PREVENTIVE MEDICINE

Preventive Medicine

Preventive Medicine helps optimizing health by preventing diseases before they occur1,5,6. Substantial improvements in population health are achievable through the use of specific preventive services2,6. It helps individuals face age in good shape, minimizing future decline, dependence and health care expenses3,5,6. Its goal is to protect, promote, and maintain health and well-being and to prevent disease, disability, and death1,5,6. Preventive Medicine is best when based on the highest quality evidence and most up to date information4,5.

Preventive medicine can deal very successfully with obesity, sleep issues, diabetes, high blood pressure, breast cancer, cervical cancer, heart attacks, strokes, dementia… and the list goes on. Preventive medicine in one form or another encompasses all known conditions.


References:

  1. Coates RJ et al. Conclusions and future directions for periodic reporting on the use of adult clinical preventive services of public health priority--United States. MMWR Morb Mortal Wkly Rep. 2012 Jun 15;61 Suppl:73-8
  2. Farley TA et al. Deaths preventable in the U.S. by improvements in use of clinical preventive services, Am J Prev Med. 2010 Jun;38(6):600-9
  3. Rula EY et al. Potential Medicare savings through prevention and risk reduction, Popul Health Manag. 2011 Feb;14 Suppl 1:S35-44
  4. Mishuris RG et al. Using electronic health record clinical decision support is associated with improved quality of care. Am J Manag Care. 2014 Oct 1;20(10):e445-52.
  5. Neumann PJ et al. Cost savings and cost-effectiveness of clinical preventive care. Synth Proj Res Synth Rep. 2009 Sep;(18). pii: 48508
  6. Gonthier R. [Quality of life in old age]. Bull Acad Natl Med. 2007 Feb;191(2):237-44; discussion 244.

How does it work?

It starts by an initial encounter that entails a very detailed medical history that is taken with the help of an advanced electronic system and encompasses about 250 variables. This is directly followed the same day by a thorough medical evaluation and physical exam. This process takes around 2 hours and allows the doctor to have a complete health assessment of his patient.

Based on the results, a specific and personalized annual health plan is recommended. This treatment will allow the patient to optimize his/her health, increase his/her well-being and prevent future diseases to the extent that is medically possible.

All plans will include:

  1. Regular follow-up consultations with the physician for a whole year
  2. Very advanced blood tests analyzed in accredited laboratories in Europe
  3. The recommended food supplements according to need

How does it work?

The crucial elements to success are an informed, willing and motivated patient, a good trusting relationship with the health team and time.

Aging: friend or foe?

We are born with great potential to grow and develop physically, emotionally, spiritually and mentally. We need to age to reach that potential.
The way we evolve and age is determined by our genetic code and environment. The more we know scientifically about our genes the more we understand that our lifestyle actually affects which ones are turned on or off. This determines how we age.

When we are young we have great physiologic reserves that help us deal with physical and emotional stress. The longer we live the more we use up this reserve and the more vulnerable we are to illness and disease, mental or physical.

Preventive Medicine - Aging

Our blood becomes thicker and less able to regenerate, our digestive system becomes weaker with decreased ability to absorb vitamins and minerals, our liver is less able to deal with fatty foods and clear medications and toxins. Our kidney becomes less efficient at clearing our blood from toxins.
The cardiovascular system, heart and vessels, has less reserve and its electric circuits start malfunctioning.
The lungs start losing functional space and ability to oxygenate the blood. Our genitourinary system also suffers with incontinence and decreased sexual function.
Our musculoskeletal system starts losing muscle and enervation and the bones become thinner and take longer to heal.
Our hormone levels change dramatically, most notably menopause in women. Some of these hormonal changes may be due to other illnesses; however, the significance of these, when not due to illness, is still under investigation. Our brain is also affected with cognitive decline that can even lead to dementia, the risk of which increases dramatically as we age.
Our skin shrinks, becomes less elastic and less able to heal. All its functions are affected including preventing infection and maintaining body temperature. Sun exposure worsens some changes.
Our sensory inputs, vision and hearing, decline also.
Our immune system undergoes critical changes predisposing us to a multitude of illnesses.

The good news is that we can do something about a lot of these age related changes. Through proper, medically directed, therapeutic lifestyle changes and use of targeted personalized supplements we can optimize physiologic functions.
Successful aging depends on psychosocial as well as genetic factors. The less health issues a person has, the longer that person will live.

References:

  1. George E Taffet, MD, “Normal aging” UpToDate, Sep 02, 2014
  2. Antoine Azar, MD, Zuhair K Ballas, MD, “immune function in older adults” UpToDate, July 22, 2014
  3. S Mitchell Harman, MD, PhD, “Endocrine changes with aging” UpToDate, Nov 07, 2014
  4. Marie-Florence Shadlen, MD, Eric B Larson, MD, MPH “Risk factors for cognitive decline and dementia” UpToDate, Oct 30, 2014

Avoid cancer! You can help

Cancer is a major health problem of the modern medical era and is one of the leading causes of death in developed countries. Approximately 40% of men and women will be diagnosed with a cancer at some point during their lifetime and one in four deaths is caused by cancer.
There are wide varieties of cancer and each can be triggered by different causes. These factors stress even more the importance of making our body unwelcoming to all potential kinds of cancer.
Cancer is mostly environmental which lends it to prevention. Half of all cancers are thought to be preventable.

Preventive Medicine - Cancer Prevention

Risk factors like tobacco use, excess weight, poor diet, and inactivity like lack of exercise account for two-thirds of all cancers in the USA. Another tragedy is that 35 percent of cancer deaths worldwide are due to the following modifiable risk factors: smoking, alcohol use, diet low in fruits and vegetables, excess weight, inactivity, unsafe sex, urban air pollution, use of solid fuels, and contaminated injections in healthcare settings

There are ways you can minimize your risk of getting cancer:
- Maintain a normal weight with minimal fluctuations.
- Eat mostly a plant-based diet and minimize animal products especially red meat.
- Eat fruits and vegetables daily and limit alcohol consumption.
- Eat mostly whole grain and stay away from refined grains and calorie dense foods.
- Avoid all sweetened beverages.
- Whole soy products are especially helpful in people with Breast or Prostate cancers or who are at increased risk for those.
- Avoid all processed foods, including processed soy, as a rule of thumb.
- All the nutrients should be obtained from food rather than supplements.
- Keep an active lifestyle and minimize sedentary behaviors like watching TV.
- Breastfeeding is highly recommended for preventing cancer in both mothers and infants.
- Protection should be used during intercourse to minimize risk of sexually transmitted infections.
- Avoid excessive sun exposure
- Get regular screening for breast, cervical, and colorectal cancer

These are general established ways to make your body less vulnerable to cancer. Our thorough assessment will allow us to provide you more personalized recommendations based on specific personal risk factors and lifestyle.

References:

  1. (Jemal, A. et al., CA Cancer J. Clin. 52:23-47 (2002); Howlader N, et al., SEER Cancer Statistics Review, 1975-2010, National Cancer Institute.
  2. Donald I.Abrams, MD. “Integrative Holistic Medical Treatment of Cancer” ABHIM study guide, pages 338-348, September 2013
  3. Kathleen Y Wolin, ScD; Graham A Colditz, MD, DrPh “Cancer prevention” UpToDate Oct 15, 2014
  4. Demark-Wahnerfried W., PhD, RD, et. al. “Lifestyle Interventions to Reduce Cancer Risk and Improve Outcomes” Am Fam Physician. 2008 Jun 1;77(11) : 1573-1578.

Cardiovascular disease, not for me.

Cardiovascular disease (CVD) was estimated in 2012 to be responsible for 17.3 million deaths worldwide annually.

The risk over the lifetime of a 30 year old person without known cardiovascular disease to get cardiovascular disease is approximately 50%.

There are four major cardiovascular disease categories:
1) Coronary Artery Disease (CAD) like heart attacks,
2) Cerebrovascular Disease like strokes,
3) Peripheral Artery Disease (PAD) like blockage of arteries in the limbs, and
4) Aortic disease like atherosclerosis as well as abdominal and thoracic Aortic aneurysms. The Aorta is the major artery going from the heart to the body.



More than 90% of the risk for a population to develop cardiovascular disease was found to be due to the following factors that a person can change:
1) Undesirable factors include: smoking, bad cholesterol, high blood pressure, diabetes, abdominal obesity and psychosocial factors like stress.
2) Desirable factors include: eating fruits and vegetables daily, moderate alcohol consumption, and regular physical activity.
Male gender, age and family history of early heart disease are risk factors that we cannot control.
The risk of cardiovascular disease doubles with each 10 years of life. So a 30 year old has almost twice the risk of a 20 year old and so on.

Other important risk factors include any degree of kidney disease and increase in some inflammatory markers most notably C-reactive protein (CRP).
Less obvious risk factors include eating red meat, air pollution, environmental noise, hypertensive disease of pregnancy, spontaneous pregnancy loss, being born prematurely before 37 weeks gestation and socioeconomic factors like education level.

Some of the above undesirable risk factors like diabetes, smoking and low good cholesterol (HDL) have a significant impact on both genders but more so on women than men. Other risk factors like high systolic blood pressure have the same impact on both genders.

The more risk factors one has the higher the likelihood of actually having cardiovascular disease.

The more alarming news is that even multiple borderline risk factors like impaired fasting sugar (fasting glucose more than 100mg/dl but not diabetes), borderline blood pressure, and borderline serum cholesterol levels increase the risk of cardiovascular disease. The recommended optimal/normal levels of blood sugar, blood pressure and cholesterol have been lowered over the past 20 years to minimize the population’s cardiovascular disease risk.

Cardiovascular mortality could be decreased significantly by the following American Heart Association (AHA) recommendations:
• Not smoking
• Being physically active
• Having a normal blood pressure
• Having a normal blood glucose level
• Having a normal total cholesterol level
• Being normal weight
• Eating a healthy diet high in fruits and vegetables and low in red meat and saturated fat

A recent study proved that young women who maintain a healthy lifestyle, compared to those who do not, have a 92% decreased risk for coronary heart disease and a 66% decrease in cardiovascular risk factors.
Although major advances in the treatment of people with cardiovascular disease have occurred and very sophisticated means of treatment are available to minimize death and complications, prevention is still key.
People aged 20 years old and older should have a cardiovascular risk assessment done. A thorough evaluation would address all your risk factors to the smallest detail. Along with addressing the above variables and risk factors, implementation of proven integrative interventions like supplements, dealing with stress and botanicals would be discussed individually and personalized to your needs. The frequency of further cardiovascular assessments will depend on the results of the initial one.


References:

  1. Wilson, Peter WF MD, “Overview of the risk equivalents and established risk factors for cardiovascular disease” UpToDate Nov 7, 2014
  2. Chomistek, Andrea K. ScD et al. “Healthy Lifestyle in the Primordial Prevention of Cardiovascular Disease Among Young Women” J Am Coll Cardiol. Jan 6, 2015;65(1):43-51
  3. Wilson, Peter WF MD, “Overview of the possible risk factors for cardiovascular disease” UpToDate Nov 18, 2014
  4. Garneri, Mimi MD et al. “IHMT for Cardiovascular disease” ABHIM study guide, pages 349-368, September 2013
  5. Wilson, Peter WF MD, “Estimation of cardiovascular risk in an individual patient without known cardiovascular disease” UpToDate Sept 8, 2014

Dementia: do not forget!

Dementia is a slowly progressive decline in multiple domains of cognition like memory, learning and executive function among others.
The usual cognitive decline associated with aging is a mild decrease in memory and the ability to learn new things. These changes, especially memory deficits, do not progress with time.

Cognitive decline is a continuum starting with Mild Cognitive Impairment (MCI). It is estimated that up to 18% of people 70 years old and older have MCI. To be considered dementia, the decline should be significant enough to represent a decrease from previous levels of cognitive function and should interfere with daily function and independence.

Preventive Medicine - Cognitive Decline and Dementia

Multiple risk factors for dementia are known with a significant number being modifiable. Age and genetics are none modifiable risk factors.
The most common form of dementia is Alzheimer’s dementia.
Genetics are studied and established for the early onset type of Alzheimer’s disease, which accounts for less than 1% of the cases. The genetic associations for late onset type of Alzheimer’s disease are less well established and not recommended for routine clinical testing at this point.
The other risk factors, which are mostly modifiable, include:
obesity and overweight, diabetes, hypercholesterolemia, cardiovascular disease, smoking, vascular disease, lifestyle including social, mental, and physical activity; metabolic syndrome, head trauma, high alcohol consumption, elevated homocysteine, vitamin D deficiency, toxins and pesticides, depression and low or high hemoglobin.

Detecting dementia has been challenging as the diagnosis is missed about 20% of the time and wrongly diagnosed another 20% of the time.

Our goal is to accurately assess your risk and work towards minimizing it. Early detection is crucial for optimizing care. Ideally, for people at risk, we need to minimize the risk factors as a first priority starting in middle age and even earlier.
Through our therapeutic partnership with you, we will implement the most up-to-date proven methods to regenerate brain cells and optimize cognitive functions.

References:

  1. David Perlmutter,MD,FACN,ABIHM;” IHMT for Neurodegenerative Conditions: Regenerating the Brain” ABHIM study guide, pages 536-542, September 2013
  2. Marie-Florence Shadlen, MD; Eric B Larson, MD, MPH “Evaluation of cognitive impairment and dementia” UpToDate; Feb 12, 2014
  3. Marie-Florence Shadlen, MD; Eric B Larson, MD, MPH “Risk factors for cognitive decline and dementia” UpToDate; Oct 30, 2014
  4. Rick Sherva, PhD; Neil W Kowall, MD; “Genetics of Alzheimer disease” UpToDate; Oct 08, 2014
  5. J. Riley McCarten, MD; Soo Borson, MD; “Should Family Physicians Routinely Screen Patients for Cognitive Impairment?” Am Fam Physician. 2014 Jun 1;89(11):861-862
  6. Eric M McDade, DO; Ronald C Petersen, MD, PhD; “Mild cognitive impairment: Epidemiology, pathology, and clinical assessment” UpToDate; Apr 29, 2014

Diabetes? No, thank you!

Diabetes is one of the leading causes of early illness and death worldwide. Worldwide 6.4% of people have diabetes on average. Up to 50% of cases are undiagnosed in some areas worldwide.
Diabetes Mellitus type 2; which manifests with high sugar levels, insulin resistance, and poor insulin secretion, is the most common accounting for 90% of all cases. Common features for most people who develop Type 2 Diabetes are weight gain and decreased physical activity. The increased prevalence of diabetes has paralleled the rise in obesity and lack of physical activity over decades.



Diabetes is responsible for a large proportion of healthcare expenditures because of the complications associated with it like heart attacks, nerve disease, eye disease, foot ulcers, strokes and end stage renal disease needing dialysis. Moreover, Diabetes has significant impact on quality of life because of the above complications as well as associated depression and anxiety, absenteeism from work and decreased work productivity.

Risk factors for diabetes that one can change include increasing weight above the normal, sedentary lifestyle, high blood pressure, high cholesterol, western diet, impaired fasting glucose above 100mg/dl, polycystic ovary syndrome, too little or too much sleep, smoking, abdominal obesity, environmental exposure to toxins and chemicals, gestational diabetes and certain medications. Risk factors that we cannot control include age 45 years old or older, certain ethnic groups,family history in first degree relative, and low or high birth weight.

Some protective factors against Type 2 diabetes include exercise, Mediterranean diet, dairy products, nuts, whole grain and cereal fiber, consumption of specific fruits, higher magnesium intake, steaming poaching or stewing instead of other cooking techniques, among others.

Persons with increased risk for diabetes according to the above risk factors should be screened at any age. It is also highly recommended to screen people over the age of 40 years old without risk factors. Subsequent screening should be performed every 3 years if there is no change in weight or other risk factors during that period.

Lifestyle interventions along with targeted individualized supplements and medications, if needed, can help the motivated patient achieve optimal and even normalized glucose control.


References:

  1. McCulloch, David K MD et al., “Screening for type 2 diabetes mellitus” UpToDate Nov 7, 2014
  2. McCulloch, David K MD et al., “Risk factors for type 2 diabetes mellitus” UpToDate Nov 5, 2014
  3. Levy, Sanford H. MD “IHMT for Insulin Resistance, Metabolic Syndrome, and Type 2 Diabetes” ABHIM study guide, pages 491-514, September 2013
  4. McCulloch, David K MD et al., “Pathogenesis of type 2 diabetes mellitus” UpToDate Sept 9, 2014
  5. Nahas, Richard MD “Type 2 Diabetes” Integrative Medicine, 3rd Edition by David Rakel, MD pages 297-311; 2012

Sleep and your health

Insomnia is the inability to fall asleep, stay asleep or wake up early despite the availability of the right setting and enough time to sleep. To be actual insomnia, it should affect negatively daytime function.
Insomnia is more common in women than men and increases with age. Insomnia is one of the most common medical complaints. It could be acute, lasting less than three months and due to specific situation like stress or pain, or chronic lasting more than three months. It tends to be a persistent and recurrent problem.

Risk factors for insomnia include: Family or personal history of insomnia, poorer self rated health, being easily aroused, and body pain. Also, certain medical conditions, medications and lifestyle habits can affect sleep.

Preventive Medicine - Insomnia and Melatonin

People with insomnia suffer on multiple levels.
They have poor quality of life and poor performance because of increased fatigue, sleepiness, confusion, tension, anxiety, and depression. They are more absent from work, use more sick days and have fewer promotions.
They have some deficits in memory, learning and physical balance.
They have an increased risk of substance abuse because of self treatment.
They have increased cardiovascular risk, such as high blood pressure and heart attacks, diabetes, weight gain, cancer, depression, anxiety and drug abuse.

Successful treatment of insomnia requires personalizing the plan to the patient and the situation. Any underlying cause should be addressed and treated. If the insomnia persists then a treatment plan can be developed by incorporating behavioral counseling regarding sleep hygiene and stimulus control, behavioral therapies, and short term use of medications and supplements as necessary.

Melatonin has proven to be a valuable supplement for sleep.
Melatonin is a naturally occurring hormone made in the pineal gland in the brain. Melatonin is readily available and has been shown to be effective as a safe supplement for Jet lag and specific kinds of sleep disturbances such as insomnia, circadian rhythm disorder, sleep wake cycle disorders and delayed sleep phase syndrome. Furthermore, Melatonin has multiple other benefits: as an antioxidant, it improves the immune response and may be helpful for cancer treatment and prevention.

References:

  1. Michael H Bonnet, PhD; Donna L Arand, PhD “Overview of Insomnia” UpToDate, Sep 02, 2014
  2. Michael H Bonnet, PhD; Donna L Arand, PhD “Clinical features and diagnosis of insomnia” UpToDate, May 21, 2014
  3. Michael H Bonnet, PhD; Donna L Arand, PhD “ Treatment of Insomnia” UpToDate, Oct 15, 2014
  4. Andrew Herxheimer, MB, FRCP; “Jet Lag” UpToDate, April 16, 2014
  5. Richard Wurtman, MD; “Physiology and clinical use of melatonin” UpToDate, Jan 14, 2014
  6. Natural Medicines Comprehensive Database; Melatonin Monograph, 2014
  7. Daniel M. Asimus,MD,ABIHM, MSEd. “Evidence-Based approaches to Treating Insomnia: Going To Sleep and Staying Awake” ABHIM study guide, pages 478-489, September 2013

Metabolic syndrome and weight problems

Metabolic syndrome is considered as one of the most significant contemporary risks for a long healthy life. The syndrome is devastating. Even some of its components can cause significant disease and decline in quality and years of life.
It is defined by obesity or increased waist circumference, elevated triglycerides >150 mg/dl, low HDL (good cholesterol) <40 mg/dl, high blood pressure 130/85 or more or on treatment for either of those, and fasting sugar more than 100mg/dl
This syndrome is unfortunately becoming more common. Increased weight is a major risk factor as an increase of just 2.25 kg or more over 16 years increases the risk of having metabolic syndrome by up to 45%. Smoking, physical inactivity, postmenopausal status, and high carbohydrate diet are other risk factors along with genetic factors.

Preventive Medicine - Metabolic Syndrome and Weight

Metabolic syndrome is due to changes in body physiology caused by the above factors, most notably insulin resistance. The syndrome is associated with a proinflammatory/prothrombotic state and increased risks for diabetes and cardiovascular disease.
In short the metabolic syndrome speeds up the aging process and affects most vital organs: heart, brain, kidneys, liver, vessels and nerves are being damaged at a faster rate. These changes increase the risk for kidney disease, cognitive decline and dementia, fatty liver and cirrhosis, polycystic ovarian syndrome affecting fertility, liver and gallbladder cancer, and gout.
The more alarming fact is that the metabolic syndrome is starting to emerge in the young, our children and adolescents. Those who have the metabolic syndrome at a young age have a 68% chance of having it as adults too. The metabolic Syndrome is brought on by poor lifestyle and weight gain or suboptimal weight in light of genetic predisposition.

We can address this major insult to our body in several ways.
The “syndrome” is a way to alert us to the cluster of a multitude of individual risk factors for diabetes and cardiovascular disease.
The most important first step is recognizing the existence of the syndrome and determining how much of the damage is due to lifestyle and how much is due to genetics. These steps are done routinely through our regular check.
Then we tackle each individual cause through specific personalized, feasible and easily achievable recommendations.
It is by teaming up together that we can, over time, reverse these changes, improve and optimize your health.

References:

  1. James B Meigs, MD, MPH; “The metabolic syndrome”, UpToDate, May 08, 2014
  2. Darwin Deen, M.D., M.S; “Metabolic Syndrome: Time for Action”, Am Fam Physician. 2004 Jun 15;69(12):2875-2882

Sexuality: to ignore is to fail

Sexuality is an important subject to both women and men that may affect mood and overall well being. Although sexual dysfunction is common in women and men, it is less often discussed because of the sensitivity of the subject and cultural prejudice.

Sexual function depends on interactions among vascular, neurologic, hormonal, and psychological systems. Female sexual function also depends on musculogenic factors, that is pelvic floor muscles. Any interference with these can affect normal sexual function.

Preventive Medicine - Sexual Health

Male sexual dysfunction includes erectile dysfunction (ED), diminished libido, and abnormal ejaculation.
Male sexual dysfunction increases with age and becomes common, up to 40% prevalent, at the age of 40 years old.
The list of risk factors for male sexual dysfunction is long but the following are some of the most notable and modifiable ones: Smoking, obesity, cardiovascular disease, diabetes mellitus, depression, low testosterone, hypertension, dyslipidemia, obstructive sleep apnea, relationship issues, stress and medication use.

Female sexual dysfunction includes lack of sexual desire, impaired arousal, inability to achieve orgasm, or pain with sexual activity.
Worldwide 40% of women report sexual concerns, most commonly lack of sexual desire.Hormones play a role especially estrogen.

Risk factors for female sexual dysfunction include smoking, poor general health, serious health conditions, depression or anxiety, conflict within the relationship, fatigue, stress, lack of privacy, issues relating to prior physical or sexual abuse, medications, or physical problems that make sexual activity uncomfortable, such as endometriosis or atrophic vaginitis.
Women and men in good health are more likely to be sexually active compared to those in fair or poor health. Men lose more years of sexually active life as a result of poor health than women.
Most of the conditions causing decreased sexual desire could be treatable.
A thorough evaluation will help you address and manage any such conditions to achieve the best possible outcome for you and your partner.

References:

  1. Chris Foley,MD; “IHMT for Prostate Conditions and Men’s Sexual Health”; ABHIM study guide, pages 579-610, September 2013
  2. Jan L Shifren, MD; “Sexual dysfunction in women: Epidemiology, risk factors, and evaluation” UpToDate, May 20, 2014
  3. Glenn R Cunningham, MD; Raymond C Rosen, PhD; “Overview of male sexual dysfunction” UpToDate, Nov 10, 2014
  4. Glenn R Cunningham, MD; Mohit Khera, MD, MBA, MPH; “Evaluation of male sexual dysfunction” UpToDate, Nov 10, 2014
  5. Jennifer E. Frank, MD et al. “Diagnosis and Treatment of Female Sexual Dysfunction” Am Fam Physician. 2008 Mar 1;77(5):635-642