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

 Emailed 2/6/2025

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To My Patients, 

Hope all is well. 

The famous groundhog, Punxsutawney Phil, saw his shadow, predicting six more weeks of winter. I suppose we'll be seeing more animal footprints in our backyard, and ski lovers will be happy. 

Colorado is expecting more cold weather, and we'll be visiting the crew for a few days this month. 

Please note that the office will be closed on Thursday, February 13th. As usual, Janine and I will be available to take messages while we're away. Dr. Sarfraz will be covering in case of any urgent needs. 

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

When there's a little free time, there are always puzzles, Sudoku, exercise, tennis, and time with friends. Sandy's favorites are the 1,000-piece puzzles. One we recently finished was a patchwork of squares, each containing a meaningful saying. Feel free to take a look at the photos. 



A special kudos to our son Michael for completing the Disney marathon last month-repeating the feat he accomplished exactly 20 years ago! 

Congratulations to our son Jeffrey on his new position as Chief Information and Innovation Officer at Firefighters First Credit Union. 

The office has been busy, with a steadily increasing demand for online telemedicine visits. While many cases still require in-person visits, a growing number of medical concerns-especially in general office medicine and its specialties, including mine-can now be effectively addressed online. 

Several factors are driving this trend:

• Convenience - No travel time, minimal (if any) waiting time, and reduced exposure to waiting room environments.
• Chronic Disease Management - Telemedicine allows for easier check-ins for conditions such as diabetes, hypertension, heart disease, and asthma, which require frequent monitoring.
• Advancements in Home Monitoring - The increasing availability of home test kits (e.g., COVID, influenza A, strep throat, urinary tract infections) and monitoring devices like continuous glucose monitors (CGMs), pulse oximeters, continuous oxygen monitors, and smartwatches that track sleep patterns. 

Many of these kits and devices are available over the counter from retailers such as Amazon and Walmart, while some, like CGMs, still require a prescription. 

Telemedicine is becoming more efficient and useful-and this is just the beginning. 

A Message to Insurance Providers & Policymakers: Pay attention and address the health needs of our people! 

Longevity: Living Longer, Living Healthier 
Longevity is on most of our minds-the goal is to live as long as possible while maintaining optimal health. 

Global life expectancy has increased dramatically due to advances in sanitation, nutrition, and healthcare access (though the U.S. lags behind in many ways-perhaps a topic for another letter). 

However, there is a genetic limit to aging, with the longest known human lifespan recorded at 122 years. Perhaps the Jewish blessing, "May you live to 120," originates from this natural limitation. 

As physicians, our role is to help extend life to its fullest genetic potential. I take this responsibility seriously. The motto "We help you live a longer, healthier life" has been with me since the founding of the old Health Extenders facility. 

The Future of Longevity Research 
A vast amount of research is now focused on breaking the genetic barrier to longevity.

• Some studies advocate dietary changes such as caloric restriction or intermittent fasting.
• Others explore removing "zombie cells"-cells that have stopped dividing but continue releasing inflammatory substances.
• Another area of focus is telomere extension. Telomeres are protective caps on the ends of our chromosomes, and when they degrade, cells lose function and die.

And the list goes on. 

There is no universal longevity prescription - every individual has unique genetics and medical conditions. Longevity strategies must be personalized. 

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

We're here to answer your questions. 


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