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.

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...

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!

Hemoglobin A1C, Why Would You Like To Know It?

Persons with a fasting blood sugar level of 126 mg/dL on two separate occasions, are considered to have diabetes. Diabetes type II is by far the most common form of the disease.

Hemoglobin A1c (or HbA1c) is a measure of the ever-fluctuating blood sugar level over a fairly long period of time, usually about three months. The blood level HbA1c is used to monitor the disease progress or disease control, and in many cases also to identify people suspected to have diabetes.

An HbA1c level of less than or equal to 6.0% is considered normal, whereas a level above 6.5% represents diabetes.

Depending on whether one follows the recommendation of the American College of Endocrinology or the American Diabetes Association, the target HbA_1c should be between 6.5% and 7%.

The most common complications of uncontrolled type II diabetes are cardiovascular, renal (relating to the kidneys), and ophthamological (retinopathy).

If you have diabetes, reaching an acceptable level of HbA1c is extremely important. This may require lifestyle changes (making appropriate diet modifications, increasing exercise, and reaching an optimal body weight), and medications where necessary. In our office, we can determine your HbA1c with blood from a finger stick; it takes 8 minutes to get the results.

So, when in your doctor's office, don't forget to inquire about your blood sugar levels; early detection is very important, and will save potential complications.

Pain Awareness Month

The following appeared in the PainEDU.com earlier this month. 

"September is Pain Awareness Month. This busy month is marked by a variety of different initiatives and activities, all with the goal of promoting education, advocacy and awareness about chronic pain in order to break down the barriers to effective pain management.

Under-treatment of pain is a significant public health issue with far-reaching impact. With over 100 million people in the U.S. affected by chronic pain, it is no surprise that the societal burden of chronic pain is simply staggering. The Institute of Medicine in 2012 reported that the economic burden of pain exceeds $500 billion per year in the U.S., including health care utilization costs and lost workforce productivity."

I'll be attending the annual meeting of the American Academy of Pain Management later this month, for three days, for continuing medical education. Learning is a life-long experience, and I to get as much out of this meeting as possible.

Credentialed by the American Academy of Pain Management

The following appeared in the Summer 2013 edition of The Pain Practitioner, a publication of the American Academy of Pain Management, under the title Newly Credentialed Members: 

"Open to all pain practitioners, the Academy's credential demonstrates that a clinician is knowledgeable about interdisciplinary/integrative pain management; has practiced in the field of pain management for at least two years; remains in good standing with federal and state regulatory agencies; has passed a rigorous exam; and is committed to ongoing education in the field of pain. The Academy welcomes the following credentialed pain practitioners who have met the Academy's requirements and demonstrated proficiency in the management of pain."

Bruce Coplin, M.D., Toms River, NJ
Joseph A. Locke, DO, Germantown, Wisconsin
Mary Mcneill, MD, Buford, Georgia
Richard Randovich, DO, Boise, Idaho, and
Yours truly, with the following "bio"

Igal Staw, PhD, MD, has been in private practice for over 30 years. His introduction into the life sciences started at Columbia University, where he was the first student to graduate with a PhD in Biomedical Engineering, in 1968. He then continued to do biomedical research work at Columbia University and joined the faculty of the Polytechnic Institute of Brooklyn (now part of NYU). Dr. Staw graduated from the Medical University of South Carolina in 1974, and preceded with a pulmonary fellowship at a Yale affiliated Connecticut hospital, where he also ran the respiratory intensive care unit for over 10 years. During that time he also held a chaired professorship at the University of Bridgeport, CT, teaching biomedical engineering and directing special student projects.
Dr Staw developed a particular interest in health risk reduction, and in doing so developed computerized algorithms for early detection and prevention of chronic and other diseases. Recently, Dr. Staw has been focusing on pain management, which had been neglected for many years, but which is becoming an increasingly important part of medical care, especially at a time of opioid use and abuse.  

It's the lifestyle

“Civilization” takes a toll

(copied from bellybillbord.com)

It’s what we eat and don’t eat

It’s the cigarettes we smoke

It’s the exercise we don’t do

It’s the weight we didn't lose

It’s the extra alcohol we drink

More than 40% of premature deaths in the US occur because of faulty lifestyles.

I believe that almost 50% of the cost of today’s medical care can be eliminated by changing our lifestyles, so that we need less medical care.

The decision is yours...