This Time I'm the Patient + Office Hours

 To My Patients, 

Summer is over, the sun is hiding, but some of the late summer flowers are still here, and the autumn ones are coming up - definitely a bright spot. 

The office has been busy, both in-office, and face-to-face by telemedicine. We are still on a COVID schedule, seeing patients primarily Tuesdays and Thursdays plus "when necessary" by arrangement. More on the subject below. 

Speaking about myself, just had double-hernia surgery, from which I'm recovering rapidly, only had to change one workday and kept the schedule a little lighter for 2 days. The surgeon was great (but I prefer not to mention names on email). 

Sandy and I will be traveling to Denver at the end of this month, to see our younger son and his family, as we've been doing every few months (we try to see them, either here or in Colorado, at least 4-5 times a year). Our time away is listed at the end of this message. 

Please give us a call at 203-853-1919 if you need an appointment!

And now back to some real medicine: 

COVID
It's still with us, and not leaving soon. I deal with new COVID cases almost every day, sometimes multiple cases a day. Most patients have been vaccinated and "boosted," but are still getting it (none of them had received the newly released Bivalent Booster before contracting COVID). 

Unfortunately, COVID death rates in the US are still at the level of 380-400 a day, and there has been no definite decline in at least 6 months. Reliable studies calculated that, overall, vaccination has reduced COVID mortality by 80% down to today's level. 

The moral of the story: Get vaccinated/boosted, and make sure you get the new bivalent booster (includes the BA.4 and BA.5 subvariants); stay away from high-risk social gatherings (or at least wear a suitable facemask, I prefer the N95), and don't be embarrassed to use a hand sanitizer frequently. 

If you get symptoms which are commonly associated with COVID (sore throat, cough, nasal congestion, fever, malaise, etc.), don't assume "it's just a cold." Get tested, more than once, and if in any doubt - contact the office (call, leave message, email). The COVID antiviral medication is very effective, but you must act quickly. 

Telemedicine
Telemedicine, barely known before COVID and now commonly used, has been very effective in my practice. I use it 5+ days a week, from office or from home, and at hours when most medical offices are unavailable. Patients now have, or have access to, a growing variety of home monitoring devices. Aside of the old thermometer, it's common to have at home a reliable blood pressure machine, a pulse oximeter, a continuous glucose monitor (for people with diabetes), and/or pulse-irregularity monitor (as part of a wristwatch such as Fitbit, Apple Watch, and others). And many more are on the horizon. Using these devices, as the need arises, adds information, and makes telemedicine visit effective. 

As of now, most insurance cover the cost of the virtual visit; the copay or deductible still applies in most cases. 

You may find it interesting to see how Johns Hopkins describes the benefits of telemedicine, just click here. 

The formats I now use are FaceTime, Zoom and WhatsApp; this may change as regulations change. With enough public support and demand, I hope telemedicine stays with us after COVID is defeated, as a great adjunct to in-office medicine. 

Periodic Health Evaluation
There are various recommendations for periodic physical exams, but it's generally accepted that one should have a yearly physical starting at the age of 50. The periodic health evaluation/physical exam is your gateway to early detection and disease prevention, and so it is the gateway to better health. 

Most insurance companies pay for periodic physical exams, and many waive the copay and deductible. Some even give you an incentive to do it. An HSA (Health Saving Account) may cover any gaps. 

Medicare will pay for an Annual Wellness Visit, AWV (that's once every 365 days - this is how they define it). They don't pay for what we refer to as a physical exam, but we include all elements of the physical exam with the AWV at no special charge. 

To make a long story short, take advantage of the periodic physical exam/wellness evaluation. And if you have no insurance, we'll work with you - give us a call to schedule your visit - 203-653-1919. 

Time Away
Our mini-vacation time away from the office starts Thursday AM 10/27/2022, and runs through Wednesday 11/2/2022. 

We'll be back in the office on Thursday 11/3/2022, 9 AM. During our time away, Janine will be in the office as usual, and I will continue to check my emailfor your messages and ongoing needs. Your voice mail messages will be answered. 

Give us a call at 203-853-1919 if you need an appointment before we go!

Until I see you (physically or virtually…), stay well, 


Igal Staw, Ph.D., M.D.
www.drstaw.com
www.twitter.com/drstaw
Dr. Staw on Facebook 

More Health Pearls: Appetite control, Testosterone, Vitamin D

• Curb your appetite.  Almonds are a great snack, providing proteins, the right type of fats and, above all, a lot of antioxidants. Eating a few almonds as you become hungry between meals will help you curb your appetite and, in doing so, help you control your weight and provide excellent nutritional value. An ounce a day (or a little more) will help a lot.

• Men, are you taking testosterone? Beware of the low testosterone hype. Don’t take testosterone unless your need for it is evaluated, and then prescribed by a physician authorized to prescribe it (testosterone is a controlled drug). Taking testosterone unnecessarily, or taking too much of it, carries with it serious health risks such as premature heart attacks and prostate cancer.

• Vitamin D. Vitamn D, “the sunshine vitamin” plays an important role in a large variety of metabolic processes. It regulates the amount of calcium and phosphorous in the body, may improve balance and muscle strength in older adults. A low vitamin level is now considered a risk for increased heart disease and diabetes (especially in overweight people). It has a tendency to lower body inflammation, a desirable property. It’s important to make sure that your vitamin D level is not too low, even in the summer, when vitamin levels are higher. It’s a simple blood test; if your level is too low, it’s usually corrected with over-the-counter supplements.

Health Pearls: Back Pain, Aspirin, Best Fruits

• For common low back pain, Tylenol (acetaminophen), even in high doses, may not be any better than placebo (recent article in The Lancet). Over the counter NSAIDS, such as ibuprofen, or Aleve (Naproxen), or prescription meloxicam (Mobic) are generally effective. Better still, drug-free therapeutic massage therapy may be very effective. It works by relaxing the low back muscles, and by stimulating the brain to release pain-relieving dopamine and serotonin.
• If you take aspirin to lower your risk of a heart attack, you would want to make sure that the aspirin you're taking works for you. A simple urine test which measures Thromboxane A2 levels is available through our office to make sure you are not "aspirin resistant." Ask me about this at your next office visit!!!
• Summer time is fruit-eating time. Some of the best fruits are those that have a low Glycemic Load, namely they only minimally increase your blood sugar level. The best include: Strawberries (one half cup), cherries (12 cherries), and peaches (1 medium size). All have a Glycemic Load of 3 or less, which is very low and good.
  
  If you want a reliable list of the Glycemic Index of common foods, call the office or send me an email → istaw@drstaw.com.

Take a walk in the cooler hours of the day, and stay hydrated.

Omega-3, What’s the Real Story?

Omega-3 fatty acids are “essential fatty acids” that are required by the body in order to perform a variety of metabolic functions, but which our bodies can not produce. Our body must get them from the food we eat. They are classified as polyunsaturated fatty acids (PUFAs) and are considered to be “the good fats.”

There are three important omega-3s: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). EPA and DHA are found primarily in fish, krill, and calamari, and in algae (algal oil). They are present in the highest concentrations in fatty fish such as salmon, tuna, sardines and mackerel. ALAis commonly found in plant sources like flax seed, soy, walnuts and canola oil.

While the function of omega-3s is not fully understood, these fatty acids definitely play a definite role in our health. Their role is the subject of extensive ongoing research, and even controversy.

People at risk for heart disease and stroke, and those who already have one or both conditions, do better when they consume fatty fish several times a week. Eating the fish may be more effective than taking supplemental fish oil, perhaps because the fish contains other helpful substances, but the jury is still out on this one.

People with inflammatory diseases may benefit from an increased consumption of omega-3s. The list is long, and includes rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and Ulcerative colitis), lupus, and some forms of immune kidney diseases.

Fish oil may play a role in the prevention of a variety of cancers, age related eye disease, dry eye symptoms (keratoconjunctivitis sicca), anxiety, depression aggression, age-related cognitive function, and even Alzheimer’s.

Much of the beneficial effect of omega-3s is thought to be due to its ani-inflammatory function. The reasoning is that many diseases are either caused by or made worse by inflammatory processes in the body, and the less inflammation there is, the easier it is to bring the condition under control.

There is no agreement about how much omega-3 is enough, and how much is too much. Some authorities place the minimum daily requirement for healthy women and men at 1,000 mg and 1600 mg a day, respectively. A prescription drug, Lovaza (used to treat high triglycerides, a cardiac risk), provides more than 3,000 mg of omega-3s a day.

Recommended doses for different conditions vary throughout a wide range.

A reasonable-size portion of salmon, approximately 6 ounces, contains a little more than 800 mg of EPA and more than 1,100 mg of DHA.

So what’s the bottom line?

Two to three portions a week of salmon or another fatty fish a week, plus a variety of ALA-foods (walnuts, soy, and flax seed) should suffice for most healthy people.

If you are not a fish or ALA-food eater, you may want to take a fish oil and flax seed oil supplement.

If you feel that you have a condition that can be treated, at least in part, with fish oil, don’t do it on your own. The subject is very complicated and in a state of flux. It may involve consideration of other supplements, dietary changes and prescriptions. Above all, it requires a thorough understanding of your condition and the potential benefits of omega-3s, and knowledge of its limitations. Discuss it with your doctor!

Cholesterol News, Again?

In November 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) released new guidelines for cholesterol therapy in adults 20-79 years old. The guidelines were based on solid medical evidence but, nonetheless, generated a lot of controversy and even opposing opinions from experts in the field. On one hand, the guidelines argue for limiting some of the cholesterol testing we now use as a guide for therapy. On the other hand, the guidelines recommend therapy (the use of statin drugs) for certain groups of patients, regardless of their blood cholesterol levels. The controversy which evolved was covered in articles in the New York Times last November. The two titles convey the opposing messages: Experts Reshape Treatment Guide for Cholesterol and Don’t Give More Patients Statins.

Some of the best known statin drugs now in use include: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Lovastatin and Simvastatin.

A study on the subject was published in the New England Journal of Medicine of  3/20/2014by Michael J. Pencina, PhD, from the Duke Clinical Research Institute. It reports that the new guidelines would increase the number of U.S. adults eligible for statin therapy by almost 13 million, and that most adults between 60-75 years old would become candidates for treatment. I also refer to the guidelines in my blog of last November, Statins, To Take Or Not To Take.

The guidelines use a newly updated, computerized cardiac risk assessment tool, in deriving its recommendations. We use the same tool in our office.

 One has to remember that the guidelines are guidelines; they are not iron clad rules. Each case has to be judged individually. In the majority of cases, the guidelines should be followed. But there are exceptions. A small percentage of people just can’t take statins because of side effects. Others may be able to make lifestyle changes, such as diet modification, an increase in physical activity and weight loss, which may mitigate against the ill effects of high cholesterol. Others may have to be convinced that the benefits of taking a statin outweigh the risks. Still others may have to be convinced that they actually already have the beginnings of heart disease before they agree to take the medication. And then there is that group of patients that “just get away with high cholesterol.” Their families have had high cholesterol for generations, and they live well into their nineties or longer. They are the ones who wouldn't hear of statins…

When necessary, additional testing is done to further assess you heart disease risk, such as specialty blood work, and coronary artery calcium scoring.

So next time you’re in the office, ask about the new cardiac risk assessment (it’s free), and see if you really need to take a statin drug.

Are You Walking Outdoors Yet?

Our citron is being acclimatized to the outdoors. Are you?

And The Cough Goes On...

Do you have an untreated cough that has lasted for several weeks? If so, you are not alone. Many patients in my practice have been complaining about a cough that does not seem to go away. I have seen more of it this year than in other years, and it started back in November of last year.

Typically, one would have an episode of bronchitis, sinusitis, or the common cold, which may have been treated with a course of antibiotics. The initial symptoms then partially or fully resolve. A few days or a week later, the nagging cough develops, and is commonly referred to as “post infectious cough.”

The cough may be “productive” (producing mucus), or it may be “dry.” It can occur during the day, when you’re lying down at night, or throughout the night. In more severe cases, the cough will come in “volleys” (paroxysms), and will awaken you, or even frighten you. It may be associated with a post nasal drip or gastric acid reflux. Some medications, particularly some of the medication used for the treatment of high blood pressure, can cause a persistent, dry cough.

The underlying reason for the cough is an inflammatory process which affects the linings of the bronchial tree leading to the lungs. It’s similar to the process responsible for bronchial asthma. It is thought by some authorities that, when left untreated, this condition can leave you predisposed to a recurrence, or even trigger the new onset of asthma.

When the cough lingers, you should be examined by a physician. This is especially important if you have a chronic condition such as asthma, chronic bronchitis or heart disease, and even more so if you have an impaired immunity, take immune suppressing medications, or are a smoker.

In treating the persistent cough, the physician must make sure that conditions other than post infectious cough are ruled out, such as pneumonia, asthmatic bronchitis and the whooping cough (pertussis).

Once other causes have been ruled out or treated, the post infectious cough will resolve on its own. But it may take weeks, and I have seen it last for months. Treating it will generally shorten the duration and severity of the post infectious cough, and should make you feel better much faster.

So, when you develop a lingering cough, don’t just tough it out, have it evaluated medically, and treated if necessary.

FREE Blood Pressure Check and Analysis

Come in all Month Long for a FREE Check!

No appointment necessary, just call 203-853-1919

2000 Post Road, Fairfield, CT

If you have a home monitor in need of calibration, bring that in too, we'll make sure it's working correctly, for FREE too!

Heart Month is All Year Round

Did you know that February was National Heart Month? Did you do anything to make sure your heart was in tip-top shape? If you're like most people, you didn't! High blood pressure is a major risk factor for heart attacks, stroke, diabetes, and almost every major life threatening condition. Come in for a FREE Blood Pressure check! During the month of March, come into the office, at no charge, to get a FREE Blood Pressure check. If you've got an issue, we'll make a plan to solve it, and solve it fast. In March, if you have a home blood pressure machine, we'll check it for accuracy, and ensure you're using the machine correctly, also for free. Just give us a call at 203-853-1919, and let us know you're coming in, appointments for this service are not necessary. Please share this important free service with your friends. You never know when you can save a life. See you at the office.

Are You Still Smoking?

Fifty years after the release of the US Surgeon General report on smoking, the percent of adult smokers has gone down from 42% to 18%. With it, the number of people dying of lung cancer has decreased somewhat. But smoking remains the number one direct cause of death in the US!

The cost of tobacco use to the USeconomy is close to $300 billion (yes, with a "b") a year in direct medical cost and productivity loss. For every dollar spent on cigarettes, $5 are spent on related health care. And for every cigarette you smoke, you are likely to lose more than 20 minutes of life.

More than 440,000 people die in the USeach year as a direct result of smoking, of which 10% are innocent, second hand tobacco smoke inhalers. Most frequently, these are the children of smoking parents. Many more suffer from chronic, tobacco related lung and heart disease.

In my book, the main issue remains the “hard core” smoker. He or she has more than a 50% chance of dying of  lung disease and spending years with an oxygen mask. But the more casual smoker is also at risk.

It’s my hope that, if you are a smoker, the horrible statistics I brought to your attention would give you pause. Stop smoking now, before it’s too late. Do it for yourself, for your spouse, for your kids and your friends.

There are several ways to quit, from “cold turkey” to stress management, to hypnosis and medication. In our practice, we have seen many successful quitters, and most of them did it on their own.

Remember that stopping to smoke is one of those times when becoming a quitter is really becoming a winner.

Fitness and Conditioning: Why is VO2 Important?

If you exercise regularly, if you exercise vigorously and want to know if you could do even better, you may want to know your VO2 max.

When you exercise, your oxygen consumption increases. It does so within limits which vary from person to person. Your VO2max (where V stands for Volume and O2 stands for oxygen) is your maximal ability to consume oxygen during exertion, measured in milliliters of oxygen per kg of body weight, per minute.

Oxygen is inhaled from the atmosphere by the lungs, where it diffuses into the blood stream, and then
propelled by the heart throughout the body. Some of the oxygen is then taken up by the cells and is used in aerobic metabolism for energy production and a variety of metabolic processes.

Normally, the limitation to VO2 max is dictated by the ability of the heart to pump the blood. This max can be impaired in cases of heart disease, especially in congestive heart failure, but it can also be limited by a lung disease – asthma, and COPD for example – and can be further limited by genetic factors.

For individuals in good health, VO2 max can be “trained” to its ultimate maximum with a suitable exercise/fitness program. This may take several months, sometimes up to 18 months of regular exercise.

Your VO2 max is usually tested on a treadmill. It’s a graded exercise test, similar to cardiac exercise testing, with the addition of a small mouth piece through which air composition is analyzed, and the VO2 is computer-calculated during the test. Once you reach VO2 max, your oxygen consumption plateaus, as seen in the graph. Most people complete the exercise within 12-16 minutes (the Olympic athletes will take longer…).

Knowing you exercise VO2 and its relationship to your max allows us to assess your level of conditioning, and better prescribe an exercise/fitness routine in order to improve your performance.

At our facility, we have been cardiopulmonary function testing, which includes both a VO2 max test and cardiac exercise for over 20 years. To my knowledge, we are the only ones in the County who are doing this test outside the hospital. Many of our patients, including some high profile athletes, have benefited from it by safely increasing their exercise capacity and performance.

Insurance may cover some or all of the test; and we have an affordable fee schedule for the uninsured and the under-insured.

Does this whet your appetite? Any questions? Call (203) 853-1919.

My Grandpa Wants You to Have a Physical Exam!

I want you to call (203) 853-1919 now...

Are You Getting Too Little Sleep?

A lot has been said recently about the adverse effects of not getting enough sleep. These range from accidents, big and small, to heart attacks, depression, forgetfulness, weight gain, and....(the list goes on). But individuals vary in their need for sleep. For some, the "classic" 8 hours sleep is just right. For others, 7 or 9 hours is the right number. And the need may change with age and other circumstances.
So how do you know if you're getting enough sleep? If you're inappropriately sleepy during the day, you may not be getting enough sleep.

The simple questionnaire shown below (known as the Epworth Sleepiness Questionnaire) was developed to assess your daytime sleepiness.For each of the 8 questions, circle the most appropriate level. Don't skip any question.

0 -  there is no chance you would doze or sleep

1 -  there is a slight chance of dozing or sleeping
2 - there is a moderate chance of dozing or sleeping
3 - there is a high chance of dozing or sleeping

Situation Chance of Dozing or Sleeping    Sitting and reading    Watching TV 0     1       2     3 0     1       2     3    Sitting inactive in a public place 0     1       2     3    A passenger in a car for an hour or more 0     1       2     3    Lying down in the afternoon 0     1       2     3    Sitting and talking to someone 0     1       2     3    Sitting quietly after lunch (no alcohol) 0     1       2     3    Stopped for a few minutes in traffic       while driving 0     1       2     3 Total score (add up all circled numbers) __________

A score of 10 or higher may indicate that you are not getting enough sleep. It just doesn't tell you the reason.

A score of 18 or above is considered "very sleepy." Further evaluation may be needed to look for the cause, which may include the high risk condition of sleep apnea.

If you are concerned, seek advice. We're here to help.

Vitamin D - For Me?

Vitamin D deficiency in the US is wide spread, affecting more than 40% of the people. Vitamin D is also known as the "sunshine vitamin," and the deficiency is much more prevalent in the northern states and in dark-skinned people. It is also more common in the elderly and the obese. Interestingly, vitamin D is synthesized in the skin from HDL cholesterol (the "good cholesterol"), and people with a very low HDL cholesterol also tend to be more prone to vitamin D deficiency.

In our practice, we check blood vitamin levels routinely, and found that, of those not previously tested, more than 50% were vitamin D deficient.

But why check the vitamin D level?

1. In women, Vitamin D plus calcium supplementation helps reduce dangerous hip and vertebral fractures (I'm sure it also happens in men, albeit to a lesser extent). It's an important factor in the prevention of bone thinning in general, especially with advancing age, and in the prevention of the bone pain often associated with bone thinning (osteoporosis and osteopenia).


2. Women who took vitamin D supplements for an average of 7 years, in an extensive study, had a 13% lower incidence of breast cancer.


3. People with low vitamin D levels have a significantly higher risk of fatal heart attacks, about 27% higher, a frightening statistic (fatal heart attacks account for more than 400,000 deaths a year in the US).


4. It has been strongly suggested, although not fully scientifically proven, that Vitamin D helps keep Diabetes type II (the common type) under better control.


5. Some cancers may be reduced in people who take vitamin D supplements, or who normally have higher (but still normal) vitamin D levels: Colorectal, breast, prostate and pancreatic.


6. There is a marked increase in uterine fibroids in women who have low vitamin D levels.

Except for the effect on bone, where the picture is quite clear, it is not fully understood why all this happens. Is it because people with a naturally normal D level, or those who take supplements simply benefit from having a more acceptable D level? Or is it because these people have other beneficial lifestyles that bring their D levels to normal and at the same time reduce their risk for associated diseases?

I don't know the answer, but I don't recommend taking a chance.

Some of the best, and desirable, food sources for vitamin D include the oily fish salmon, mackerel and tuna, and fortified milk (skimmed or low fat, of course). Others include cod liver oil, beef or calf liver, and egg yolks (do you really want to do that? It will do wonders to your cholesterol).

Vitamin D levels may fluctuate with time, especially with the change of seasons and more so in the north. So you have to check the level periodically.

Does this give you enough reason to have your vitamin D level checked? If it doesn't, talk to me!

This article, as well as some of my other articles, was also published at: http://ezinearticles.com/?Vitamin-D,-To-Take-or-Not-To-Take?&id=8228492

You Call This Exercise?

I saw joggers outdoors through my window. I'll stay indoors, but I'll pedal...

Holiday Weight Gain

We used to believe that the average American adult gained 5 or more pounds during the holiday season, between Thanksgiving and New Year. But a study published in the New England Journal of Medicine (NEJM) in 2000 changed all that. It concluded that the average Holiday Season weight gain was "only" 1 pound.

But this just didn't sound right. As many of you know, my practice had a weight management division for over 25 years, known as Health Extenders, where we followed a large number of patients for their weight and behavior over long periods of time, including the holiday period. We never believed the 1 pound weight gain, and I still believe it's much higher than that.

Revisiting the NEJM article recently, the study was relatively small, including only 200 people. In reality, the study showed that perhaps 3 pounds were gained during the actual holiday season, and that one of these three pounds was still "retained" during the following 6-9 months. In addition, the study did suggest that, the heavier you are, the more you are likely to gain weight during the holiday season. The statistical variability between individuals was, in my opinion, too wide to render a scientifically valid opinion.

So what's the lesson? Weight gain during the holiday season is still a real problem, which, if it goes unchecked, can lead to ongoing weight gain. Taken cumulatively over several years, this can indeed become a real health hazard.

Especially during this holiday season, please be selective in your choice of foods. Politely reject the fatty cuts of beef, the skin on the chicken, the fried food, and, yes, the white wheat products and sugar. Choose the leaner cuts of meat (even lean pork is OK today), chicken, turkey and fish. Don't forget whole wheat bread and pasta, and use Stevia instead of sugar to sweeten your drinks. Exercise, not only to help maintain a lower body weight, but also as a relaxation method.

Above all, enjoy the holiday season, your friends and family, and drive responsibly.

Statins – To Take or Not to Take?

And the controversy rages on. If you followed the article Experts Reshape Treatment Guide for Cholesterol and the editorial Don’t Give More Patients Statins in the New York Times in the last two days, you’d see the breadth of the issue.

The problem is that, while heart disease is the number one cause of death in the US, most heart disease is not necessarily caused by an elevated cholesterol or abnormal cholesterol pattern. The number one cause of premature heart attacks (and overall mortality) is smoking!

It is quite clear that people who have already had a heart attack are at a high risk for a subsequent heart attack, and those with type 2 diabetes carry a similar risk. These people should be treated with statins, if possible. Most experts agree.

But...
What is one to do with the healthy person who has a high LDL (“bad cholesterol”), a family history of heart attacks, and faulty lifestyles such as eating the wrong foods and not exercising? Some people simply get away with it – without statins. According to the new guidelines, these people should still get statins, even if in retrospect they should not have had them. So how do you know who will “get away with it?” You don’t know for sure, but you try to better assess their risks.

Besides the usual physical examination and lab results, additional testing may be in order. This may include more sophisticated blood tests, such as those done by Berkeley Heart Lab or Boston Heart Diagnostics, and a variety cardiac stress testing (simple, radionuclear, or ECHO).

When there’s still a question, a non-invasive CT scan of the coronary arteries can be performed. This test determines the amount of calcium in the major coronary arteries. The higher the “calcium Score” the greater the risk of a future heart attack.

In my practice, I’ve had a fairly large number of patients with very high total cholesterol  and “bad cholesterol” levels who lived, or still living, with no statins and no heart attacks to a ripe old age.

So, my take is that statins are not for everyone, and a reasonable attempt should be made to identify those who are at an increased risk for a heart attack. And then treat.

Low Glycemic Index Foods – Why Bother?

After a meal blood sugar levels usually rise. To keep the blood sugar in check, insulin levels rise, and then return to normal, in order to bring blood sugar levels back to normal.. There are many reasons to keep both blood sugar and insulin levels within acceptable limits, but most important are the control of diabetes, cholesterol, and weight.

Keeping you sugar under control helps curb appetite- that’s how it helps you lose weight.

The foods that raise your blood sugar the most, the culprits, are “simple carbohydrates” (or simple carb’s): Sugar, high fructose corn syrup, and highly processed wheat products (mainly white flour).

The “good carbohydrates” are complex carbohydrates such as whole wheat products and a host of vegetables, legumes and some fruits (don’t forget the grapefruit, the season is approaching…).

The Glycemic Index (GI)is a measure of the blood sugar rise after a test amount of a given food is ingested. The Glycemic Load (GL) is a measure of the sugar level rise after a regular portion size amount of the same food is ingested.  The lower the numbers, the better the food.

You can find many GI and GL tables on the internet. A reliable source is the one by Berkeley Labs. Use it.

Any question? You know where I am.

Curb Your Sweets

I need not tell you the dangers of dietary sweets/sugars, especially if you have, or are at risk for, diabetes. Here are some hints for curbing your sweet-craving:

• Start the day with a balanced meal of protein, vegetables (yes, vegetables for breakfast) and complex carbohydrates. This will allow your blood sugar to rise slowly and gradually, as it should, and avoid a “sugar rush.”
• Avoid eating “light bread” made of wheat flour, which is made of simple carbohydrates. Have whole wheat bread instead of light bread, sweetened crackers, white rice, or potatoes.
• Incorporate into your meals complex carbohydrates: whole wheat products, corn, beans, peas, lentils, whole grain rice.
• Try to eat something as frequently as every three hours, in order to not deplete your energy stores, and to avoid sugar craving. A piece of fruit or whole wheat cracker may do.
• Get enough sleep. Tired bodies demand immediate energy in the form of simple carb’s.
• Have some sun exposure. Avoid staying in dark environments most day (as you may do in the office). Lack of sun exposure causes a decrease in serum serotonin, which causes relative depression and an increase in sugar craving. A little bit of Chocolate (70% cocoa, please) will increase serotonin level, and may elevate the mood.
• A boring lifestyle, associated with low serotonin, drives sweet craving. So keep busy. Exercise, yoga, or spending  quality time with someone will help a lot.
• You don’t have to totally abstain from sweets. Have a measured amount of your favorite candy periodically – every day, two days, or a week. Don’t eat it all at once, leave some for tomorrow.

Have a great day, without the sweets...

Lo T, Do You Really Have it?

I get questions daily from my male patients (and concerned "better halfs") about "Low T."  And, in view of the media blitz about low testosterone, this is not surprising.

If you listen to the ads, "tired, fatigued, decreased sexual drive, erectile difficulties" you may think that you, like everyone else, has this "common" problem. The ads would also lead you to believe that treatment is very simple, just take this or that supplement and it will make you very happy. But, here's the problem, there is a ton of misinformation out there.

Low testosterone level is indeed more prevalent now than in previous years. The population is aging, and an age-related decrease in testosterone production does occur. Other conditions which can give many of the same symptoms as Low T are also on the rise, diabetes, obesity, and general stress, to name just a few. And while some medications can do it too, narcotic pain medications are notorious.

Don't let the commercials fool you. A diagnosis of low testosterone requires blood tests and clinical evaluation. It is virtually impossible to make a diagnosis or treat the condition without testing.

So, if you think you belong to the low T group, give us a call. We'll get you tested, and if necessary, put you on a proper treatment plan. Don't rely on television advertising for your medical advice!