The Glory of Gum – A Smoker’s Tale

Recently, on a medical sojourn, I was met at the airport by a garrulous woman driver. She was a young-appearing fifty year old who as it turns out had recently sustained a TIA, or “mini-stroke.” Although my first thought was atrial fibrillation, she actually had developed a near occlusion of her left carotid artery. Her right carotid artery, she informed me, had a mere 40% stenosis. Our discussion continued and I gleaned that she had a very strong family history of early onset vascular disease, several close relatives even dying quite young from their events. So my next thought was Familial Hypercholesterolemia. But no, her LDL was apparently normal. Then she fessed up. She had been – and continued to be – a smoker. Just like everyone else in her family! Shocking.

To smoke cigarettes nowadays is something I simply cannot wrap my head around. Cancer, stroke, heart disease, lung disease, wrinkles… Tobacco is devoid of any redeeming quality. It’s just plain bad. So why would anyone smoke in the first place? But, once an individual has experienced a near death event that is a direct consequence of tobacco, how in the world could she continue to smoke. My 40-minute drive took on a mission. I was going to get her to quit. I asked about her children and even grandchildren. We spoke about loss of limbs, dependence upon an oxygen tank, facial cancers and their attendant disfigurement, another stroke – the next one of course placing her in a wheel chair, unable to speak or care for herself. Then she dropped me at my destination. She was to pick me up several hours later. Before stepping out of the car I told her with stern authority that a cigarette should never again cross her lips. Chew gum I said. Gain weight if you must, but please don’t ever come near another cigarette. (I must confess; my tone was intentionally severe and perhaps even paternal. The impact I hoped would justify my behavior.)

I went through my day, completed my tasks, and eagerly awaited her return. Upon her arrival she stepped from the car and proudly and loudly through a mouthful of gum intoned that she had done it. She quit smoking. I am not certain whether her resolution will last an hour or a lifetime. For that moment though she was no longer a smoker. A gum chewer yes, but not a smoker.

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Diet Tip: Please Read the Label

A good deal of my time with patients is spent teaching. I teach about theories regarding plaque formation, consequences of a ruptured plaque – heart attack being the most feared – and the spectrum of cardiac risk factors. In discussing risk factors I then delve deeper. I discuss LDL particles and why counting them is so important. I discuss the role of inflammation in heart disease. We talk about eating a balanced and healthful diet, and of course we always discuss achieving and maintaining an optimal weight.

For the last few years I have been working with a gentleman in his forties who suffers from premature coronary artery disease. He’s already had one stent and our mission is to prevent a second event. And so we have systematically and effectively mitigated each of his risk factors. Except for his weight. As hard as we’ve tried, we have failed. His stubborn 15 to 20 pounds of excess overweight has been a thorn in both of our sides.  He really has tried quite hard. He’s trimmed portions, eliminated all simple carbohydrates, stopped drinking excess alcohol, and religiously exercised an hour a day. Yet, no weight loss… Until his last visit.

The other week my young patient entered the room with draping pants and a flouncy shirt. His clothes were not those of an older, larger brother. They were his. Somehow he had done it. He had lost 19 pounds. And his smile betrayed his brimming desire to let me know his secret.  So here it is. He started reading labels. Though we had previously discussed the importance of label reading, I apparently had failed to adequately emphasize the point. Now here he stood, proving the power of the label. What he had discovered is quite fascinating. My patient, a lover of coffee, had been consuming over 3,600 calories each week in the form of coffee creamers. Although the creamer labels revealed a mere 20 calories per serving, he had failed to recognize just how many servings he used per cup of coffee. It wasn’t until he had counted the bottles of creamer he used on a weekly basis, along with the total number of calories per bottle, did he recognize just how caloric and fattening was his coffee creamer habit. He responded to his newfound knowledge with discipline and resolve, and in three short months without doing anything other than eliminating excess coffee creamer he achieved his desired weight.

The lesson here is simple: Know exactly what you’re consuming. Be careful about portions. And don’t be misled. Do the math if you’re having trouble losing weight. Count the calories you consume and eliminate those you don’t need. This basic approach worked magic for my patient; I’m confident it can do the same for you.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Time for a Food Police Force?

Incessantly the media, scientists, doctors, self-proclaimed experts of this or that pronounce they have found the answer to some burning issue. Mostly the matters involve health. What fat is best, or are carbohydrates better than saturated fats, or is fish oil really any good, or is the rampant use of statins the product of evil pharmaceutical propaganda. The list is interminable. And everyone has a voice. Actors and actresses somehow as a consequence of their on-screen fame have absorbed knowledge beyond that which is possessed by even our greatest scientists. Newscasters weigh in and authors sell their latest tomes with promises of truth. The whole dance of the experts would be quite amusing were it not so dangerous.

What seems to be missing from all those who have managed to communicate so easily with the almighty is a sense of responsibility. When people voice their opinions with such certitude, and their audience believes in their veracity with such solidarity, what is truly opinion then masquerades as fact. As a consequence, fiery battles flare among opposing sides. The vegans pound their fists shouting, “Not even a drop of oil! No fat at all!” The Wheat Belly folk eschew the grains, while the dairy exorcists discard the milk, and the Atkins aficionados chow down on meat and more meat. Get them together on TV and you have a firestorm.

Now bring in the politicians and celebrities. They take whatever “science” they find most convincing and try to turn it into law. No large sodas for the sugar busters; no trans fats for practically everyone (that one I have to admit is compelling), nothing with a face for the vegans. In short order there won’t be much left to eat at all.

I have my own take on the diet issue. In short I’m fairly certain we are all quite different, and consequently do better with different diets. As a generalization though I’d recommend moderation in all things, avoiding processed foods, eating a balanced diet, maintaining an optimal weight, and exercising daily. Perhaps that prescription would make a good law.

Fundamentally it comes down to this. We should all be permitted to eat whatever we wish as long as it doesn’t harm anyone but us. Government should not have the right to tell an individual what he or she can or cannot consume. There is a key caveat though. This holds true, “as long as it doesn’t hurt anyone else.” So what do we do about the ailments that occur as a consequence of food-induced obesity – diabetes for one? Do we penalize the consumers of sugar who as a consequence of their dietary predilections become obese and diabetic? Do they pay higher health insurance premiums? Probably not a popular notion. How about the smokers, should everyone foot the bill for his or her heart disease, COPD, and lung cancer treatments? Clearly these issues are slippery slopes, ones upon which I have no desire to tread.

I will emphasize one point however, and of this I am sure. No one knows what diet is best for all mankind. And until such a discovery is made, creating a food police force is probably not a good idea at all.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Perspective

Sitting on a plane I run through the possible subjects to discuss in this week’s blog post. I consider health related matters but cannot bring myself to settle on a topic. I feel compelled instead to introduce a subject that tortures me far more than do the demigods of media and science. It is the conflagration of Muslim extremism that threatens to engulf our world. Wow, where did that come from you might be wondering. In a word, sadness. I am sad for the young Christian girls of Nigeria who have been stolen from their families, and in a 10th century style forced to convert to Islam and threatened with slavery or marriage to Muslim men. They most likely will never again lay their eyes upon their parents, siblings, and other blood relatives. I am sad for the woman who sits beside her 20-month-old child in a Sudanese prison awaiting a sentence of torture followed by hanging. Her crime: marriage to a Christian. I am sad for all the men and women in other nations forced to follow their religious beliefs in silence, lest they be silenced for good. I am sad that the world watches as so many suffer and I am sad we have lost perspective as we fan the flames of our own relatively petty issues. And finally I am sad for us as we watch a world that will most likely collide with ours, potentially ending the freedoms we now take for granted, ones our ancestors struggled so hard to leave as a legacy for us to enjoy.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Response to “A New Gender Issue: Statins” an Article by Roni Caryn Rabin

There appears to be an endless supply of medically related stories in the lay press that serve nothing more than to create mass misunderstanding of science and medicine. Surely their provocative messages sell papers and airtime. But they have an often-ignored downside as well. Tuesday we saw another such article. In the New York Times’ Rabin piece, a prevalent fear of medications is fueled, and the integrity of a prominent physician is impugned. (Full disclosure – I too unabashedly receive compensation from pharmaceutical companies for consulting and educational purposes.) Statistics are cited; the quintessential anti-statin doctor is quoted; and fabricated conclusions are rendered. The science of statin therapy is much too complex for a single cursory article to do it justice. In fact, entire conferences are devoted to the subject matter. And yet a sweeping conclusion – with potentially devastating ramifications – has again been made. Women reading this article will do what one would expect, either discontinue their statins on their own, or hopefully discuss such an action with their doctors prior to doing so. The article is meant to be terrifying, citing exceedingly rare muscle complications and referring to an unproved complication of statins, memory loss. So much is left unconsidered. For starters, the ACC/AHA risk scoring system cited by Ms. Rabin likely underestimates, not overestimates, CVD risk in women. And, as the leading cause of death in US women is cardiovascular disease, we do not want to make the mistake of under-evaluating and under-treating this segment of the population.

Today in the office I saw a young woman who suffers from premature heart disease that would not have been detected or appropriately treated had the guidelines been followed to a tee. Yet her coronaries have been non-invasively imaged; significant disease was detected; and yes, statins are being utilized. As a result, her life may very well have been saved. Doctors must be able to think and act with fluidity, moving both within and beyond the guidelines, in order to render the best care we can. Articles such as Ms. Rabin’s serve solely to diminish our ability to do so.

To demonstrate more clearly why we need to drastically broaden – not shrink – our efforts to identify and treat cardiovascular disease in women here are a few chilling and sobering statistics:

  • Women are 15 times more likely than men to die within the year following a heart attack.
  • Women with angina have twice the morbidity and mortality as men with angina, even in the absence of obstructive coronary artery disease.
  • 64% of women dying suddenly from heart disease had no prior symptoms.
  • Women under 50 are three times as likely as men under 50 to die after a bypass operation.
  • Marriage decreases cardiovascular risk in men, yet increases it in women (a frightening statistic, yet one that provides fodder for some excellent jokes).

Other similar statistics abound. The point is that we unambiguously understand that women are at great risk for heart disease. Sadly though, we currently have inadequate clinical trials assessing their risk. The appropriate answer is to fight even harder to identify and treat women at risk. It is not to dismiss our vast and growing understanding of the salient role cholesterol plays in the genesis of cardiovascular disease. It is not, as this article implies, to withhold a medication that has done more to thwart heart disease than any other therapy in the last century. I entreat all in the press to be more circumspect and responsible in your reporting. You have a great influence on your readers. Please wield it with caution.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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The National Lipid Association – A Glimmer of Hope

The field of Medicine is undeniably in turmoil. Patients are unhappy with long wait times in doctors offices coupled with ever shortening visits with their physicians. Doctors are dismayed by their unprecedented spike in “busy work,” instigated predominantly by insurance companies and governmental mandates. The fallout from more time spent on paperwork is of course less time spent with patients. There are after all only 24 hours in a day.  So it is eminently fair to say that neither doctors nor patients find themselves happy with the current course Medicine is following. Oftentimes outlooks are so bad that many of us in the field feel there is no hope. In essence we believe the battle has been lost; there is no chance of recovery.

Enter the National Lipid Association (NLA). Currently boasting over 3,000 active members, the NLA is a group of diverse doctors, nurses, dietitians, scientists, and exercise physiologists whose governing goal in participating in the organization is to improve healthcare. I just returned from the 2014 Annual NLA meetings in Orlando Florida and was once again struck by the authenticity of this sentiment. Meetings began as early as 6 AM and extended well into the evening hours. And the seats were not bare. They were filled by groups of highly focused and engaged individuals. Ranging from Cholesterol Guideline discussions, to basic science talks on drugs’ mechanisms of action, to lectures reinforcing the need to amplify our efforts to identify and treat patients with the not so rare but highly lethal disorder Familial Hypercholesterolemia, the topics were fascinating and irrefutably pragmatic. The attendees were riveted. Side conversations were plentiful, including promises of new clinical trials and better ways to help our patients. The pace was quick and the excitement, palpable. All this at a medical meeting!

Although uniformly doctors are troubled by Medicine’s fall from grace, rays of hope were clearly visible at the NLA meeting. Beneath our acrimony doctors, nurses, and others in medicine still have at their core the desire to help. We genuinely want to be the ones who people look to during their oftentimes-darkest moments. We also most definitively strive to keep people from experiencing such grim periods. The best way to achieve these goals is to continuously learn. Curiosity, inquiry, dialogue, knowledge, and caring are the cornerstones of the practice of Medicine. And these are the elements that beat at the heart of the National Lipid Association.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Legalizing Marijuana, What Might the Future Hold?

With all the excitement and controversy swirling around the legalization of Marijuana, as a physician I have no choice but to consider what negative ramifications might be in store for our country. Here are just a few of the many issues we must all consider.

What could be the adverse health consequences of rampant and regular marijuana use? Over the past few years, studies have begun to demonstrate unfavorable psychiatric fallout from marijuana. Schizophrenia, and other disorders of psychosis, it seems can be expressed in predisposed individuals who utilize the drug. The incidence of schizophrenia is already one in a hundred. The toll this disease takes on not only the patient, but also the entire family, is enormous. A life-long disease with no cure in sight, schizophrenia leaves its victims unable to function adequately in society, often leading to homelessness and premature death. There is also of course an associated financial burden our society bears from the disease. Imagine then the consequence of even a minor uptick in the frequency of this disorder. Anyone who understands schizophrenia would agree that saying it would be horrific is a gross understatement.

Then there is heart disease. Just last week a study was published citing an association of marijuana with premature heart attacks. Right when doctors are making inroads into reducing heart disease, we may now be unleashing a new and previously unrecognized threat. Remember the days of the great cigarette ads, “LSMFT. Lucky Strike means fine tobacco.” In days of old, tobacco use was the norm; nearly everyone smoked. Socially, it was the thing to do. Then came the studies proving the relationship between tobacco and heart attacks, strokes, chronic obstructive lung disease, and of course death. Following the studies there were lawsuits. The tobacco industry paid dearly for being less than forthright about the potential downside of smoking. The attorneys did quite well, bringing in personal gains of a billion dollars. Tobacco’s victims however did not do so well.  Will marijuana become the tobacco of our future? Have we just begun yet another global experiment testing the effects of a substance on us, the American populace? If so, let’s at least prepare for the fallout.

To protect our society as best as we can, I propose the following. Wherever marijuana becomes legalized, set aside a large portion of tax revenue for future payment of medical expenses related to marijuana’s use. Also, be sure to allocate enough funds to cover the lawsuits that will surely follow our inevitable acceptance of marijuana’s health dangers. Perhaps not just the marijuana sellers will be held accountable. If a government earns revenue through taxation of marijuana, might not the government be liable through complicity? I would also recommend that all marijuana users be forced to sign a waiver of liability. Let the finest attorneys craft this document so it can be as solid as is legally possible. Then, when the lawsuits start flowing in, marijuana enthusiasts will have a much tougher time blaming others for their choice. They need to be fully informed of the potential risks of marijuana, and their understanding must be well documented. Let’s not repeat the tobacco experiment with all its attendant errors. If marijuana is to be the next widespread health hazard, let’s at least protect the nation’s financial interests. Clearly our country is not in a position to take on any more debt.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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Butternut Squash Risotto

2 Tablespoons olive oil                      IMG_1167

1 onion, finely chopped

2 cloves garlic, finely chopped

1 Tablespoon fresh thyme leaves

1 cup pearled barley

32 ounces chicken broth

1 teaspoon salt

1/2 teaspoon black pepper

1 small butternut squash, peeled, cut into 3/4-inch pieces

1 cup frozen petite peas

1 cup grated Parmesan cheese

In a large pot, heat olive oil over medium heat. Add chopped onion and cook, stirring frequently, until softened (about 5 minutes). Stir in garlic and thyme and cook stirring for one minute.  Stir in the barley and the broth; season with salt and pepper. Bring to a boil, lower heat, cover and simmer for 15 minutes.

Stir in squash, cover the pot and cook until tender, about 20 minutes. Stir in peas and 3/4 cup cheese. Garnish with  remaining 1/4 cup cheese. Serves 4.

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Is Marcus Welby, MD Resuscitatable?

Over the last decade or so doctors have felt their stature steadily slip away. Their significance has of course remained; without doctors healthcare would come to a screeching halt. Newly named “physician extenders” cannot do what most physicians can. They are simply not trained for the task. As important and passionate as they are in healthcare delivery, physician assistants and nurse practitioners possess just a small portion of the training required to become practicing MDs. Doctors often spend more than a decade after college training to a level required to deliver the most sophisticated and complex care. Many laypeople seem oblivious to this fact; some likely have intentionally blinded themselves to it. Physicians are “where the buck stops”. We are the CEOs of our practices, the generals if you will. Yet, the insidious degradation of doctors has led to a variety of deleterious and likely unintended forms of fallout. Most obvious is our title. Once called nothing but “doctor”, we are now dubbed, “health care practitioners”, “health care providers”, and most recently, “EP”s or eligible professionals. This fact may seem trivial, but its reverberations run deep. We have been equated to all others who treat patients – nurses, advanced nurse practitioners, physician assistants, medical assistants, and physical therapists…  Our distinction as leaders in patient care is being eroded. Imagine if the same were true in the military – no more generals, colonels, sergeants or the like. Just “military personnel.” Or, what if we applied the same rule to government – no more senators, congressmen, mayors, governors, or even presidents. Simply “public servants.” There is no doubt such an arrangement would be justifiably unacceptable to those involved. These two systems, like the medical system, would crumble absent titular distinctions. But the damage to medicine dives far deeper than this.

We have just witnessed the release of Medicare payment information for each doctor in the US. Soon the “Sunshine Act” will also become a reality. The amount of money paid to highly specialized doctors to deliver educational talks will become fodder for the public to muse. The lunches, coffee, or even requested medical articles brought to offices by pharmaceutical representatives will soon be open for public scrutiny. Total transparency is a beautiful concept for an ideal world. In such a world everyone would love and respect each other; no one would compete with another; and all would be subject to the same laws and regulations. Such is not the case of course. Do you know what your attorney earned last year, or how much money your grocery store pays for its eggs?  Of course not! We live in a land that purportedly permits freedom to compete. Competition requires a high degree of privacy. Our country was in fact built upon such a premise. How can one dermatologist fairly compete with another if confidential internal financial records become open access? There are far too many financial ramifications to explore in this short blog, but the adverse fallout from such transparency will be pervasive. And it will most certainly include a drastic decline in the education of practicing doctors. That of course will translate into deteriorating quality of care.

The most consequential outcome of medicine’s recent evolution will undoubtedly be decay in heath care delivery. Marcus Welby, MD was an excellent television show because it depicted a dedicated, diligent, assiduous, committed physician. Dr. Welby captured the hearts of viewers because he loved his patients and they loved him. He was honored, respected, appreciated, and yes, even well compensated. The reality, for better or for worse, is that doctors are human beings. They crave recognition and appreciation for their sacrifices. Absent such recognition, and assuming a continued decline in reimbursement as well as the massive increase in federal regulations, the Marcus Welby, MDs of this nation will become extinct. At times this augury feels inevitable. At other times there is hope. Unfortunately however, until the general population recognizes the physician resource it is rapidly losing, I believe the more pessimistic outlook will prevail. Marcus Welby, MD may truly be unresuscitatable.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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ConsumerLab Approval: A Brief Boast about VitalOils1000

couple bike riding

I make it my practice not to blog about VitalRemedyMD or any of its products, but this week demands a self-promoting shout-out. VitalRemedyMD is a company I started over ten years ago. It is now owned and operated by my wife (Laura Baum – also an MD). VitalOils1000 was created about six years back as the first and only enteric-coated fish oil pill to contain a full 1,000 mg of combined DHA and EPA. Thus, VitalOils1000 was the first omega-3 fish oil to meet the American Heart Association recommendation for individuals with cardiovascular disease in just one pill. This fact holds true even when considering prescription fish oil.

Yesterday we made the grade again. On April 6th ConsumerLab.com, the preeminent watchdog of the nutritional supplement world, released their every-other-year study of omega-3 fish oil products. Once again VitalOils1000 was “approved.” This year, in addition to “proving” our purification, concentration, and quality of enteric coating, we were also tested for PCBs and Dioxins. We were one of only two products tested in this comprehensive fashion, and we “passed” this important criterion as well. Our purification process of supercritical fluid technology enables us to achieve these exceptionally high standards for safety and purity.  There is so much confusion about omega-3 products that I felt compelled to write about our continued success with VitalOils1000. Needless to say, I am very proud. Thank you for permitting me a moment to boast.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

For more information more about essential vitamins and supplements visit www.vitalremedymd.com.

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