House Calls

House Calls Started This Year

House calls are meant for patients who are temporarily or permanently home bound, or for other good reasons can't make it into the office.

To schedule a house call: Tel (203) 853-1919; email

Monday, December 21, 2009

New Year's resolutions... why wait?

As 2010 approaches, many of us are ready to make New Year’s resolutions. Some of the most popular resolutions have been to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, despite economic difficulties, and may be because of them, more people are resolving to change their lifestyle, enjoy life more, and devote more quality time to their family. In short, many people are deciding to have a less stressful life, and also that less is more.

In reality, 50% of those who start an exercise program drop out within 6 months (or much less...) and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of the rest, daily stresses resurface. So how do you succeed?

Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For many, this translates into increasing exercise, and managing stress.

Exercise: For beginners, it is extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.

Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.

Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.

The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. For a good example look at the blog Stress, Relaxation and the Mind-Body Connection, on the left hand column (September 2009).

There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.

People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…

Tuesday, December 1, 2009

Insuring the uninsured

A headline article in today’s New York Times entitled No Big Cost Rise in U.S. Premiums Is Seen in Study is very revealing, but fails to tell you who will really pay for this No Big Cost Rise.

For people buying their own insurance, which, includes the unemployed, self employed and uninsured, the article quotes the Congressional Budget Office

“…as a result of the subsidies, it said, most people in the individual insurance market would see their costs decline, compared with the costs expected under current law. The subsidies, a main feature of the bill, would cost the government nearly $450 billion in the next 10 years and would cover nearly two-thirds of premiums for people who receive them.”

It does stand to reason that if you buy a health insurance policy on your own, and some of the payment is subsidized, then your premium will not go up, or may be even be lower. But where will this 450 billion subsidy come from? It can come from printing more money, and it can come from raising taxes (or both).

I believe that the majority of Americans are for some form of medical health coverage for everyone. But let’s not hide the fact that we are all going to pay for it.

I also believe that the best way to decrease the cost of health care is to reduce the need for health care. This is done by paying serious attention to disease prevention and the establishment of healthy lifestyles as the New American Way.

Sunday, November 29, 2009

What really ails us?

We all know the grim statistics. The four most common causes of death in the US in the last few years have been heart attacks, cancer, stroke and chronic lung disease, accounting for almost two thirds of all deaths, or close to two million deaths last year. Health care expenditure in the US is now over 2.2 trillion dollars a year, approximately $7,400 per person in 2007. The cost is now over 16% of our gross national product, and is expected to rise to 20% within 10 years. The out of pocket cost to you in the form of co-pays, deductibles and non-covered services is also increasing dramatically, from an average of $850 per person 3 years ago to an estimated $1,400 in less than ten years. And in comparison with other industrialized countries, we are losing our edge and are actually lagging by many measurements of health care, such as longevity and infant mortality.

What does all of this mean to you, the health care consumer? As you’ll see, you’ll have to actively participate in your own health care.

Tuesday, November 10, 2009

Better sleep, better golf

Are you a golfer, and do you have sleep apnea?

If so, the news is quite encouraging. In a study presented at the 2009 annual meeting of CHEST in San Diego, it was shown that patients with sleep apnea who were treated with a continuous positive pressure device during sleep (a common treatment for sleep apnea), improved their golf scores significantly after several months of treatment.

This study only confirms what we already know about sleep, lack of sleep, and sleep apnea: Better quality sleep improves performance.

So, if you (or someone who observed you while you sleep) think that you have sleep apnea, be proactive, take the next logical step and seek medical advice.

Sunday, November 1, 2009

Exercise prevents diabetes


We have known for many years that regular exercise (cardio, plus weights, plus stretching, for 20 minutes or more each session, most days of the week) helps a great deal in the control of diabetes.

Also, we've been saying for over ten years, that vigorous exercise plus dietary discretion can delay the onset of diabetes for an indefinite period for many individuals.

An October 29, 2009 article in The Lancet reports a study (Diabetes Prevention Program, DPP) done on patients at high risk for the development of diabetes. The study concludes that an intensive lifestyle prevention program can prevent or delay the onset of diabetes for at least 10 years.

This really validates much of our thinking about the development of diabetes.

Imagine, another 10 years free of diabetes with lifestyle changes and no medications!

And imagine the cost saving to you and to the health care system.

So what are you doing it? and if not, what are you waiting for?

Monday, October 26, 2009

How important is Apo B?

Most of us realize how important it is to control your cholesterol level, especially if you have additional risks for the development of heart disease. Of course, it’s not necessarily the total cholesterol that has to be controlled. Rather, it is cholesterol’s most important components, the “bad cholesterol” (HDL), and “good cholesterol” (LDL). Depending upon gender and age, HDL level should be at least 40-55 mg/dl. Depending on the risk of developing a future heart attack, LDL should be kept less than 70-100 mg/dl.

HDL levels are determined primarily by genetics (blame you parents for this one). LDL levels are determined by a combination of genetics and lifestyles (eating and exercise habits). Abnormal LDL levels are much easier to control than abnormal HDL levels.

Drug therapy is aimed primarily (but not exclusively) at lowering LDL to the recommended level of 70-100 mg/dl. But is this good enough?

After many years of research, it turns out that apolipoprotein B, Apo B for short, is a much more reliable predictor than LDL of the risk of developing heart attacks, and it also provides a much better assessment of cholesterol therapy.

In abbreviated form, the reason is as follows: The risk of LDL is not expressed by the usual measurement of how much LDL is in your blood stream. Rather, it’s the number of LDL particles in a given volume of blood that determines the risk, and this depends on how large the particles are. Small particles are much more dangerous than large particles. The Apo B measurement is a fair estimate of the LDL particle number and thus a better estimate of cholesterol risk and of progress of therapy.

The use of Apo B has already been adopted in Canada, but to my knowledge has not yet been adopted by our own National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) or by other “guidelines makers” in the US.

We appear to be years behind in the treatment of a condition that is the number one killer in the US! As a country that boasts of having the best medical system in the world, why have we not taken this simple step?

Many doctors, including yours truly, are already using Apo B as a guide. But in recent weeks I have gotten numerous complaints from patients who have received bills from their labs because insurance companies (mainly HMO’s and alike) stopped paying for the Apo B lab test. This is absurd.

Both patients and physicians must fight this non-payment trend. The physicians must fight it because this trend impedes their duty and ability to treat effectively, and the public must fight it because this trend will yield suboptimal medical outcomes.

Let your political representatives know that you care and want to change.

Sunday, October 18, 2009

Sleep apnea, do you have it?

More than 18 million Americans have sleep apnea, and almost everyone knows someone who has it. Many cases go undiagnosed for years. But what is sleep apnea, how do you make the diagnosis, and how is it treated?

There are three basic types of sleep apnea: Obstructive Sleep Apnea (OSA), which accounts for most cases, Central Sleep Apnea (CSA), and a mixture of the two. Here, only OSA will be addressed.

Sleep apnea was first described in medical literature in 1965, as a breathing disorder characterized by numerous brief interruptions of breathing during sleep. But don’t be misled; it’s been described quite accurately by Charles Dickens in his Pickwick Papers in 1837-1938, when he portrayed Joe as the fat, red faced boy who was repeatedly falling asleep during the day.

Sleep apnea is defined as the presence of more than 30 episodes of apnea (cessation of breathing), each lasting more than 10 seconds. In severe cases, apnea periods may last longer than 60 seconds, and may recur hundreds of times a night. Obstructive Sleep Apnea occurs mostly in the obese person, typically with a short neck. It may occur in persons who have abnormalities in the nose and throat, such as enlarged tonsils, polyps or excess adenoid tissue, which obstruct the flow of air while asleep. Most OSA patients are heavy snorers. During an apnea episode snoring stops, then breathing resumes with a typical “snort.” While sleeping, the tongue and throat muscles relax causing airway blockage. When the apnea period ends, these muscles tighten up temporarily, allowing breathing again until the next episode.

Full blown OSA leads to irritability and lack of concentration; learning and memory difficulties; sexual dysfunction, and the development of high blood pressure, headaches, irregular heart beats, premature heart attacks and sudden death. In sleep apnea there is a major disturbance of the sleep cycle. Sleep quality is poor, and in reality you are sleep deprived. As a result, you may fall asleep irresistibly during the day, even while driving. You may not realize that you fell asleep during the day while in a meeting or at lunch; but your friends notice it, and will hopefully tell you about it.

While you may strongly suspect sleep apnea, the definitive diagnosis is made in a sleep laboratory, where the severity of the disorder can be quantified, and treatment suggested.

Treatment is individualized, usually consisting of a pressurized face mask at night to allow better airflow and to minimize the number and severity of apnea episodes. Surgery to remove excess tissue in the throat is occasionally recommended. Alcohol and caffeinated beverages have to be kept to a minimum, and sleeping medications must be avoided.

Most importantly, the long term therapy of Obstructive Sleep Apnea must include weight management. Reducing weight to normal or near normal range frequently eliminates the sleep apnea altogether, allowing you to return to normal life.

If you suspect that you have sleep apnea, have it formally diagnosed and, above all, take care of your health, no one will do it for you...

Monday, October 12, 2009

Exercise and Aging

You’re asking yourself: I’m a Senior Citizen; do I really need to exercise?

“Rest is precisely what aging people do not need” stated William Evans, Ph.D., of the U.S.D.A Human Nutrition Research Center on Aging at Tufts University about ten years ago. And it hasn’t changed since.

Starting in middle age, people gain fat, and lose muscle, strength, bone, and aerobic capacity. Their risk of heart disease, diabetes, high blood pressure and osteoporosis rises. While a healthy diet can help reduce these risks, exercise is at least as important. The single most important step to slow down the aging process is strength training. Many of us believe that we lose our ability to respond to exercise as we age, but nothing is further from the truth. You can strengthen your muscles as you age, and the improvement may even be more noticeable than at a younger age.

Women are at a special risk because they have less muscle mass to begin with, and they start to lose muscle strength more rapidly after 60. The Framingham Heart Study showed that half of women aged 65 or over can’t lift ten pounds. Muscles weaken rapidly after age 70. At age 20, 90% of the volume of the thigh is muscle. At age 90, it’s only 30% muscle, the rest is fat and bone. With weight lifting, muscle mass can be increased by 10%, but the increase in strength can be 200%. When women lose weight by dieting alone, they may also lose muscle and bone. With exercise and weight lifting, muscle and bone are preserved.

Dr. Steve Blair of the Cooper Aerobics Institute in Dallas has shown that inactivity is as risky as having a high blood cholesterol level.

Strength training: Lift a weight heavy enough so that your muscles will feel fatigued after eight or nine lifts. For a healthy 65 year old, that's about 20 pounds (60-80% of maximum lifting capacity). If you lift weights properly, it will not dangerously increase your heart rate or blood pressure. Weights should be lifted without holding one’s breath. Move slowly, take time to warm up and cool down, so that muscle stiffness is minimized. With exercise you can become more limber and increase your range of motion. Weight lifting promotes weight loss; the number of calories you burn increases with your muscle mass. So, the more muscle mass you build, the more calories you burn.

Aerobic exercise: While strength training is important, don't abandon aerobic exercise, which increases cardiovascular fitness, reduces blood pressure, increases HDL cholesterol (the "good cholesterol”), and reduces the risk of dying of heart disease, diabetes, and even colon cancer.

A reasonable recommendation today is that aerobic exercise be done at least three days a week for 30 to 45 minutes each time, and strength training 2 or 3 days a week.

What’s the reward? It’s very simple: Not only will you feel better about yourself, you’ll live longer. So what are you waiting for?

Tuesday, September 29, 2009

How does your health carrier treat you?

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?

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.

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.

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.
  1. Close your eyes.
  2. Begin by breathing in through your nostrils while bringing your count slowly to five.
  3. Now begin to exhale; let the air escape through pursed lips, and bring your abdomen back in.
  4. 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.

  1. Start by getting as comfortable as possible. Take off your shoes. Sit comfortably in a chair or recline in a couch.
  2. 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.
  3. 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.
  4. Clench your teeth together tightly. Feel the tension build. Hold it. Relax your jaw, letting it go loose.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Moving on to your stomach, hold these muscles in as tight as you can. Hold it. Let the tension build and now relax.
  10. 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.
  11. 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.

Sunday, August 30, 2009

Do you know your BMI?

Your BMI (body mass index) is a number, usually between 18-50, that expresses the relationship between a person’s height and weight. It is considered a good indicator of normal or excess weight, and of the links between overweight and disease. Generally, a BMI of 19-25 is considered normal. BMI’s below 19 are considered underweight, and BMI’s over 25 are considered overweight. A BMI over 40 is referred to as morbid obesity, and carries with it serious medical risks. Use the calculator on the right hand column to get your BMI.

Saturday, August 22, 2009

A new Preventive Medicine blog; who needs it anyway?

Preventive medicine, also called preventive care (my preferred way of calling it), refers to the steps taken to prevent illness or injury. In addition to the public health prevention programs aimed mainly at vaccinations, there are two main aspects of preventive care, primary and secondary.

In primary care, one tries to identify the risks you may have for the development of acute or chronic disease. These risks are assessed from knowledge of your lifestyle, environment and family history, and also on the basis of the physical findings and laboratory tests you may undergo at your physician’s office.

Based on your health risk factors, a program can be developed to help you reduce these risks, so that the likelihood of disease is decreased. A simple, but very important, example is smoking. The risks are well known: heart disease, chronic lung disease, lung cancer, and many other. And the preventive intervention is well known too. Quit, in time. Don’t start. Other risk factors are much more subtle or less well known. Did you know that the presence of the KIF6 protein in blood is associated with an increased risk for heart attacks, and that certain medications can reduce this risk? (If you didn’t, don’t be disappointed, I only learned about it recently…).

Secondary care is the early detection of disease, before symptoms occur or before the disease becomes chronic or otherwise incurable. This is the reason why women get periodic pap smears and mammograms, men have a prostate examination, and both have periodic colonoscopies.

But you probably already know much of this, so why am I stressing prevention here?

Prevention is not only what your doctor can do for you. Much, if not most, of primary prevention relies on things you can do for yourself. This is particularly important in the US today, when the cost of medicine is skyrocketing and healthy lifestyles are frequently taking a back seat, and where the environment is becoming continuously less friendly (yes, that does include some of the bad stuff we’re eating).

It’s been said again and again that “we have the best medical system in the industrial world.” In many respects this is true. We have some of the best physicians here, and more of the sophisticated diagnostic and treatment facilities than anywhere else in the world. People do come to the US for treatment; they don’t usually leave the US for better treatment elsewhere.

But look at longevity. If we’re so good, we should be number one! But number one is not the US. It’s little Andorra with an average life expectancy of almost 85 years. The US is not at the bottom; it shares a very humble 33rd place with Cuba. You draw the conclusions.

In industrialized countries, the main reasons for the differences in longevity are diet, use of tobacco, and access to medical care.

A little more emphasis on prevention, by the medical profession, by every individual and by the government, will go a long way toward increasing health and longevity, and will save trillions along the way.

I’ll cover the obvious and much of the less obvious things that can be achieved with the practice of prevention in subsequent segments.

Health care reform, in one way or another, is coming. I’m not here to fix the blame on any entity (yet…), but this has been brought upon us because the system of which we were so proud is rapidly breaking down. There is no way to know what shape medicine will take in the next few years. Will it become a single payer system, will some form of free market be preserved or will there be serious rationing of care? Will it answer your needs? But of one thing I am certain, that if we don’t push for prevention at full throttle, it would not matter at all, the system will fail.

Please give me your comments, your experiences, your successes and frustrations. We can all learn from each other and do our best to enjoy a longer healthier life…

Twitter / Dr. Staw