Functional medicine

I think we are going to see a change in the way we approach chronic diseases. For example, we know that there is more that we physicians need to do when we treat diabetes than just lowering blood sugar levels. For years it has been accepted that low HDL (good cholesterol) increased the risk of heart disease. This study looked at the FUNCTIONALITY OF HDL. Studies showed that HDL-cholesterol levels are not reflective of HDL functionality. One of the key functions of HDL cholesterol is the cholesterol-efflux pathway, which is the pathway where cholesterol is removed from macrophages within the arterial walls back into the bloodstream and out to the liver. As one of the key functions of HDL, their hypothesis was that if they could measure HDL-cholesterol–efflux capacity, they’d have a better handle on the role of HDL in atherosclerosis. It looks like the actual HDL number may in fact be meaningless and that low HDL’s do not appear to increase your risk of heart disease. Several years ago, the FDA refused to approve two new drugs that would have increased HDL levels in everyone to 100 because studies also showed a corresponding increase in heart disease! This is also why we no longer prescribe NIACIN.

We have already started practicing functional medicine and many of our patients have been screened for nutritional and metabolic deficiencies. Even large institutions like the MAYO CLINIC and the CLEVELAND CLINIC have started functional medicine departments.

If you would like to be screened, contact our office. 941-747-2090

New safety concerns for E-Cigarettes

I have written about e-cigarettes in the past and unfortunately I have not had many kind words about them. First of all, we know that e-cigarettes have not been proven to help one quit smoking for more than 1 year. Then, there’s been the safety issue: just how safe are these cigarette substitutions? A new study from Japan has discovered a high level of carcinogenic toxins (such as formaldehyde and acetaldehyde) in some brands of e-cigarettes. What’s more amazing is that some of these brand have 10 times the amount of cancer causing agents then tobacco! In August 2014, the World Health Organization called on governments to ban the sale of e-cigarettes to minors, warning they pose a “serious threat” to unborn babies and young people.

So who stands to profit? BIG TOBACCO who is now trying to corner the $3 billion/year “vape” ( Oxford Dictionary: the act of smoking an e-cigarette) market.


Osteoporosis in men

This study was performed in Hungary but I believe it is relevant for American men, too. Researchers suggest that osteoporosis exists in 20% of men. However, women are diagnosed and treated up to 20 times more often. The reason for this discrepancy is that women are routinely screened for osteoporosis, but men are not. Another reason is that there are no diagnostic screening codes to submit to insurance companies for payment. Yes, if osteoporosis is accidentally discovered, we can than do further testing and treatment. Some risk factors for men include prolong use of cortisone products anytime during their lifetime, low testosterone, chronic kidney disease and overactive parathyroid gland function.

Exercise remains the best way to improve bone density, followed by certain prescription medications. The role of calcium and vitamin D in men is not as clear as it is in women.

We should not wait for a fall and fractured bones to diagnose osteoporosis in men.

Does Niacin help preserve kidney function?

Kidney Week 2014: American Society of Nephrology Annual Meeting: Abstract TH-OR052. Presented November 13, 2014

Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction which may help prevent a decline in kidney function as we age. This was an observational study which looked at 120,000 patients in the VA hospital system. At baseline, all patients had normal eGFR (kidney function). However, the niacin patients had a higher body mass index than non-niacin patients (31 vs 29 kg/m²), lower high-density-lipoprotein cholesterol levels (39 vs 46 mg/dL), higher triglyceride levels (214 vs 148 mg/dL), and more use of ACE inhibitors, angiotensin receptor blockers, and statins and were more likely to have hypertension, diabetes, atherosclerotic cardiovascular disease, and congestive heart failure. (These are all risk factors for developing kidney disease)

But, before we hop on the NIACIN bandwagon, it is also known that NIACIN has absolutely NO proven benefits in preventing cardiovascular disease and there are a lot of side effects including flushing, diabetes and gout. We also know that low HDL is NOT predictive of heart disease and raising HDL or lowering triglycerides any way other than diet and exercise has no benefits.

Double-blinded studies need to be done to explore these findings before we can routinely recommend niacin for the general population.


Can a simple blood test predict lung cancer?


Cleveland Clinic Respiratory Institute

There are no great screening tests for lung cancer. Right now, we are recommending low dose C-T scans to screen for lung cancer in current or past smokers. However, these tests can show some ambiguity and false positive results.

Researchers at the Cleveland Clinic have analyzed multiple metabolites in their patients who have different types of lung cancer. The analysis identified 534 metabolites from eight metabolite superpathways and 73 subpathways. The concentrations of 149 metabolites were significantly different — 70 were lower and 79 were higher — between cancer patients and control subjects. In patients with adenocarcinoma, the concentrations of 65 metabolites were significantly different from those in control subjects; in patients with squamous cell carcinoma, the concentrations of 50 metabolites were different. The researchers then built a model with 36 metabolites that  distinguished between cancer patients and control subjects.

Although it is still early, this study suggests that one day we might be able to not only diagnose, but also predict who will get lung cancer, with a simple blood test.

Chocolate (cocoa) and memory loss

US researchers think that age related memory loss may be reversed with high doses of naturally occurring cocoa flavanols. The dentate gyrus, which is a region within the hippocampus in the brain, is linked to aging and age-related memory decline and studies in mice have shown cocoa increased function selectively in that region of the brain. Then, in a series of experiments with healthy volunteers, the researchers were able to confirm that task performance declined with normal aging, and through use of CBV-fMRI, that this cognitive task’s function was localized to the site of age-related dentate gyrus dysfunction.

More studies have to be done, but it is known that dark chocolate has anti-oxidative properties.

We recommend using dark chocolate products with at least 70% cocoa, but do limit the amount you eat each day. Avoid milk chocolate as it contains too much sugar.

 Flavanols can be ingested from either cocoa powders or chocolate bars. The problems with the powders is that they contain, cadmium which may have safety concerns.

The chocolate bars with the most flavanols are (from highest concentrations to lowest):

Reserveage CocoaWell True Energy

Navitas Natural Cacao Nibs


Hershey”s Cocoa-Narural Unsweetened

Nestle Toll House Cocoa

Trader Joe’sUnsweetened

Baker’s Unsweetened Baked Chocolate Bar

Ghiradelli’s 100% Unsweeneted Cocoa

Endangered Species Chocolate Natural

Ghiradelli Chocolate Intense Dark

Lindt Excellence 90% Cocoa

Trader Joe’s 72@ Cocoa

Hershey’s Special Dark


New England Journal of Medicine

There were 14 trials studying the effects of fiber (Metamucil, etc.) and bran in over 900 patients who have IBS. IBS is an illness that is easy to diagnose although there are no tests to confirm it. Symptoms usually occur for years before a physician is consulted. The symptoms can be variable and include gas, bloating, cramps and either diarrhea, constipation or a combination of both. Fever, weight loss and bleeding are not seen in IBS and may indicate a more serious condition like colon cancer or inflammatory bowel disease. Some doctors think IBS can lead to DIVERTICULOSIS, but IBS itself poses no health risks.

This study looked a bran vs fiber vs placebo and found only a mild improvement in symptoms with either bran or fiber.

In my experience, the best results that I see are when anti-depressant medications are prescribed. This does not mean you are suffering from depression or an anxiety disorder any more than a woman with PMS (another condition that responds to anti-depressants) does.

My theory is that there are serotonin deficiencies outside of the brain which may explain the benefits of these medications in non-psychiatric conditions. The dose of the medications are usually lower, too, than when used to treat depression.

There are also special diets that are beneficial and our registered dietitian, Nora Clemens is available for consultations. Call our office for more information. 941-747-2090


High cholesterol and recurrent prostate cancer?

Researchers from DUKE UNIVERSITY studied 843 men who had surgery for prostate cancer. No one in the study had ever been on cholesterol lowering statins. They found that the risk of the  cancer coming back rose 35% if their triglyceride level was greater than 150 and 9% for cholesterol levels greater than 200. They also found a 39% decrease if the HDL (good) cholesterol was over 40. Because there is a link between cholesterol, obesity and prostate cancer, a combination of lifestyle changes along with taking a statin drug may reduce the recurrence of getting cancer.

Vitamin D and memory disorders

Neurology 2014 Sep 2

Will the controversy over Vitamin D ever be resolved?  Because Vitamin D plays an essential role in brain health, it has been postulated that a deficiency of it may be associated with cognitive disorders and Alzheimer Disease. (Vitamin D and its metabolites mediate the synthesis of various neurotransmitters including acetylcholine, catecholamines, serotonin, and dopamine. Vitamin D also helps maintain neurite outgrowth and promote synaptic plasticity, influences neurotransmitter synthesis, protects against oxidative stress and mitochondrial dysfunction, reduces the proinflammatory response, and regulates ageing). This comes at a time when some healthcare professionals have recommended not to screen for Vitamin D deficiency and some insurance companies have decided not to pay for testing.

Normal Vitamin D levels in the blood is 30. Any results lower should be treated. There is no evidence, however that once levels are above 30-40 that there are any further benefits.



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