythritol’s main advantage is that it’s almost calorie free, and does not significantly raise blood sugar or insulin levels. Erythritol is considered very safe, but using it in very large amounts may cause abdominal bloating and discomfort.
3. Xylitol. Xylitol is a natural sugar-alcohol, a powder with some similarities to erythritol. It is present in plants, fruits and vegetables, and also in the human body as part of glucose metabolism. Most xylitol used and sold commercially is extracted and processed for human consumption from birch and corn. Xylitol contains approximately half the calories of table sugar, and causes a significantly smaller increase in blood sugar and insulin levels than does table sugar. It is considered “tooth friendly,” not causing tooth decay. Xylitol is much more likely to cause abdominal bloating than erythritol, which may limit the amount one can use.
Are you a dog lover? Make sure your dog doesn’t get a hold of your xylitol. In dogs, xylitol can cause severe hypoglycemia which can be fatal.
4. Truvia. Truvia is a natural product made from rebiana, a sweetener derived from the sweet leaves of the Stevia plant. It is approximately 200 times sweeter than table sugar, and has essentially zero calories. Stevia is native to South and Central America; its leaves are harvested and dried, and are steeped in fresh water in a process similar to that of tea making. Unlike agave syrup, Truvia is available as a powder. It contains erythritol as its first item on the list, but most of its sweet taste comes from the rebiana. According to the Truvia website, you can cook and even do some baking with Truvia. But I’m not so sure about “traditional” cake baking.
When shopping, read those labels and pay special attention to sugar or sugar-like ingredients like corn syrup and high fructose corn syrup. Frequently, you’ll find more than one sweetener in the ingredient list. In my opinion, this is done mainly to confuse us by shifting these sweeteners to a lower position on the ingredient list, and to make us think we’re consuming less of the bad stuff.
My vote (as table sweetener)? Erythritol, agave, xylitol, Truvia, in that order of preference.
Sunday, September 20, 2009
About Vitamin D…
Vitamin D deficiency in the US is now widespread, and appears in headlines and news media with increasing frequency. But what’s the fuss all about?
Vitamin D, also referred to as “the sunshine vitamin,” is not even a true vitamin, because the body can actually synthesize it under appropriate conditions. Vitamin D is synthesized in the deeper sections of the outer layer of the skin. It does so from cholesterol derivatives present in the skin in the presence of sufficient sunlight (UBV radiation).
It's a true epidemic. Depending on the study, vitamin D deficiency in the US is said to be present in 26-58% of the population. It is more prevalent in the elderly, in dark-skinned people, and in those with some chronic diseases. The further north you are from the equator, the more likely you are to be vitamin D deficient.
The major contributors to the recent increase in vitamin D deficiency are the general decrease in exposure to sunlight (skin cancer awareness), the use of sun screens, and the use of cholesterol lowering medications which reduce the availability of cholesterol compounds in the epidermis.
Vitamin D deficiency is believed to be associated with a wide variety of disorders, with its full role in some conditions under intense investigation and not fully understood yet. This includes vitamin D’s well established role in bone metabolism, and less well established roles in the prevention of diabetes, heart disease, prostate cancer, muscle fatigue, postmenopausal weight gain and hypertension, and the list goes on. It is believed that people with adequate vitamin D levels have an overall increase in longevity compared with those with D deficiency.
Vitamin D deficiency can sometimes be treated with diet modification, and almost always with over the counter supplements (prescription drugs are required in some cases).
Foods that contain significant amounts of vitamin D include fatty fish such as herring, catfish, salmon, mackerel, sardines, tuna and eel (also cod liver and beef liver, but who really wants that…), and whole eggs.
So pay attention, and make sure your doctor pays attention, to vitamin D, the frequently unmentioned vitamin.
Vitamin D, also referred to as “the sunshine vitamin,” is not even a true vitamin, because the body can actually synthesize it under appropriate conditions. Vitamin D is synthesized in the deeper sections of the outer layer of the skin. It does so from cholesterol derivatives present in the skin in the presence of sufficient sunlight (UBV radiation).
It's a true epidemic. Depending on the study, vitamin D deficiency in the US is said to be present in 26-58% of the population. It is more prevalent in the elderly, in dark-skinned people, and in those with some chronic diseases. The further north you are from the equator, the more likely you are to be vitamin D deficient.
The major contributors to the recent increase in vitamin D deficiency are the general decrease in exposure to sunlight (skin cancer awareness), the use of sun screens, and the use of cholesterol lowering medications which reduce the availability of cholesterol compounds in the epidermis.
Vitamin D deficiency is believed to be associated with a wide variety of disorders, with its full role in some conditions under intense investigation and not fully understood yet. This includes vitamin D’s well established role in bone metabolism, and less well established roles in the prevention of diabetes, heart disease, prostate cancer, muscle fatigue, postmenopausal weight gain and hypertension, and the list goes on. It is believed that people with adequate vitamin D levels have an overall increase in longevity compared with those with D deficiency.
Vitamin D deficiency can sometimes be treated with diet modification, and almost always with over the counter supplements (prescription drugs are required in some cases).
Foods that contain significant amounts of vitamin D include fatty fish such as herring, catfish, salmon, mackerel, sardines, tuna and eel (also cod liver and beef liver, but who really wants that…), and whole eggs.
So pay attention, and make sure your doctor pays attention, to vitamin D, the frequently unmentioned vitamin.
Thursday, September 17, 2009
Stress, Relaxation and the Mind-Body Connection
It works. Compiled by Dr. Staw from reliable sources, and based on our clinical experience.
Invest a little time in managing your stress through slow, deep breathing, and earn big dividends in a very short time.
In the last few decades, it has become unequivocally clear that the mind can indeed affect the body's health. Frequent unrelieved stress can cause hypertension and raise your cholesterol level. It also directly causes heart disease and other ailments. Stress is difficult to define, and what is stressful to one person may not be stressful to another. One of the best definitions of stress was given by Dr. Herbert Benson (Director Emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital) as a situation which requires a behavioral adjustment. Stress causes an increase in the body's adrenaline production and with it a myriad of physiologic changes such as a rise in heart rate, blood pressure, muscle tension and blood-sugar, and excessive sweating. This is the primordial flight-or-fight response which was necessary for the survival of the cave man, but is frequently unsuitable for dealing with the stresses of the modern world. Recurrent stress can make hypertension and other medical conditions permanent. You may not be able to control your stressors (e.g., you can't fire your boss), but by learning how to handle stress you can lower your risk of heart disease and live a healthier, more satisfying life.
Below, find two methods similar in concept, to relax. The first, by eliciting the Relaxation Response; the second by performing Deep Muscle Relaxation exercises. Both are effective, try them!
The Relaxation Response:
The simplest way to reverse the stress response, or the flight-or-fight response, is to breathe deeply and slowly in a controlled fashion, which brings about the desired Relaxation Response.
Take 10-15 minutes each day to practice it, especially when you¹re under stress. Sit comfortably, assume a passive attitude, and wear loose, comfortable clothing.
Invest a little time in managing your stress through slow, deep breathing, and earn big dividends in a very short time.
In the last few decades, it has become unequivocally clear that the mind can indeed affect the body's health. Frequent unrelieved stress can cause hypertension and raise your cholesterol level. It also directly causes heart disease and other ailments. Stress is difficult to define, and what is stressful to one person may not be stressful to another. One of the best definitions of stress was given by Dr. Herbert Benson (Director Emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital) as a situation which requires a behavioral adjustment. Stress causes an increase in the body's adrenaline production and with it a myriad of physiologic changes such as a rise in heart rate, blood pressure, muscle tension and blood-sugar, and excessive sweating. This is the primordial flight-or-fight response which was necessary for the survival of the cave man, but is frequently unsuitable for dealing with the stresses of the modern world. Recurrent stress can make hypertension and other medical conditions permanent. You may not be able to control your stressors (e.g., you can't fire your boss), but by learning how to handle stress you can lower your risk of heart disease and live a healthier, more satisfying life.
Below, find two methods similar in concept, to relax. The first, by eliciting the Relaxation Response; the second by performing Deep Muscle Relaxation exercises. Both are effective, try them!
The Relaxation Response:
The simplest way to reverse the stress response, or the flight-or-fight response, is to breathe deeply and slowly in a controlled fashion, which brings about the desired Relaxation Response.
Take 10-15 minutes each day to practice it, especially when you¹re under stress. Sit comfortably, assume a passive attitude, and wear loose, comfortable clothing.
- Close your eyes.
- Begin by breathing in through your nostrils while bringing your count slowly to five.
- Now begin to exhale; let the air escape through pursed lips, and bring your abdomen back in.
- Silently say the word “out” and count slowly to five.
Do this deep breathing for five minutes two or three times a day. With practice, you will be able to count to ten or higher with each breath. After two to three weeks of practice the Relaxation Response will become a part of your system. You can enhance your Relaxation Response if you simultaneously create an image of yourself in a pleasant situation such as breathing ocean air, or the scent of flowers or forests, or sitting in your favorite easy chair at home. After practicing for a while, you'll be able to bring about the Relaxation Response almost at will during most stressful situations by flashing back to the image of your pleasant situation.
Deep Muscle Relaxation:
The following exercises will help your entire body relax. The instructions tell you to tighten and then relax certain muscles or muscle groups in a sequential manner. As you tighten each of these muscles or muscle groups, take a deep breath, and hold that breath for a slow count of 3 to 5 seconds. Then let the air out of your lungs slowly as you relax these muscles. Do it twice for each muscle or muscle group. For optimal results, perform these exercises once in the morning and once in the evening.
- Start by getting as comfortable as possible. Take off your shoes. Sit comfortably in a chair or recline in a couch.
- Raise your eyebrows as high as possible, feeling the tension build. Hold that tension for a moment. Now relax and feel the tension flow out.
- Squeeze your eyes shut as tight as you can. Hold that tension, let it build. Now relax your eyelids. Feel the relief from the tension.
- Clench your teeth together tightly. Feel the tension build. Hold it. Relax your jaw, letting it go loose.
- Squeeze your entire face into a knot. Hold it there. Hold it. Let the tension build as you squeeze your eyes, mouth and nose together hard. And now relax. Notice how loose and relaxed your whole face feels.
- Bring your chin slowly down toward your chest, feeling the tension build in your neck and shoulders. Hold it. And now relax. Feel the relief.
- Make your right hand into a tight fist. Raise your right arm to shoulder height, extending it in front of you. Feel the tension build in your clenched fist and arm; keep your arm stretched. Now relax, letting your arm fall slowly to your side.
- Make your left hand into a tight fist. Raise your right arm to shoulder height, extending it in front of you. Feel the tension build in your clenched fist and arm; keep your arm stretched. Hold it. Now relax, letting your arm fall back to your side. Relax. Feel the relief in your arms and hands.
- Moving on to your stomach, hold these muscles in as tight as you can. Hold it. Let the tension build and now relax.
- Raise your right leg parallel to the floor, tensing your thigh and calf muscles and pulling your toes back toward you. Hold it. Feel the tension build. Now let your leg back down and relax.
- Now raise your left leg parallel to the floor. Tighten your calf and thigh muscles as you pull your toes back. Let the tension build. Hold it. Now let your leg back down and relax. Feel the sense of relief.
Now stay still and spend a few moments experiencing the deeply relaxed, restful feeling. Sense the quiet and restfulness that comes from releasing the tension in your muscles.
Take a few full, deep breaths. Hold each breath a moment. Then as you slowly exhale, let any remaining anxieties and tensions just flow away.
You are now very deeply relaxed and at ease. Open your eyes, stretch your arms and legs and move them about. Get up when you feel ready.
Tuesday, September 8, 2009
The Metabolic Syndrome, Do You Have it?
Rarely mentioned by physicians to their patients, the Metabolic Syndrome is an astonishingly common and dangerous disorder that now affects more than 30% of adult Americans, and more than 51% of people over the age of 60, but what is it?*
The term Metabolic Syndrome refers to a cluster of metabolic abnormalities which, when taken together, are a major risk indicator for the development of heart disease, peripheral artery disease, stroke and diabetes.
The central metabolic abnormality of this syndrome is insulin resistance. The hormone insulin is produced by the Islets of Langerhans within the pancreas. Its main function is to regulate the metabolism of the body’s main fuel, glucose, which derives from commonly ingested sugars and carbohydrates. It affects how glucose is ultimately stored in the liver, and how it is utilized by muscles. It also plays an important role in the control of body fat, and in cell growth.
The problem begins when cells throughout the body, mainly muscle cells, lose some of their responsiveness to insulin. When this happens, blood sugar levels increase, and the pancreas, in an attempt to keep sugar levels controlled, gradually goes into an overdrive mode, producing more insulin, and creating the background for additional metabolic derangements.
Do you have the metabolic syndrome? There is no universally accepted way to diagnose it, but, depending on the guidelines used by your physician, the diagnosis will be made on the basis of a physical examination (including blood pressure, height, weight, and waistline measurement), and laboratory tests, some of which are common (e.g., fasting blood glucose and a simple cholesterol profile), and more sophisticated tests (e.g., fasting insulin, and indicators of blood vessel inflammation and clot formation tendency, cardiac CRP and Fibrinogen, respectively).
A particularly useful, inclusive diagnostic and informative blood test is the one offered by Berkeley Heart Lab, Inc., available through some medical practices, and widely used in our practice (despite the great value of this test, many insurance companies are still balking about reimbursement does this make any sense to you?).
Some risks include: A waistline of 40 inches or more for men or 35 inches or more for women, blood pressure of 130/85 mm Hg or higher, triglyceride level above 150 mg/dl, fasting blood glucose level greater than 100 mg/dl, high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women), BMI** (body mass index) of 40 or more (morbid obesity), high fasting insulin level, high prothrombin level, or a high specific indicator of blood vessel inflammation.
Most people with the metabolic syndrome are obese and sedentary, with genetics playing a significant role. There are no specific symptoms; it’s frequently a silent, neglected killer.
The most dreaded complications of the metabolic syndrome, heart attack and stroke, may be delayed or decreased with lifestyle changes including weight loss, exercise, and diet changes (mainly reducing carbohydrates). But medications are necessary in a large percentage of cases.
So, if you suspect that you have the Metabolic Syndrome, don’t waste time, seek medical advice and make the necessary changes to make it a longer, healthier life.
*Statistics based on the National Health and Nutrition Examination Survey (NHANES) 2003–2006.
**A BMI calculator is available on the left column of this page.
Igal Staw, Ph.D., M.D.
The term Metabolic Syndrome refers to a cluster of metabolic abnormalities which, when taken together, are a major risk indicator for the development of heart disease, peripheral artery disease, stroke and diabetes.
The central metabolic abnormality of this syndrome is insulin resistance. The hormone insulin is produced by the Islets of Langerhans within the pancreas. Its main function is to regulate the metabolism of the body’s main fuel, glucose, which derives from commonly ingested sugars and carbohydrates. It affects how glucose is ultimately stored in the liver, and how it is utilized by muscles. It also plays an important role in the control of body fat, and in cell growth.
The problem begins when cells throughout the body, mainly muscle cells, lose some of their responsiveness to insulin. When this happens, blood sugar levels increase, and the pancreas, in an attempt to keep sugar levels controlled, gradually goes into an overdrive mode, producing more insulin, and creating the background for additional metabolic derangements.
Do you have the metabolic syndrome? There is no universally accepted way to diagnose it, but, depending on the guidelines used by your physician, the diagnosis will be made on the basis of a physical examination (including blood pressure, height, weight, and waistline measurement), and laboratory tests, some of which are common (e.g., fasting blood glucose and a simple cholesterol profile), and more sophisticated tests (e.g., fasting insulin, and indicators of blood vessel inflammation and clot formation tendency, cardiac CRP and Fibrinogen, respectively).
A particularly useful, inclusive diagnostic and informative blood test is the one offered by Berkeley Heart Lab, Inc., available through some medical practices, and widely used in our practice (despite the great value of this test, many insurance companies are still balking about reimbursement does this make any sense to you?).
Some risks include: A waistline of 40 inches or more for men or 35 inches or more for women, blood pressure of 130/85 mm Hg or higher, triglyceride level above 150 mg/dl, fasting blood glucose level greater than 100 mg/dl, high density lipoprotein level (HDL) less than 40 mg/dl (men) or under 50 mg/dl (women), BMI** (body mass index) of 40 or more (morbid obesity), high fasting insulin level, high prothrombin level, or a high specific indicator of blood vessel inflammation.
Most people with the metabolic syndrome are obese and sedentary, with genetics playing a significant role. There are no specific symptoms; it’s frequently a silent, neglected killer.
The most dreaded complications of the metabolic syndrome, heart attack and stroke, may be delayed or decreased with lifestyle changes including weight loss, exercise, and diet changes (mainly reducing carbohydrates). But medications are necessary in a large percentage of cases.
So, if you suspect that you have the Metabolic Syndrome, don’t waste time, seek medical advice and make the necessary changes to make it a longer, healthier life.
*Statistics based on the National Health and Nutrition Examination Survey (NHANES) 2003–2006.
**A BMI calculator is available on the left column of this page.
Igal Staw, Ph.D., M.D.
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