Wednesday, March 24, 2010


March 24, 2010

Institute For Medical Wellness Healthy Living Report


There have been many in our time.

Many I understand, and some not quite as much.

First there was Adam and Eve.

In the Entertainment industry there was Laurel and Hardy, and Sonny and Cher.

Let us not forget Mickey and Minnie, or Batman and Robin.

Raising a daughter, I got to know Bert and Ernie as well as Ken and Barbie.

Politically speaking, we can not forget about Bill and Hillary or their television clones Homer and Marge ;0)

The latest duet, however, comes from New Zealand, and is a highly unusual pair, if I may say so myself.

Would you believe Weight Watchers and McDonalds !!!

You see, Weight Watchers has come to an agreement with McDonalds in New Zealand to endorse some of their products, including Chicken McNuggets and their Filet-of-Fish sandwiches.

I am told that McDonalds Chicken McNuggets are just 12 Weight Watchers points, whatever that means.

Now most of you know that I am not a believer in eating processed foods.

So let us take a look at the ingredients in McDonalds Chicken McNuggets and Filet of Fish, from McDonalds website, and decide if they contain processed ingredients.

Chicken McNuggets®:
White boneless chicken, water, food starch-modified, salt, seasoning (autolyzed yeast extract, salt, wheat starch, natural flavoring (botanical source), safflower oil, dextrose, citric acid, rosemary), sodium phosphates, seasoning (canola oil, mono- and diglycerides, extractives of rosemary). Battered and breaded with: water, enriched flour (bleached wheat flour, niacin, reduced iron, thiamin mononitrate, riboflavin, folic acid), yellow corn flour, food starch-modified, salt, leavening (baking soda, sodium acid pyrophosphate, sodium aluminum phosphate, monocalcium phosphate, calcium lactate), spices, wheat starch, whey, corn starch. Prepared in vegetable oil (Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness). Dimethylpolysiloxane added as an antifoaming agent.

Fish Filet Patty:
Fish Filet (Hoki and Pollock), water, food starch-modified, yellow corn flour, bleached wheat flour, salt, whey, dextrose, dried yeast, sugar, sodium polyphosphate, potassium polyphosphate, cellulose gum, paprika and turmeric extract (color), natural flavors (plant source). Prepared in vegetable oil (Canola oil, corn oil, soybean oil, hydrogenated soybean oil with TBHQ and citric acid added to preserve freshness). Dimethylpolysiloxane added as an antifoaming agent.

Yum Yum.

It is like eating something I concocted in high school chemistry lab!

Just what I want to eat for good health and weight loss??

I don't think so !!!

I prefer to eat real non-processed food, where the ingredient list is 4 items or less, and contains real food, not items such as autolyzed yeast extract, sodium phosphates, food startch-modified, sodium acid-pyrophosphate, hydrogenated soybean oil with TBHQ, and on and on and on......

Actually I find Weight Watchers name is actually very appropriate. You join weight watchers and watch your weight go down a little, and then up a little, but do you ever really get anywhere? For those of you who do lose weight on weight watchers, how much of your loss is actually fat loss, as opposed to water or muscle? A truly healthy weight loss for overweight or obese individuals should compose of greater than 90% fat loss. This can be easily measured in our office with a body fat analyzer and is a part of our Healthy Weight Programs.

Achieving a healthy weight can be difficult, but the know-how to achieve a healthy weight should not be. That is what our Traditional Healthy Weight Program, and our Healthy Weight Program-Lite edition are all about. Teaching you how to alter your diet for your individual lifestyle and metabolism.

Now, you actually can lose weight eating fast food meals, if you alter the meals by avoiding the carbohydrates. Have a Big Mac, but eat it open-faced, without the bun, even if draws some funny looks. There was a very funny movie I viewed recently, Fat Head, and I highly recommend it. In the movie, which is actually a documentary, the writer actually lost weight and fat while eating nothing but fast food. So he proved you can lose weight eating at McDonalds, but at what cost? All the processed ingredients and chemicals, preservatives, etc, etc, may end up costing him in the end!

I guess my major issue is more with Weight Watchers than with McDonalds. We all know McDonalds is in business to sell you food. Weight Watchers, is supposed to help you lose weight, and to be on your side, not beholden to any corporate interests. Can you tell me that the dollars moving from McDonalds to Weight Watchers corporate office for their endorsement will not cause any conflicts of interest? Is it any different from big political donors bribing coercing politicians to vote a certain way?

I don't think so!

If you have any other duets you find amusing, please let me know!!!


Institute For Medical Wellness New Offers:

Phone Consults have been available at The Institute for Medical Wellness since January 2010.

While many patient's take it for granted that doctor's will prescribe treatment over the phone, it is not always good sound medical practice, nor the best for patient care. But many patient's in my practice have strongly requested these consults. Thus, I have added phone consultations to the services I offer, in the hope that when used in the proper circumstances will be of benefit to you. Phone consultations simply consists of phone time spent with you evaluating your health complaints, and prescribing treatment. For example, if you are feeling ill, but stuck at work or home, you can arrange a phone consultation.

The following fees will be charged dependent upon the time spent on consultation or if treatment is ordered or prescribed:

5 minutes or less without treatment prescribed = No charge
10 minutes or less with treatment prescribed = $45
11-15 minutes with treatment prescribed = $75

Any consultation that would require more than 15 minutes requires an in-office evaluation. Phone consultations will most often be used to evaluate and treat recurrent illnesses such as allergies, sinusitis or urinary tract infections. This service is not available to new patient's, nor to any condition that requires an in-office evaluation. Phone consults also need to be scheduled during regular office hours.

To schedule a phone consult, please call our office at 856-231-0590. A valid credit card is required.

Telephone consult fees are not applicable for the following:

* Quick follow-up phone conversations about a recent office evaluation.
* Wellness plan members, as these services are already included as part of your plan.
* As Medicare rules are vague on telephone consults, this service is not available to Traditional Medicare patients.
* Routine requests such as pharmacy refills, appointments or non-physician requests.

Healthcare Reform Update:

I have decided to refrain from further reform updates in these newsletters. Instead I have set up a separate blog that will give my opinions of what healthcare reform will mean now and in the future. So for those of you who are interested in my opinions on these issues, you can find this new blog here, which will not be sent out as a newsletter. Instead, I encourage you to sign up on the blog to receive new issues as they are published.

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

Sunday, March 21, 2010

Defining the Healthcare Reform Debate:

March 21, 2010

Institute For Medical Wellness Healthy Living Report

Defining the Healthcare Reform Debate:

The debate has raged for over a year now. The vote will be taken today. As this newsletter was written and sent prior to the vote, I do not yet know the outcome, yet I fear that this reform bill will pass. While our healthcare system has many faults, the reforms that may become law are more like the San Andreas fault.

Here are a few words, that I feel aptly describes the healthcare reform debate, taken from a few different online dictionaries.

1) Oligarchy: An oligarchy (Greek ?λιγαρχ?α, Oligarkhía) (oligocracy) is a form of government in which power effectively rests with a small elite segment of society distinguished by royalty, wealth, family ties, military might, or religious hegemony.

Opinion only: Public opinion has been against this reform bill. Yet the Congress may yet make it law. Is our present day Congress an oligarchy?

2) Collusion is an agreement, usually secretive, which occurs between two or more persons to limit open competition by deceiving, misleading, or defrauding others of their legal rights, or to obtain an objective forbidden by law typically by defrauding or gaining an unfair advantage. It is an agreement among firms to divide the market, set prices, or limit production. It can involve "wage fixing, kickbacks, or misrepresenting the independence of the relationship between the colluding parties. As another example, collusion may involve cooperation between competing sellers, in the form of an agreement, express or tacit, limiting competition, or a merger or other means to raise the market price above the competitive level.

Opinion only: At first, I thought this was about health insurance companies and pharmaceutical companies fixing prices to benefit the profits of both. But after watching healthcare reform pushed through our Congress, it appears that our politicians are even better at collusion, and have colluded with just about every special interest and industry around, leaving individuals without representation.

How many private backroom political deals were struck to buy get votes?

This bill was originally written in large part by politicians in collusion with health insurers. So the major benefits are political, and for the profits of the large insurance companies. All the demonizing of insurance companies was just a tactic to try to swing public opinion in favor of reform. It did not work. We all have issues when we fight an insurer to cover a treatment. Our biggest threat is legal, supposedly with the power of the government at our sides. With the collusion between the insurers and the government, just whose side will our government be on during our next battle with the insurers?

Individuals may soon be mandated to purchase insurance, and their choices of policies to purchase will be regulated and limited by the government. What the government fails to understand is that it is the government regulations and mandates that increases the costs of healthcare. They are just doubling down on bad policy!!

I will stop here, but not because I have run out of opinions.

But first, here is a link on healthcare reform from one of my volunteer crackerjack patients researchers.


After the above reform discussion, I feel the need to lighten it up a little, and no better way then some HMO humor.

HMO Jokes Segment

•The problem is that 99.99% of the HMO's make a bad name for the rest of them.
•Title for the meeting held in Michigan was an excellent example for oxymoron: "Managed care ethics."
•Q: What is the difference between an HMO and a car battery? A: The battery has a positive side.
•Q: What's the difference between an HMO doc and a seagull? A seagull can still make a significant deposit on a Mercedes.
Disclaimer: I have never owned a Mercedes, and my car is now 12 years old!!!



For those of you who are not internet savvy, a blogroll is not a type of sushi. But they are part of the many sources I research for new, old or changing information concerning your health.

I have many blogs that I follow, some of which are listed below: Diabetes Update Fat Head- You've been fed a load of bologna Health and Medicine from an Evolutionary Standpoint paleolithic nutrition - duplicating the evolutionary metabolic milieu explores food, fitness, pharmacy, freedom, and philosophy using an evolutionary paradigm. Primal Wisdom refers to the accumulated wisdom of our pre-agricultural ancestors as well as the innate wisdom built into the modern human organism through millions of years of evolution. Intermittent Fasting, Fitness, & Paleolithic Nutrition Self-Experimentation, Scientific Method, the Shangri-La Diet, etc. The Blog of Michael R.Eades, M.D., A critical look at nutritional science and anything else that strikes my fancy Measure, track and control coronary atherosclerotic plaque A blog about health, food, wholesome living and whatever else captures my interest.


So if healthcare reform passes and is signed into law, what do I see happening?

I really do not like making predictions, but since you asked:

I will limit my predictions to the Institute For Medical Wellness. We will continue to offer patient-centered, non-rushed medical care focusing on prevention of illness regardless of any reform bill, because it is what is demanded from my patient's and what is best for your health.

So if and when millions of individuals are forced to purchase insurance, and find their way into physicians offices, my question becomes, are there enough physicians? The answer is NO! So these newly insured will find themselves waiting in long lines at doctors offices or emergency rooms. But the era of the 8 minute doctor visit will be over. It will be replaced with a 5 minute visit, as doctors will need to see many more patients each day. Please tell me how can that be accomplished while maintaining high quality care?

The Institute For Medical Wellness will continue as is.

•Our routine office visit will remain at 20 minutes.
•Yearly wellness exams will continue at 45-60 minutes.
•Same day appointments and minimal if any waiting room time will continue.
Wellness Plans that are less expensive than your cell phone bill or gym membership!

When we can no longer continue meeting the above conditions, we will stop accepting new patients. We value every individual in our practice, I hope as much as each individual values themselves!

So you are all still free to decide, regardless of healthcare reform, where to obtain your healthcare. You can remain in the present healthcare system, where doctor visits last 5-8 minutes, and it can take a week for a sick visit. Or you can join with The Institute for Medical Wellness for healthcare delivery the way it should be, where the focus is always on you!!

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

Wednesday, March 17, 2010

Introducing our Healthy Weight Program - Lite Edition

March 17, 2010

Institute For Medical Wellness Healthy Living Report

Introducing our Healthy Weight Program - Lite Edition

Our Traditional Healthy Weight Program has many popular items, including many in-office consultations, as well as a starter package of supplements and protein shakes included. But by popular request, we are now able to offer our Healthy Weight Program, in a sleeker, Lite Edition.

The Lite Program benefits those who are "too busy", and do not have the time to spend on the Traditional Healthy Weight Program, and is also good for individuals who need the guidance, but less hand holding, to meet their healthy weight goal.

This program fits best after your yearly physical, as review of laboratory testing give valuable information about your metabolic profile, which helps to determine your proper program. The main part of your program will be your online Healthy Weight Notes, which we will privately share via a personalized google document. You will use this document to keep a diary of your food intake, as well as anything else pertinent to help you achieve your goals. I will be monitoring your IMW-Healthy Weight Notes, and giving what I hope to be good instruction and comments, as well as other helpful information, including any links to articles that I feel will be helpful to your success.

I will instruct you to weigh yourself on your home scale intermittently, to monitor your progress. At the end of each month, you should come to the office for a weigh-in. If you are doing well, and want to continue, you may renew the plan on a month-to-month basis. I believe that you will learn enough within the first month or two, that two months on the program will probably be sufficient for you to learn how to continue with your healthy weight goals. But if you need more help and guidance, you can continue for a longer period.

The cost for the Institute for Medical Wellness Healthy Weight Program-Lite Edition is, as its name includes, pretty lite at just $99 for the initial month, and $79 a month thereafter. To make this program even more effective, I suggest you combine it with exercise guidance with our affiliated personal trainers. I hope you use the training sessions to further move yourself towards your goals. For just $175 for the initial month, you can get both the Healthy Weight Program-Lite Edition and three one hour personal training sessions, and you will receive 10% off of all Institute for Medical Wellness supplements for the length of your program.

So no time is better than now to start working towards your healthy weight!

Healthcare Reform Update:

Below is an email I sent to Congressman John Adler yesterday concerning the healthcare reform debate.

To Congressman Adler:

I write to encourage you to oppose government-run health care and any legislation which might broaden the federal government's control over my health care, and the healthcare I provide to my patients. The current health care legislation, if passed and signed into law, will result in higher insurance premiums, lost health insurance and lost jobs for the American people which will push us deeper into recession. It will force many individuals, who execute their freedom of choice to not purchase insurance, into buying health insurance that they do not want. Many of these individuals are in their 20's and 30's and can not afford insurance, regardless of any government stipend they may receive.

I hope that you fight against health care legislation that would drive up costs, diminish quality and limit access. As a private solo primary care physician, I know all too well the problems with our healthcare system! I also am certain beyond a shadow of a doubt, that the bill before you will only make it worse. So you have a decision to make. If you side with your political party, instead of with the people who you are sworn to represent, do not expect to be re-elected in November. I am not a politically active person. I am too busy trying to provide quality medical care to my patients. But please know that if you vote for this government takeover of healthcare, not only will I speak up to every patient in my practice, but I will encourage and help every other doctor in my area to speak up as well and elect your opponent in November. Physicians rarely get involved politically, but the healthcare debate that has occurred in Washington D.C. has awoken a sleeping giant. Ask your friends and neighbors who they trust more about healthcare, their doctor or their Congressman. I do not think you would fare to well in that poll!

To have politicians and special interests dictate to me how to best treat my patient's is ludicrous and insulting. If you are ill, would you rather call me, as your physician, or your political party officials and special interests? I hope your answer is you would rather call your physician! If so, then make it happen by voting NO on this reform bill!

I would welcome a response directly from you, and not by way of a form letter. You may call me at my office at 856-231-0590. Better yet, I invite you to come visit my office and see how healthcare is actually delivered in a patient-centered and cost effective manner.

If you want my support in November, and I am a registered Independent, you not only need to vote NO on this reform package, but you need to show some leadership and speak out against this monstrosity of a bill to other members of Congress. Do not fear your Congressional leaders. They can not vote for you. I can, as well as all the patient's in my practice and my community that you are sworn to serve.

So I urge you again, to not only show some backbone and vote NO, but tell the truth about these reforms, that they are bad for individuals, bad for business, and catastrophic for our country.


Dr. Steven Horvitz
128 Bortons Landing Rd
Moorestown, NJ 08057-3011
Phone 856-231-0590


So what do you think?

A: Form letter response
B: Personal Email response
C: Phone call to meet at my office
D: No response
E: Other

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Bortons Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

Friday, March 12, 2010

A Hearty Dose of Calcium???

March 12, 2010

Institute For Medical Wellness Healthy Living Report

A Hearty Dose of Calcium???

Everyone always asks, Hey Doc, What type of calcium supplement should I take? You know, I don't want to have weak bones or Osteoporosis.

But does calcium supplementation help you or hurt you?

To answer this question we need to go back to a term mentioned a while back in an older, more ancient newsletter. The term or concept is called NNT, or number needed to treat. This is, to me, a very valuable statistic. It tells me how many people we need to treat to help or to hurt one person? I then convert that number into a percentage to see the actual percentage of people helped, or hurt, by a treatment.

Here is an example:

If 11 people have strep throat, and I give an antibiotic to all 11, on average, 10 people will be cured and 1 will not. The NNT is 10/11, or a 91% success rate. In healthcare, that is pretty good odds, especially for a treatment that is very safe.

Before I get to calcium, let me provide another NNT, this time for one of my favorites, the cholesterol drug Lipitor. Lipitor has an NNT of 100 to prevent one cardiovascular event. So it helps 1 out of every 100 people who take it, or 1%. I'll bet that is not what you see or hear on the television advertisements.

Now let us look at NNT for calcium supplementation in a few different ways.

Over five years,to prevent one symptomatic fracture in one person, we need to give calcium supplementation to 50 people. That is an NNT of 50, which means 1 out of 50 or 2% of people may benefit. That also means 98% do not!

Now, can calcium cause any problems?

In the above population, the NNT of individuals who took calcium supplementation over 5 years and went on to have a heart attack, otherwise known as an MI, or myocardial infarction, a coronary, or acute coronary syndrome, or coronary thrombosis .............

Sorry bout that! I sometimes get carried away!

The NNT of individuals who took calcium supplementation and went on to have a heart attack was 44. This means that 1 out of 44 individuals or 2.3% went on to have heart attacks. Here is another study on Vitamin D, calcium and prevention of cardiovascular events.

Things that make me go Hmmm!!!

2% of people benefit from calcium by not developing a symptomatic fracture, while 2.3% had a heart attack. More had heart attacks than prevention of fractures.

I do not exactly like those odds ; (

So the benefit of calcium supplementation appears to be overblown!

But I can still take one of those Osteoporosis drugs to prevent my bones from weakening. They will help because I trust Sally Fields!!! Sally would not lie to me!!

Full disclosure time: The only movie I ever liked with Sally Fields was Smokey and the Bandit. But that was a long, long time ago!!!

Below are the NNT's for prevention of hip fractures over 3 years for 3 common Osteoporosis drugs, as well as for low dose Vitamin D supplementation and hormone replacement therapy.

1. Risedronate (Actonel): 77
2. Alendronate (Fosamax): 91
3. Zoledronic Acid (Reclast): 91
4. Vitamin D 800 IU daily: 45
5. Hormone Replacement Therapy: 385

The lower the number, the better.

It appears that low dose Vitamin D was twice as effective as Fosamax or Reclast.

My suggestion.

Eat a well balanced diet, low in processed carbohydrates, with an abundance of colorful vegetables, meats, chicken, fish and eggs. Throw in some nuts, butter and olive oil. Get some summer sunshine for Vitamin D, or take a Vitamin D supplement.

And "just say No", to calcium supplements and Osteoporosis drugs!

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

Monday, March 08, 2010

HDL Cholesterol- Is something fishy??

March 8, 2010

Institute For Medical Wellness Healthy Living Report

HDL Cholesterol- Is something fishy??

HDL, otherwise known as the good cholesterol, is one of the types of cholesterol that makes up your total cholesterol measurement. Unlike certain types of LDL (type-B small dense LDL's), HDL cholesterol is generally good for you! While small dense LDL's can go through your bloodstream and get taken into the vessel wall, where it can cause blockages, HDL does the opposite. HDL cholesterol, due to its even smaller size, is able to get through the vessel walls, and acts as a transport vehicle, or bus, to takes the bad cholesterol out of the wall and recirculate it back to the liver for processing. That is why I call HDL, the Happy Cholesterol!!!

So that brings up a nice math problem that I do almost every day at the office.

Almost on Monday, almost on Tuesday, almost on Wednesday.

Sorry bout that. I always liked that joke ; )

One of the first things I look at when reviewing cholesterol values is what I call the Total/HDL ratio. This ratio is defined as the Total Cholesterol divided by the HDL cholesterol. A good ratio is 4 or below, which indicates a less than average risk of developing heart disease. A ratio greater than 5 puts you at above average risk for heart disease.

So who do you think has the lower risk of heart disease based on the below cholesterol levels?

Patient #1)

Total Cholesterol = 240
HDL Cholesterol = 60
LDL Cholesterol = 145
Triglycerides = 110

Patient #2)

Total Cholesterol = 180
HDL Cholesterol = 30
LDL Cholesterol = 115
Triglycerides = 100

Patient #1 has higher levels of all the cholesterol components and triglycerides. Patient #1 also has a ratio of 240/60 = 4.0

Patient #2 has lower levels of all the cholesterol components and triglycerides. Patient #1 has a ratio of 180/30 = 6.0

Patient #1 has a lower risk of heart disease based on the ratio of 4.0 .

As already mentioned, the HDL or good cholesterol, goes through the body and scavenges up or cleans up after the bad cholesterol or LDL. So the more HDL you have, the better. Some medications have been shown to raise HDL. Niacin, sold as prescription Niaspan, has some very good studies showing just this effect. Unfortunately for niacin, the high doses needed to exert this effect, has some very annoying flushing, itching and other skin side effects, and is rarely tolerated. Niacin also has an annoying habit of raising diabetics and prediabetics sugar levels.

My advice on the best way to improve your ratio is to lower your processed carbohydrate intake, increase your healthy fat, protein and fiber intake, increase your exercise, and if able, supplement with fish oils. This will raise the amount of good cholesterol (HDL) and lower your ratio to healthier levels. Our Healthy Weight Program is one way to help you lower your overall risk. A new Healthy Weight Program-Lite edition, will soon be available to help you further.


Fish Oils and PCB's

That leads to a perfect segway into our next subject.

Fish oil supplements, when used correctly, have been proven beneficial in prevention of heart disease, arthritis and some mood disorders. Other benefits have been reported, but I like to wait for more data to come in before making any recommendations.

I was asked to comment about a recent news story from Good Morning America (GMA) concerning fish oil supplements and PCB content. PCB's have been proven in the past to increase one's risk of cancer. A lawsuit has been filed against some fish oil manufacturers related to PCB's in fish oil supplements.

What is my take on this?

The GMA segment appeared to be well balanced, and the physician interviewed stated that only ten fish oil supplements were studied, which is a very small sample size. Concluding that all fish oil supplements are hazardous, from that sample size, would be equivalent to throwing out all the eggs at your supermarket due to a dozen or so bad eggs. Still, it will be interesting to see how this lawsuit plays out.

I can also take a conspiratorial view of this lawsuit. There is presently talk in Congress about further government regulations on the nutritional supplement industry. This lawsuit may be the trial balloon, pun intended, to drum up support for further government regulations. These regulations would put a big damper on individuals freedom to purchase supplements on their own.

The Institute For Medical Wellness, for the past seven years, has had available for purchase, Carlson's Fish Oil. Here is what is written on the Carlsons Fish Oil label.

THIS PRODUCT is regularly tested (using AOAC international protocols) for freshness, potency and purity by an independent, FDA-registered laboratory and has been determined to be fresh, fully potent and free of detectable levels of mercury, cadmium, lead, PCB's and 28 other contaminants.

I would not let the GMA story scare you away from fish oil supplements. But you should, as I always recommend, do your homework before starting or purchasing a supplement for use.

The Institute For Medical Wellness has a select list of supplements available, chosen based on efficacy, reliability, safety and cost. If a supplement does not meet those specifications, I do not recommend it.

Funny Times at The Institute For Medical Wellness:

We all have days when we get tongue-tied, myself probably more than others. But here is a funny that I need to mention.

When I asked a long-time patient, who I shall anonymously refer to as "The Man", what insurance he had, for laboratory testing purposes only, the response given was,

"Blue Cross- Blue Cheese"

Maybe I caught him after lunch at Salad Works ????

Special thanks to "The Man" for his good wit and great sense of humor!!

And for all the hassles of health insurance today, maybe they should change their name to Blue Cross-Blue Cheese !!!

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

Thursday, March 04, 2010

LDL Cholesterol- Is it truly a villain?

Institute For Medical Wellness Healthy Living Report

LDL Cholesterol- Is it truly a villain?

In my previous newsletter, I discussed the meaning of a Total Cholesterol reading as it relates to your risk of vascular disease. If you missed that newsletter, I'll update you.
Total Cholesterol is meaningless.

I'll say that again.

Total Cholesterol is meaningless!!

You see, total cholesterol is made up of many subfractions.

There are two common subfractions we usually hear about.

One that we measure is called LDL, otherwise known as low density cholesterol or BAD cholesterol. A simple way to remember LDL is bad is that L is lousy or bad.

A second that we measure is called HDL, otherwise known as high density cholesterol, or GOOD cholesterol. A simple way to remember that HDL is good is that H is happy or good.

So while two individuals may have the same Total Cholesterol, the amounts of the HDL and LDL may differ.

Today I will focus on LDL which has long been blamed for heart and vascular disease. What you may not know is that just as Total Cholesterol has subfractions that are both good and bad, LDL cholesterol also has subfractions. These subfractions are not all bad for you. Unfortunately, a routine cholesterol or lipid panel does not break down LDL into its subfractions. That is why at the Institute For Medical Wellness, we order a more detailed lipid panel to include these measurements. These added LDL subfractions enable us to better stratify your risk for heart and vascular disease and guide you towards a healthier diet and lifestyle to match your levels.

The first LDL subfraction I will call Type B LDL, otherwise known as small and dense. The small dense Type B LDL's tend to be more problematic. A simple way to understand this is to imagine a cholesterol doorway that is only 25 nanometers wide. Only LDL cholesterol particles smaller than 25 nanometers can fit through the doorway. Type B LDL tends to be 25 nanometers or less and can fit easily through the doorway. Unfortunately this doorway leads the cholesterol towards increased plaque formation and a higher risk of heart disease.

The second LDL subfraction I will call Type A LDL, otherwise known as large buoyant or big and fluffy. These big fluffy Type A LDL's tend to be much less problematic, as they tend to be larger than 25 nanometers in size, and do not fit easily through the cholseterol doorway. This makes the Type A LDL's not as dangerous.

OK. Now let me put this all together for you. Just as measuring a Total Cholesterol level by itself tends to be meaningless, measuring a total LDL is not very helpful without the subfractions we now call big fluffy and small dense.

So, I know people do not like to be call big and fluffy. But when we are talking about LDL cholesterol, big and fluffy is what you want to be.

For more information about this type of cholesterol testing, please visit the following website.

Unfortunately, there is a caveat. One insurance company, Aetna, is way behind the eight ball when it comes to lipid measurements, and refuses to allow payment for this testing. But I am always looking for a way to guide you through or around the health insurance quagmire. Presently I am in discussion to get this special testing at a reduced price for Aetna patients.

Stay tuned.

Next in the cholesterol series, in an upcoming newsletter, will be HDL.

Healthcare Reform Update:

Yes, here we go again!

First let me say that my views on healthcare reform are not meant to be political, as healthcare should never be held hostage to politics. Your healthcare and the decisions you make about your health should be yours to make, and yours alone. Unfortunately too many outside interests (insurers and politicians) have gotten in the way. It was not always like this.

My whole life has been centered around healthcare. I started my medical education in 1988, but I grew up in my father's medical office. My father was an independent family doctor who practiced for 25 years, before the insurance companies or the government took over control of the system. Insurance premiums were much more affordable during that period. The doctor-patient relationship was paramount when I would visit my father's office and see the interaction between him and his patient's. There was no concern for what insurance a patient had. So the problem, as I see it now, is not that there is not enough government and third party control of your healthcare, but too much. Way, way too much!!

So when I discuss the healthcare reform debate, it is personal. Healthcare costs, as I see it, have skyrocketed due to government and insurance control, so how will giving them more control of the system lower costs?

I am not part of any political party. I am not a republican or democrat, and I do not belong to a tea party. I am proud to be just as independent politically as I am independent in my practice of medicine. My views on this healthcare reform issue gravitate towards what I personally feel gives the most control of healthcare decisions to patient's and their physicians. Any reforms that try to intrude on the doctor-patient relationship, I will oppose, and oppose strongly.


Institute For Medical Wellness Planning Stages or what we hope to offer in the near future.

•Healthy Weight Program- Lite edition- pun intended!
•New Heart and Vascular Wellness to focus even more on prevention of heart disease.
•More In-Depth Nutritional Testing

If you have any ideas for future newsletters please let me know!

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311