Pre-Authorizations and a Vegetable Challenge

emailed to patients 4/9/2026

To My Patients, 

I Hope all is well. 

Hope you enjoyed the last several warm days. We used some of that time to do outdoor work and begin preparing the garden for the coming growing season. 

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

A Few Administrative Issues to be Aware of: 

Pre-authorization For Medications
We receive denials for prescribed medications daily, and the number continues to grow steadily. This is not limited to GLP-1 medications. We frequently see denials involving insulin, common asthma inhalers, and many others. 

You will often hear the pharmacist say, "All your doctor has to do is get a PA (prior authorization)." Unfortunately, this is often a tedious and time-consuming process, which may require appeals, re-appeals, and submission of chart documentation. Approval can take an inappropriately long time. 

Insurance companies often favor their own medication lists (their pharmacopeia), which vary from plan to plan and are not always the best clinical choice. Don't be surprised if PA takes longer than expected, totally denied, or an alternate drug is approved. 

Email Address - Action Required
As explained in a recent notice, my personal email address, istaw@optonline. net, was abruptly discontinued by Optimum for no stated reason. We were able to retrieve emails from the last five years through 4/8/2026. 

Please use istaw@drstaw.com for all office communication. If there is a problem, use the alternate igalstaw22@gmail.com. If you believe I missed any prior emails sent to the old address, please resend them. 

Now to Medicine: 

Fatigue
Many patients complain of fatigue. Medically, this is an important but often misunderstood symptom. Fatigue means different things to different people - and frequently different things to the physician as well (that includes me). 

By saying "fatigue," some patients mean sleepiness. Others mean low energy, reduced stamina, lack of motivation, muscle weakness, poor concentration, or simply "not feeling right." For that reason, the first step intreating fatigue is to define what type is really present. 

Common causes include inadequate sleep, emotional stress, medication side effects, poor nutrition, dehydration, anemia, thyroid disorders, low vitamin B12, chronic inflammation, heart disease, lung disease, and blood sugar problems. Frequently, more than one factor is involved. 

And it could be age related; but age itself is not the usual cause. Many seniors remain highly energetic, while younger adults may feel exhausted. 

A detailed discussion, questions and answers, often provides the clue. 

Laboratory testing can be helpful, but bloodwork alone does not always provide the answer. Sometimes treatment involves correction of iron deficiency, thyroid imbalance, uncontrolled diabetes, or vitamin deficiency. Other times it requires better sleep, improved fitness, stress reduction, or adjustment of medications, to name a few. 

The key point: fatigue should not be ignored or blamed on age. If persistent, it deserves evaluation and usually can be improved once the true cause is identified. 

Zepbound For Obstructive Sleep Apnea (OSA)
There is encouraging news for patients with obstructive sleep apnea and excess weight. Zepbound (tirzepatide) has recently received FDA approval for adults with OSA and obesity. With this new indication, some insurance companies may be more willing to provide coverage than before. Weight reduction can significantly improve sleep apnea severity and, in some cases, reduce CPAP pressure, or even eliminate the need for CPAP. If you think this may apply to you, we can discuss whether it is appropriate. If you believe that you have OSA, but it hasn't been documented, this may be a good time to get a sleep study. 

Vegetables Revisited
We usually encourage you to eat "lots of vegetables," and for good reason. They provide fiber, vitamins, minerals, antioxidants, and help support metabolic health. 

Some vegetables and legumes also contribute meaningful protein. Foods such as lentils, chickpeas, soybeans, peas, and edamame are especially valuable. They contain all essential amino acids - the ones the body cannot produce on its own and must obtain from food. 

While many plant foods may not contain the full amino acid profile individually, a varied diet over the course of the day generally provides what the body needs. 

Vegetables remain one of the best foundations for long-term health. 

Challenge Yourself
Choose a vegetable you have not eaten before. Also consider quinoa - not a vegetable, but a highly nutritious seed that cooks like rice and beats it nutritionally. 

And remember our Health Extenders motto: 

We help you live a longer, healthier life

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

Stay well, 


Igal Staw, Ph.D., M.D.

istaw@drstaw.com

Telemedicine Update and Our New Family

 emailed to patients 2/24/2026

I Hope all is well. 

No trips to report this time, but we welcomed a new baby into the family. Aurora, born in February to Gaby and Jordan, makes our daughter Laurie a grandmother for the third time. Life continues its forward motion. 

This is a snowy winter! But soon the dormant basement plants and the seed trays will sit under the growing lights, and then come upstairs to enjoy the coming spring sun. Health, too, follows cycles - maintenance, renewal, growth. 

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

Administrative Notes 

Telemedicine (Medicare and Commercial Plans)
Governor Lamont recently formally codified telemedicine into Connecticut law! That's an important, positive development. While insurance coverage details may still vary by plan, telemedicine remains viable and available. 

Advantages in a practice like ours include definite appointment times, no waiting room delays, and flexibility for patients working remotely or traveling. 

Certain concerns still require in-person evaluation, to be judged on a case-by-case basis. Please be aware that, depending on your insurance plan, copays and deductibles may still apply, similar to an office visit. 

Insurance Reminder
If there has been any change in your insurance coverage - even if the carrier remained the same - please notify us before your next visit or telemedicine appointment. ID numbers and group details often change at the beginning of the year. 

If an insurance claim is not filed on time ("timely filing"), sometimes 90 days, or even less, for commercial insurance, the claim may be denied. Accurate information prevents unnecessary billing confusion. 

Medical Notes 

Colorectal Cancer in Younger Adults
A January 2026 study published in JAMA analyzed nearly 1.3 million cancer deaths in Americans under age 50 from 1990 to 2023. 

The finding is alarming: Colorectal cancer is now the leading cause of cancer death in Americans under 50. 

While overall cancer mortality in this younger-than-50 group has declined about 40% since 1990, colorectal cancer deaths have increased by approximately 1% per year since 2005. 

Routine screening now begins at age 45. If you are 45 or older and have not been screened, please consider doing so. If there is a significant family history of colon cancer, screening should begin earlier. 

Don't ignore symptoms such as blood in the stool, persistent change in bowel habits, unexplained weight loss, ongoing abdominal discomfort, or unusual fatigue. Early detection remains the key to survival. 

Longevity
When we speak about longevity, it's helpful to think in two contiguous stages. 

First: achieving your full "genetic allowance." 

Each of us inherits a biologic range of potential lifespan. Our primary responsibility is to remove the treatable conditions that shorten it. This includes tight control of blood pressure, lipid burden, inflammatory markers, glucose variability, visceral fat, and preservation of muscle mass and cardiorespiratory fitness. These measures are well-established determinants of health span and survival. 

Second: exploring whether the genetic ceiling can be raised. 

This is an area of extensive and accelerating research. Longevity science is now examining cellular senescence, epigenetic signaling, mitochondrial resilience, metabolic pathway modulation (including mTOR and AMPK balance), and systemic inflammation biology. While definitive lifespan-extending therapies remain under investigation, early insights are emerging. 

As part of this evolving field, new multi-cancer early detection blood tests - including one marketed as CancerGuard - are being developed to identify circulating tumor DNA before symptoms appear. The tests require a physician order and are generally not covered by insurance. 

Performance varies by cancer type and stage. The main difficulty is still in detecting cancer in its early stages. Early-stage pancreatic cancer detection rates are currently reported to be approximately 30%, meaning most early cases would still be missed. As technology advances, this type of testing will become part of individualized, risk-based preventive strategies. 

We continue to monitor these developments carefully. 

If you would like to review cancer screening, or discuss a structured longevity strategy, you know how to reach me! 

Always remember our Health Extenders motto: 

We help you live a longer, healthier life

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

Stay well, 


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

My Take on the Inverted Food Pyramid and More

 Sent to patient 1/21/2026

To My Patients, 

Hope all is well. 

Just returned from a couple of trips. The most meaningful was during the recent holidays in Israel; we spent time with family and friends and also had the opportunity to volunteer - this time, picking lemon (lemons, really? Sounds silly, but rewarding). We also made a brief trip to Denver to watch our grandson David, age 15, perform as a violinist in a regional high-school concert. When a grandchild asks you to come, could you say no? 

As always, it's been busy at work. Below are a few updates. 

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

Administrative Notes 

Insurance Changes
If your insurance changed- common at the start of the year - please let us know before your next office visit or telemedicine appointment. Insurance changes often affect medication formularies, deductibles, and coverage rules. 

Telemedicine (Medicare and Commercial Plans)
Telemedicine continues to be an important and convenient option for many visits. Certain Medicare telemedicine flexibilities are currently scheduled to expire on January 30, but it appears that several basic elements may remain in place. Commercial insurance plans generally continue to support telemedicine, but coverage details may vary by plan. We are hopeful that telemedicine will remain broadly available and applicable in our area. That said, some medical concerns still require in-person evaluation, and we'll handle it accordingly. 

Medication Renewals & Prior Authorizations
At times, both you and I may receive automated pharmacy notices requesting "prior authorization" for medications. In some cases, these notices are generated even when a medication is not on the formulary, and an appeal will probably be denied. Nevertheless, we try… 

Medical & Lifestyle Notes 

The "Inverted" Food Pyramid - Not Really Inverted
You may have heard references to a "new" or "inverted" food pyramid. In reality, it is not inverted at all, and it doesn't matter if you represent it upside down. It's the concept. The base, inverted or not, still represents the foods we should emphasize most. What has changed is which foods occupy that base. The Pyramid base now focuses on vegetables, legumes, whole grains, fruits, olive oil, nuts, and fish - while processed foods, refined carbohydrates, and excess animal fats were placed higher up, meaning they should be consumed less frequently. 

Some versions place greater emphasis on full-fat dairy than I believe is appropriate; dietary choices should remain individualized based on metabolic health, cholesterol profile, and blood-sugar response. We can modify this framework to your needs, especially if you have a chronic condition, such as diabetes, hypercholesterolemia, or kidney disease. 

Mediterranean Diet
Closely aligned with this updated pyramid is the Mediterranean diet, one of the most consistently supported approaches for cardiovascular health, metabolic balance, inflammation reduction, and overall longevity. It emphasizes plant-forward meals, healthy fats ( particularly olive oil), regular fish intake, and minimal processed foods. A simple handout outlining the Mediterranean diet is available - you may request a copy by email or pick one up during your next office visit. 

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

Continuous Glucose Monitoring (CGM)
Even if you don't have diabetes, CGM trends can provide insight into energy levels, inflammation, and weight regulation. If you are interested in using CGM data to better understand how specific foods affect your body, we can review this together. This is particularly important if you have diabetes of pre-diabetes. While CGM monitors are usually not reimbursed by insurance, a short 1-2-month use may be affordable and can provide valuable insight into individual food responses. 

If you want help/advice on any of the above, please call us at 203-853-1919, or email at istaw@drstaw.com 

Stay well, 


Igal Staw, Ph.D., M.D.

istaw@drstaw.com

istaw@optonline.net

Office Hours and What's Up With Your Gut

 To My Patients, 

Hope all is well. 

Summer is coming to a rapid close, hope you had a chance to get some valuable time off. The vegetable garden already passed its peak; the crop this year was unusually plentiful. The prize belongs to the tomatoes, two of them weighted over 1.75 pounds each. 


Back from Israel after a relatively short whirlwind trip. Had to see my friends and family; haven't seen them in two years. Sandy stayed home this time "so you can keep your conversations in Hebrew." Our daughter, Laurie, was there with me. Together, with a close group, we volunteered some time picking peppers (hot ones…) in a kibbutz by the Gaza border. The volunteer movement in this time has been outstanding. 

The office continues to be busy, with telemed done on off-office days. We try to keep 2-3 open appointments every office day for urgent visits, just in case. Call us at 203-853-1919 if you need to take advantage of those open times. 

The office will be closed on Tuesday, September 23, for the Rosh Hashanah holiday. 

Your Gut: The Big Influencer 
The gut contains trillions of live bacteria, viruses, and fungi, collectively known as the microbiome. These microbes produce vitamins, help digest food, and communicate with our immune and nervous systems. It may be hard to believe, but more than 70% of our immune defenses are linked to the gut. 

The microbiome deeply influences our biogenetics - the way genes are switched on or off. Certain gut bacteria release short-chain fatty acids and other compounds that act like molecular messengers, signaling our genes to regulate inflammation, metabolism, and even mood. This implies, correctly, that what you eat doesn't just fill you up - it literally affects how your genes express themselves on a daily, continuous basis. 

For example, a diet rich in plant fibers (vegetables, beans, whole grains, nuts) feeds beneficial bacteria, which in turn encourage genes that protect against diabetes, heart disease, and even some cancers. Diets heavy in ultra-processed foods and excess sugar, on the other hand, promote bacterial strains that "turn on" inflammatory pathways and accelerate aging processes. 

The gut communicates directly with the brain; it does so through the vagus nerve. Patients with balanced microbiomes report steadier moods, clearer focus, and less fatigue. An unhealthy gut can worsen anxiety, contribute to brain fog, and chronic inflammation.  

You may think of your gut as a microbiome clinic that constantly dispenses natural compounds to the rest of your body. But the gut clinic is a living entity, which itself is subject to health and disease. The healthier your microbiome clinic is, the better the message it sends; that's where you come in! 

Keep your gut healthy:

• Eat a wide variety of plant foods - aim for 25-30 different types weekly (It may sound challenging, but it is quite achievable).
• Include fermented foods such as yogurt, kefir, sauerkraut, or kimchi (and the list goes on).
• Minimize unnecessary antibiotics; use them only when necessary.
• Get regular exercise and sunlight. In addition to the widely known benefits, this helps diversify gut bacteria.

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

Sleep revisited 
In the last letter we touched on "sleep as medicine." Let's go a step deeper. Sleep occurs in repeating phases, usually 4-6 times each night:

1. Light sleep (stages 1 and 2) - Your body relaxes, heart rate slows, and memory traces begin forming.
2. Deep sleep (stage N3) - growth hormone surges, muscles and bones repair, and the immune system resets. This is when the body does its most important physical healing.
3. REM sleep - the brain becomes highly active, consolidating memories, regulating emotions, and clearing toxins such as beta-amyloid (strongly associated with Alzheimer's). This is when vivid dreaming occurs.

Each phase is vital. If you miss deep sleep, your body suffers; if you cut REM sleep short, your brain and mood take the hit. Poor sleep fragments these cycles, leaving you unrested even after long sleep. 

Studies show that inadequate or irregular sleep increases the risk of obesity, diabetes, heart disease, and depression. Consistent, restorative sleep strengthens memory, supports healthy metabolism, and even slows biological aging. 

Practical steps:

• Keep a regular bedtime and wake time, even on weekends.
• Minimize, or avoid, TV or other screens an hour before bed - blue light tricks the brain into staying awake.
• Avoid caffeine after midday.
• Create a dark, cool, and quiet sleep environment.

Sleep is the body's most reliable, cost-free prescription - one that renews your mind and body every night. Make good use of it! 

Have specific questions about healthy diet and sleep?
Call the office at 203-853-1919

Stay well, 


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

Office Hours and Few New Weight Tips

 To My Patients, 

Hope all is well. 

It's been an unusually long time since the last "To My Patients," but here we are. 

The practice has been very busy, both in the office and through telemedicine. Our Colorado crew, all four of them, spent almost three weeks with us - a yearly tradition of togetherness and happiness. 

The garden is blooming vigorously this year, flowers and vegetables alike. The Garden Phlox has done particularly well, blooming ahead of schedule, as you can see from the picture. 

Time Away 
We'll be out of the office the week of September 1st, returning Tuesday morning, September 9th. It promises to be exciting; I'll let you know all about it when back. 

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

Insurance and Billing Notes 
Dealing with health insurance continues to be tough for both patients and physicians. Much of the difficulty is obtaining prior authorization (PA) for medications such as inhalers for asthma and COPD, and weight-loss medications (Ozempic, Mounjaro, and others). Occasionally approval comes quickly, but more often it's a tedious, drawn-out process. 

Billing can also be confusing. Sometimes you'll notice an open balance - for example, if a telemedicine encounter carries a copay, or if part of a charge isn't covered by insurance. By the time you receive a statement (now by email unless you prefer paper), we've already appealed and settled what we could. Please always make sure we have your current insurance information on file. 

Medical Notes 

Sleep as Medicine 
Just as we prescribe medications for blood pressure, cholesterol, or diabetes, your nightly sleep is a powerful therapy that works silently and effectively - provided you take it consistently. 

Think of sleep as medicine. Many of us underestimate the importance of good, regular sleep. Adequate sleep lowers blood pressure, reduces risk of diabetes, strengthens the immune system, and helps memory and mood. Poor sleep raises body inflammatory processes and can contribute to the development of heart disease, stroke, worsening of diabetes, and others. Think of quality sleep as one of your "daily medications" for longevity. 

During sleep, the body is actually very active. The brain consolidates memories, clears toxins such as beta-amyloid (which is linked to Alzheimer's disease), and resets its circuits for attention and learning. Muscles, bones, and tissues repair themselves; growth hormone and other repair signals become more active at night, and the immune system mobilizes and produces infection-fighting cells. People with inadequate sleep are at a higher risk for colds, flu, and other infections. 

Without adequate sleep, irritability, anxiety, and depression worsen; people who sleep well handle stress better, they have less brain "fuzziness" during the day. For the elderly, good sleep is also protective against cognitive decline and dementia. 

Most adults need 7-8 hours of sleep each night, but individual needs vary. Scientific studies show that performance, judgment, and reaction times all decline with chronic sleep debt. But length of sleep is not everything. Quality matters: frequent nighttime awakenings, sleep apnea, or restless legs can undermine the benefits of sleep even if hours seem sufficient. Improving sleep quality - whether by treating sleep apnea, restless legs, or other conditions - can improve alertness and heart health. And it can increase life quality and longevity. 

Most importantly, think sleep as your key to a healthier, longer life! 

Need Suggestions? Call Us at 203-853-1919

New Frontiers in Heart Risk Testing 
Beyond the familiar cholesterol panel, newer tests now give a clearer picture of cardiovascular risk:

• ApoB – measures the actual number of "bad" cholesterol particles.
• Lipoprotein(a) - a genetically inherited cholesterol particle linked to early heart disease.
• Insulin Resistance - indicates how effectively the body uses insulin, a key factor in metabolic and heart health.
• Coronary Calcium Score (CT Scan) - shows if cholesterol has already begun forming plaques in arteries.

These tests are becoming part of preventive care and help identify those who may need more aggressive risk reduction, long before symptoms appear. 

Nutrition Nuggets 
Sometimes small swaps make a big difference:

• Try half an avocado instead of cheese on a sandwich - more potassium, less sodium.
• Add berries to breakfast - natural antioxidants and fiber that support the microbiome.
• A handful of unsalted nuts (almonds, walnuts, pistachios) is linked to lower risk of heart disease. As a bonus, almonds are mild appetite suppressor, and had a very low glycemic index, so important for people with diabetes or even prediabetes.
• Want to minimize sugar consumption? Try a pinch of monk fruit extract (the pure one, not in combination with a filler).

Sandy and I wish all of you and your families a happy, healthy late summer and fall. 

Stay well, 


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

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Internal Medicine * Pulmonary Medicine * Preventive Medicine * Health Risk Reduction 
2000 Post Road, Fairfield CT 06824 
(203) 853-1919