NUTRITIONAL GENOMICS : THE FUTURE IS NOW

I recently attended an amazing seminar on the role of genetics and its relationship to our health . Make no mistake about it . This clearly fills a missing niche . Can’t figure out why you can’t lose weight no matter what? Why you suffer from severe brain fog? Why you can’t handle certain medications ? hormones ? Why your immune system is faulty ? Why you are sick and tired of always being tired ?

It’s taking the information from 23andMe and/ ancestry.com and applying it to an individual patient .

I’m the first to say that diet and lifestyle are paramount to wellness . But there may well be some confounding factors that are thwarting your best efforts . The answer may lie in your genome . Once this information is uncovered , we may well be able to implement changes in diet , exercise and supplements to help you achieve your health and wellness goals .

HeartWise Fitness & Longevity Center will be introducing new programs in the next few weeks . Stay tuned !

The latest statement by the ACP (American college of Physicians) reports that HbA1c, a marker for diabetic control, be between 7-8. Anything lower might cause hypoglycemia. Furthermore overall mortality is not affected by more stringent control.

This is clearly a contradistinction to what the ADA (American Diabetic Association) believes. I concur with the ADA that a level of 8 is NOT good enough.

First of all death is not the only end point. There are reports that many of the microvascular complications of diabetes can be mitigated by tighter glycemic control. Examples include retinopathy, kidney disease and neuropathy.

A major concern by the ACP was the risk of hypoglycemia (or low blood sugar) by tight control of diabetes. What they failed to mention is that many of the newer agents used in diabetes do not significantly lower blood sugar levels. Why I don't even use these older drugs that are infamous for lowering blood sugar.

Keep in mind that this was based on diabetics on medications. In my practice, I always start with lifestyle,My aim is to convert a diabetic to a borderline, and a borderline to a non-diabetic status. Getting the A1c below 7 and preferably below 6.5 is my aim.

Read original article here: https://www.medpagetoday.com/endocrinology/diabetes/72336

Here's more promising news about lifestyle changes and prevention of heart disease; recently published in the peer reviewed journal CIRCULATION were the results of a large study from the UK. They found that regardless of an individual's genetic risk for heart disease, those with unfavorable genetics derive as much benefit from exercise as the general population. This was a large study of a half million people over a 6 year span. Interestingly enough, they studied both cardiopulmonary fitness as well as grip strength They concluded that both aerobic activity and strength training have a positive role in mitigating the effects of unfavorable genetics when it comes to heart disease. The large sample size was deemed a strength of the study, while the observational nature of the study is an obvious limitation.

Genetics seems to be a huge deal these days. Practicing integrative cardiology, I often test for certain genetic makers. But what do you do with the information? I work with the patient and help them minimize the effects of their unfavorable gene pool by exercising (pun intended) lifestyle measures.

Read original article here: https://www.medpagetoday.com/cardiology/prevention/72221

One test that I find particularly useful in the appropriate patient is the coronary calcium scan. This is a CT scan that takes only minutes.There is no contrast involved nor any intravenous lines. This scan literally detects the presence or absence of calcium within the 3 main coronary arteries. You end up with a total calcium score. The perfect score is zero. (probably the only time in your lifetime you would be content with a zero score)! The higher the score, the greater degree of calcium in the coronaries . Besides learning the calcium burden, an individual's results are compared to a large database of several thousand patients. So you actually learn where you fare with individuals matched by your age and gender.

How do I use this test? As an integrative cardiologist, I'm simply not interested in treating everyone who walks in my door with an elevated cholesterol level with statins. I prefer to stratify my patients according to their risk. A high calcium score would bend me in the direction of more aggressive risk factor. modification.This always begins with lifestyle changes. It always boils down to diet and exercise.For me, it's all about treating those patients who need it the most!

One caveat : A zero score doesn't mean you are totally off the hook! Keep in mind that this test only measures the calcium within plaque. Plaque actually starts off as an inflammatory reaction involving smooth muscle cells and cholesterol esters. This inflammatory complex subsequently takes up calcium which is what this test detects.

Read original article here: https://www.nytimes.com/2018/04/02/well/live/the-value-and-limitations-of-a-cardiac-calcium-scan.html?smid=fb-share

I'm thrilled to see that mainstream medicine is truly getting it! Those of us practicing functional medicine have inherently known how powerful diet can be. In this study published in the prestigious British journal the LANCET, type 2 diabetes could be successfully arrested after a 12 month period of dietary manipulation. Although the study is not of great magnitude, the fact that 46% of participants were able to achieve remission is extraordinary. In contrast, only 4% of the control group was able achieve this feat.

As a cardiologist I am frequently asked what constitutes the best treatment for diabetes. My answer is always the same : PREVENTION

But regardless of the extent of the disease, so much can be done with lifestyle measures.

Read original article here: https://www.medpagetoday.com/endocrinology/diabetes/69657

Men can now rejoice! After a careful analysis of the available data, it has been recently reported that the dreaded rectal exam may provide no real benefit when it comes to screening for prostate cancer in the primary care setting.This is no small deal because prostate cancer is the second must common cancer in men second only to non-melanoma skin cancers. It is a major source of morbidity and mortality in the Western world. This is not to say that prostate cancer screening isn't important. It's just that the traditional digital exam seems to be of limited usefulness.

Read original article here: http://www.annfammed.org/content/16/2/149.full

Those of us practicing functional medicine are not only aware ,but also quite concerned about the impact of antibiotic usage on our microbiome,
defined as the community of microorganisms that inhabit a particular environment. The gut is but one of these important sites. No doubt antibiotics can be life saving, but there are drawbacks.They can disrupt the microbiome, and can contribute to potentially serious consequences. Traditional medicine has tended to focus on resistance and treatment failure,as it relates to the use of antibiotics. Fortunately now, as you can see from this peer-related website , there is a compelling need to look at the effects on the microbiome. This is complex science as the number of microbes (bacteria,fungi and viruses) in our body outnumber us 10:1 (100 trillion microbes within the 10 trillion cells within our body). But it's not just about the microbes themselves,but also their metabolites. So we are now entering the world of metabolomics I find this work very promising and beyond necessary as it relates to chronic diseases involving the cardiovascular system, inflammation and the central nervous system to name a few..

Read original article here: https://www.medpagetoday.com/resource-centers/infectious-diseases/antibiotic-exposure-and-microbiome/1138?xid=NL_mpt_special_reports_2018-02-26&eun=g565590d0r

We may be the wealthiest nation in earth, but we are far from the healthiest. For the first time in the last 50 years, American life expectancy has fallen 2 years in a row.

Its easy to blame the opioid crisis which is huge, but this problem is more widespread than that. Socioeconomics is a major player. We all know that accessibility and quality of medical services strongly affect life expectancy among the elderly.

We have to examine and blame the current US health system. Look no farther than the profit motive for prescription drugs, limitation of access to care for the elderly in Medicare, and the lack of a strong safety net to mitigate the effects of economic hardship.

For all the opulence that this country exudes, how can we continue to ignore the needs of the elderly , the infirm, the poor and the homeless ?

Read original Article Here: https://www.statnews.com/2018/01/04/life-expectancy-us-health-care/

Never one to rest on my laurels , I am spreading my wings once more. Having practiced both integrative cardiology and anti-aging medicine in Whittier,Ca for 31 years, I am expanding my services to the Westside. As of February 6 you will find me in the office of Dr. Ben Weitz in Santa Monica on Tuesdays. This will be a unique concierge practice with enhanced access to myself,the Medical Advocate, while enjoying the benefits of priority scheduling.

For details please contact Mary at: 562.945.3753

A HAPPY HEART MONTH TO ALL !

Finally we find a recent study suggesting that testosterone risks in older men may well have been overstated. The benefits of testosterone replacement therapy cited here are pretty impressive. There were several improvements in metabolic parameters such as blood pressure, cholesterol and triglyceride levels and fasting blood sugar to name a few. Body weight dropped significantly and erectile function clearly improved.

Moreover, there was no increase in cardiovascular events,such as heart attacks, TIAs or strokes in the men receiving such therapy.

This is not surprising to me and numerous physicians practicing anti-aging medicine today. I have been a spoken advocate for this therapy in the proper patient for quite some time. I have vehemently contested some of the deeply flawed studies that showed unfavorable results back in 2013 and 2014. (see both my written blog and video blog on this subject at: heartwise.com)

There is still work that needs to be done with additional research, but this is a great start.

Read original article here: https://www.medpagetoday.com/resource-centers/hypogonadism/medpage-today-news-studies-suggest-testosterone-risks-may-overstated-some/1455

25th annual American Academy of Anti-aging Medicine was held this weekend in Las Vegas. The mood was upbeat and progressive. This is what I’m talking about when I say“functional medicine “. The buzz words were intermittent fasting , FMD (Fasting Mimicking Diet, low carb/ high fat, microbiome , the “ hidden organ” and its effect on cardiovascular health , diabetes , the brain , health of newborns and aging in general .Also lots on energy medicine , artificial intelligence , and lots of really cool hi- tech stuff.

THE FUTURE OF MEDICINE IS NOW !

In this era of cost containment at the time of the passing of the Senate tax reform bill, the FDA approves Repatha as a stand alone for those with documented coronary heart disease. Repatha is a new class of medications that dramatically decreases LDL cholesterol which I name the "lousy cholesterol " It's a monoclonal antibody injected twice monthly under the skin. One problem is the cost,approximately $12,000 annually for a drug whose long term side effects are unknown.

Don't get bogged down by in the stats! Amgen the company that manufactures the drug sponsored the recent FOURIER study which led to this week's FDA approval. A 15-20% relative risk reduction may sound great,but when you break it down, the absolute risk reduction is more like 2 % ! The number of patients needed to prevent ONE cardiac event is 74 ! (not a home run in my book). It's been estimated that the cost of the drug would have to be slashed by 70% for it to be accessible to those in need.What's the chance that's ever going to happen ?

So this "victory" isn't so great when you break it down. As an integrative cardiologist, I'm all for the latest developments in testing and therapeutics.I have to say this class of meds truly decreases LDL cholesterol dramatically. I've used it is selected high-risk patients and it works ! But who's going to pay for it? Besides, have we truly exhausted lifestyle measures when it comes to heart disease prevention. Cholesterol is but one piece of the pie.

Read Original Article Here: https://www.medpagetoday.com/cardiology/prevention/69627

The new guidelines for Bp control were recently released by the American College of Cardiology and the American Heart Association. It boils down to this:
Anything above 130/80 is now considered hypertensive. That said, nearly 50% of US adults are hypertensive and only 54% of these are under adequate control. As this article mentions, it can't all be up to the doctor. We can only prescribe but so many meds before dealing with nasty side effects, drug-drug interactions and expense. Just think of how many more doctor visits will be necessary to attain these values. Patient compliance and responsibility are going to have to play a bigger role. We are talking about weight loss, exercise and cutting back on alcohol consumption. Patients need to invest in a home Bp monitor and keep an ongoing record of their Bp,

This is what I'm talking about when I say you must become your own medical advocate.

Read The Original Article Here:

 https://www.medpagetoday.com/cardiology/hypertension/69450

I've never been a fan of energy drinks. There is just something inherently unnatural and contrary to vibrant health when one needs to down such drinks to either stay awake or avoid an energy crash. Reports of the ill effects of these drinks are not new, but, attached, is a recent study linking these drinks to cardiac and blood pressure changes. It appears from this small study that such deleterious effects may not be merely related to the caffeine content. Those consuming energy drinks had a distinct electrical abnormality on EKG, commonly referred to as prolongation of the QT interval. Such electrical abnormalities carry potential risk, as dangerous rhythm disturbances (arrhythmias) can result, leading to loss of consciousness and even sudden death. FYI, there are many medications that can increase QT interval, placing patients at cardiac risk.
Again, this is a small study involving young healthy adults. Additional limitations include absence of a true placebo group. Despite these study limitations, the results are of interest, especially when you consider the popularity of energy drinks. Hopefully such interest will garner additional and larger studies to address the true effect of these drinks on the electrical system of the heart. In the meantime, I would clearly dissuade older individuals or those with hypertension or other underlying cardiac conditions to avoid consuming these drinks until we have more information regarding their impact on heart health. ~ your Medical Advocate! - H.E.

Written in Response to Article: Check it out HERE

https://www.medpagetoday.com/PrimaryCare/DietNutrition/64812

I just returned from an incredibly informative 2 day conference, CONTROVERSIES & ADVANCES IN CARDIOLOGY given by Cedars Sinai Medical Center. The latest and greatest in both the invasive and non-invasive aspects of my specialty were brilliantly presented by renown cardiologists.. What's particularly exciting to me is how Artificial Intelligence and the entire spectrum of the digital world is making a difference in patient care. The focus needs to be on HEALTH rather than just providing health care. Virtual reality systems are being set up in hospitals so that patients in pain can engage in a 3-D program,rather than stare at the blank walls, The results are quite promising.

Statins are still the buzz word. The new thinking is that anyone undergoing a coronary artery scan with a calcium score greater than 1 needs to be on a statin ,or whatever it takes to get the Ldl (lousy cholesterol) to a level less than 70. Now as an integrative cardiologist, I don't really buy that (at least in regard to the patients I see). Ldl cholesterol is but one piece of he pie. But I get it, Most cardiologists base their decision making on the conclusions of large randomized trials. The problem is that not all patients fall into a certain class. Some are truly committed to making lifestyle changes. 
Stay tuned!

There has been this ongoing debate about percutaneous coronary intervention (PCI), be it balloons and/or stents. Is it truly being overused ? As cardiologists, are we too quick to jump to intervention ? As an interventionist,I can say without a doubt that in the throngs of a heart attack OR unstable angina( known as Acute Ischemic Syndromes) that prompt intervention is life saving. But what about those with chronic symptoms who are clinically stable? We've known from previous studies that such patients do fine on medical therapy. Enter the recent ORBITA trial. This was a small study comprised of 200 patients with clear-cut blockage in a coronary artery.All patients underwent intensive medical therapy for 6 weeks. In the 2nd phase of the study, they were randomized to undergo the real deal (stenting of the affected artery) or a sham procedure in which the artery was left alone.(without the patient's knowledge) The outcome in both groups was the same. There was no difference in symptoms of chest pain , or differences in exercise stress testing..

So should we leave behind a significant blockage that we discover by invasive testing vs. stent it since we are already there? Are we too quick to bring patients to the cardiac cath lab? What constitutes optimal medical therapy anyway? With multiple drugs come multiple risks and costs. Fortunately in my office we offer EECP which is a FDA approved treatment for coronary artery disease. This is a great adjunct to those on medical therapy.

The bottom line is that there are too many variables that this study fails to address. Expect to hear a lot of debate about this trial in the coming weeks and months.

Read Original Article Here

http://www.cardiobrief.org/2017/11/02/small-trial-raises-big-concerns-that-pci-in-stable-angina-is-just-a-placebo/

For months I've been speaking and blogging about the benefits of a high healthy fat diet. I've gone on record disagreeing with the recent advisory statement by the AHA who decried the use of saturated fat (including coconut oil) in our diet. Their statement was based on studies dating from the 60's.But old science is not necessarily good science. Released last week in the prestigious British journal the LANCET, are the findings of the PURE study.This was a huge study from 18 countries in 5 continents over a 7 year period.A significant survival advantage was noted in those following a high fat diet. Yes, that even included the often maligned saturated fat.

Those consuming the highest level of fat had a reduced risk of fat of 23%. On the other hand, the higher the carbohydrate intake, the greater risk of total mortality.

Isn't it time to embrace new ideas based on new data?

View Original Article HERE

https://www.drperlmutter.com/powerful-new-study-confirms-high-fat-diet-is-best/

Fasting of some sort seems to be the buzz word these days when it comes to longevity medicine. Dr. Valter Longo was one of the keynote speakers at last month's American Academy of Anti-aging (A4M) meeting held in Las Vegas. He brings a new twist on fasting ; FMD =Fasting Mimicking Diet where one doesn't actually fast ,but drastically reduces calories 5 days of the month. His research is pretty compelling. Potential benefits run the gamut from cancer treatment and prevention to cardiovascular disease prevention, improved cognition with aging, and stem cell proliferation. I don't believe this is merely a fad. I believe we will be hearing quite a bit about FMD in the very near future.