Stressed out? Turmoil takes a toll on diet, exercise routine

Thu Apr 24, 6:30 PM ET
Stressed workers often reach for calorie-rich foods, skip the gym after a taxing day or forego meals because of heavy workloads. Or they indulge in other bad-for-you behavior like smoking, drinking or staying out late.
As the credit and housing crises rattle Wall Street, pressures over bigger workloads, job security and shrinking nest eggs are upending diets and fueling unhealthy habits across the country.
Breakfast is diet Pepsi and two packets of M&M's. For lunch, macaroons and white chocolates filled with marzipan from the farmer's market near Wall Street.
After learning her job would be cut this summer, Kelly Daly started reaching more frequently for the soothing effects of sugar.
"It's a stress reliever. Especially now that a bunch of us are going to be laid off," said the 49-year-old Daly, whose job reviewing medical insurance records in Manhattan's financial district is being cut after 11 years.
But it is in times of duress, experts say, that minding your health is perhaps more critical than ever.
Eating right and getting exercise may seem burdensome and even frivolous under such circumstances, but it actually gives people a greater sense of control and calm, said registered dietitian Heather Bauer, author of "The Wall Street Diet."
"It's one less thing to stress you out," Bauer said. "If you're out of a job or in a financial slump, it can give you a sense of inspiration as well."
For Aleksandra Cogura, heftier workloads in recent months means skipping lunch. If she's lucky, she'll manage to grab breakfast on the go. Once a gym regular, she hasn't been in four months.
"I just feel like I need to complete my work," said Cogura, a 44-year-old sales analyst in publishing in Manhattan.
Stress can take more serious, physical tolls. People under great stress release hormones and nerve chemicals that weaken the immune system, rendering them more susceptible to illness, said Dr. Esther Sternberg, who studies the effects of stress at the National Institute of Mental Health. Stress can also slow the body's ability to heal wounds, she said.
That could all translate into higher worker absenteeism, and those who do show up are likely not as productive when under great stress, said David Ballard, who specializes in work stress issues at the American Psychological Association.
Some ingredients for happy, productive workers include a flexible work-life balance, employee recognition programs and an atmosphere that lets employees take part in decisions, he said.
"It's about looking at the big system, creating a work place that puts a variety of components in place," Ballard said.
For individuals, reducing stress means "controlling the things you can control" when works seems to get too chaotic, said Marlene Clark, a dietitian with Cedar Sinai Medical Center in Los Angeles.
Taking a brisk, 10-minute walk can do wonders for clearing the head, Clark said. She suggests penciling the breaks in and giving them as much priority as other meetings.
Laying off the caffeine — coffee, tea, soda or even chocolate — could also help calm nerves, she said. Getting enough sleep is critical, too, especially when faced with more demanding work and hours, Clark said.
Taking such measures to reduce stress will only become more critical as the economic forecast darkens.
The nation's unemployment rate, now at 5.1 percent, is expected to move higher in coming months. Gasoline and food prices are at record levels, too, with ground beef, milk, apples, coffee and orange juice costing more these days.
"The first thing people want to do when they get stressed is eat stuff that's bad for them," said Bauer, who counsels Wall Street executives. "But the end result is that they're more stressed out because they're eating something they shouldn't have."
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On the Net:
Information on stress: http://www.nlm.nih.gov/medlineplus/stress.html

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Andy Dick, an affiliate of The Institute for Medical Wellness has some helpful tips:

I think it is important that everyone acts selfishly to an extent. Take care of yourself first. By this, I mean to put your health, wellness, and happiness with your life before deadlines and perceived stresses by outside influences. If you take care of yourself, and feel better overall, every aspect of your life should be the better for it. If you are well rested, properly nourished, and enjoying your choices, then your personal life should be better, your family life should see benefits, and you should be a better, more efficient worker. I think it is important that I note I am not specifically talking about exercise. Although I feel that exercise is important to most, this should be a personal decision. If it does not make you feel better short, or long term, than you need to change what you do.

Rest, healthy living, nutrition, personal enjoyment, and anything else that you value should never be put on the back burner.

Andy Dick
Owner, Optimum Results
(609) 304-7598
www.optimumresults.net

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One of my favorite movies growing up was “The Karate Kid”. Mr. Miyagi (The karate instructor) taught Daniel (the Karate Kid) the meaning of the word Balance and how it relates to ones own life. There are many things that are important in life, and we need to balance out the good with the not so good, the stressful with the calming. We always look for things that make us happy, but sometimes the quick burst of happiness can cause further problems down the line. I try to tell my daughter, when she needs to make a decision, think of safety, health and happiness in that order.

First what you want must be safe, then it must be healthy for you, and then it should make you happy. Choosing happiness over safety or health will just make you end up in my office sooner rather than later!

Steven Horvitz, D.O.

Founder of The Institute for Medical Wellness

For past issues of the Newsletter please click here.

More information on Dr. Horvitz can be found at his website at www.DrHorvitz.com

Heart exam, EKG recommended before children get ADHD drugs

By STEPHANIE NANO, Associated Press Writer

Children should be screened for heart problems with an electrocardiogram before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder, the American Heart Association recommended Monday.

Stimulant drugs can increase blood pressure and heart rate. For most children, that isn't a problem. But in those with heart conditions, it could make them more vulnerable to sudden cardiac arrest — an erratic heartbeat that causes the heart to stop pumping blood through the body — and other heart problems.

About 2.5 million American children and 1.5 million adults take medication for attention-deficit hyperactivity disorder, or ADHD, according to government estimates. Stimulant drugs, like Ritalin, Adderall and Concerta, help children with ADHD stay focused and control their behavior.

The medications already carry warnings of possible heart risks in those with heart defects or other heart problems, which some critics said were driven more by concerns of overuse of the drugs than their safety.

The heart group is now recommending a thorough exam, including a family history and an EKG, before children are put on the drugs to make sure that they don't have any undiagnosed heart issues.

"We don't want to keep children who have this from being treated. We want to do it as safely as possible," said Dr. Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation.

The label warnings were added after a review by the Food and Drug Administration of its databases found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003. There were also reports of heart problems in adults; the committee didn't look at adults.

An EKG can detect abnormal heart rhythms that can lead to sudden cardiac arrest. Children who are already on ADHD drugs should also be tested, Vetter said. If problems are found, the child should be sent to a pediatric cardiologist. With careful monitoring, Vetter said, children with heart problems can take the medicines if needed.

The cost of an EKG varies depending on who does it and the location. For example, the amount that Aetna Inc. pays for an EKG in a doctor's office ranges from $24 to $50; Medicare's payment rate is about $23. Vetter said Children's Hospital of Philadelphia, where she works, has been doing EKG screening for three years and it has been covered by insurance.

She said a screening of about 1,100 healthy children found that about 2 percent of them had some kind of heart problem.

"We thought it was reasonable to include the electrocardiogram as a tool for the pediatrician, the psychiatrist so that this would help identify additional children who have heart disease," Vetter said.

But Dr. Steven Pliszka, a child psychiatrist at the University of Texas in San Antonio, said he was baffled by the EKG recommendation. He said there's no evidence that sudden death is a bigger problem for children taking stimulants than for children who aren't taking the drugs.

Pliszka said an EKG might deter people from seeking treatment because it's an added expense and hassle. Psychiatrists aren't likely to have an EKG machine, and pediatricians might not either, making patients go elsewhere to get the test, he said.

The American Academy of Child and Adolescent Psychiatry recently updated its treatment guidelines for ADHD, and did not recommend routine EKGs, said Pliszka, who was the lead author. He has received research support or served as a consultant for makers of ADHD drugs.

"We definitely did not feel we needed to screen everyone," Pliszka said.

He noted that the heart association doesn't recommended EKG screening for young athletes to prevent sudden death. The group has said it wasn't feasible or cost-effective to screen all student athletes.

Representatives for Shire PLC, which makes Adderall and two other ADHD treatments, and Norvartis Pharmaceuticals Corp., which makes Ritalin, said the labeling already suggests patients be evaluated for heart problems and an EKG done if needed.

"There's no new information here. And frankly, we're a little perplexed as to the purpose of the American Heart Assocation coming out with this statement at this time," said Shire spokesman Matt Cabrey.

An ADHD advocacy group called CHADD said parents should monitor their child's reaction to all medications. EKG screening "will bring an even further measure of safety to what is already a safe clinical treatment approach," the group said.

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On the Net:

ADHD drugs: http://www.parentsmedguide.org/

American Heart Association: http://www.heart.org/

National Resource Center on ADHD: http://www.help4adhd.org/

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This article shows another case of putting the fear into parents of "Should I get this test or not???"

Heart abnormalities in children, thankfully are extremely low. I do not understand the reasons for recommending EKG's for children before potential treatment with ADHD stimulant medication. A thorough history and physical should tell most doctors whether the child is at risk for side effects.

Could the American Heart Association be recommending this to drum up more business??

My job is to help my patients stay healthy, through good preventive care and guidance, hopefully with as little medication and unnecessary testing as possible.

How do I know whether to recommend testing? By spending extra time talking with my patients and really honing in on the problems that need to be dealt with. The more specific we get, the less testing and treatment necessary!!

Steven Horvitz, D.O.

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For past issues of my newsletter please click here.
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August 10, 2008

Addendum: Copied below is the AAP (American Academy of Pediatrics) opinion on the above topic which agrees with my opinion.

AAP and AHA Differ on ECG/ADHD Advice

Sue Hughes

Heartwire 2008. © 2008 Medscape

August 1, 2008 — The American Academy of Pediatrics (AAP) has issued a new policy statement emphasizing that routine ECGs for children receiving medications for attention-deficit/hyperactivity disorder (ADHD) are not warranted [1]. The statement comes after advice given by American Heart Association (AHA) earlier this year [2], that physicians consider ordering an ECG to aid them in deciding whether or not underlying heart disease is present before prescribing ADHD drugs.

A spokesperson for the AHA told heartwire that in May/June it "clarified" its original advice, issued in April, in a joint advisory from the AHA and the AAP [3], saying that an ECG should be at the physician's discretion and it is not mandatory to obtain one. The AHA also updated its original statement [4]. "Our recommendations have not changed since we issued them this spring. Rather, we issued a clarification as a result of confusion and concern among the public and healthcare professionals. Routine use of ECGs to assess these children has not ever been part of our recommendations," the spokesperson said.

The current statement from the AAP, published in the August 2008 issue of Pediatrics, formalizes its position on the issue, an AAP spokesperson told heartwire. However, the two organizations still seem somewhat out of kilter on the strength of the advice they are issuing, with the AHA still more strongly recommending the use of an ECG than the AAP.

AHA Recommendations

The AHA makes the following recommendations for children starting ADHD medications:

• A thorough patient and family history should be obtained for assessment of these children. This is a class I recommendation (using the ACC/AHA classes of recommendations and levels of evidence).
• Acquiring an ECG is a class IIa recommendation. This means it is reasonable for a physician to consider obtaining an ECG as part of the evaluation. It is not mandatory, but rather is left to the physician's discretion. Treatment of a patient with ADHD should not be withheld because an ECG is not done. The child's physician is the best person to assess whether there is a need for an ECG.
• It is reasonable to use ADHD medications with caution in patients with known congenital heart disease and/or arrhythmias if these patients are stable and under the care of a pediatric cardiologist.

Latest AAP Statement

The latest AAP statement says that the AHA's recommendation to obtain an ECG before starting medications to treat ADHD "contradicts the carefully considered and evidence-based recommendations of the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics." It notes that these organizations have concluded that sudden cardiac death in people taking medications for ADHD is a very rare event, occurring at rates no higher than those in the general population of children and adolescents. It also notes that it has not been shown that screening ECGs before starting stimulants have an appropriate balance of benefit, risk, and cost-effectiveness for general use in identifying risk factors for sudden death. "Until these questions can be answered, a recommendation to obtain routine ECGs for children receiving ADHD medications is not warranted," the statement concludes.

The AAP statement adds that the authors of the AHA statement acknowledge the lack of evidence showing a benefit of routine ECG screening for these children, but still assigned their recommendation for screening a IIa classification (weight of evidence/opinion is in favor of usefulness/efficacy) and a category C level of evidence (only consensus opinion of experts, case studies, or standard of care). The AAP disagrees with both of these classifications. "Using AHA criteria, the AAP would, at most, classify this recommendation as IIb ('the level of evidence is less well established by evidence/opinion . . . . Additional studies with broad objectives needed'). In addition, using the AAP classification of recommendations, the AAP would assign the recommendation a category D level of evidence (on the basis of expert opinion without even observational studies)," the statement says, adding that the AAP avoids making guideline recommendations with a category D level of evidence.

It further claims that expert opinion suggests that the harm outweighs the benefit of recommending routine ECGs for healthy children who are starting stimulant medication for ADHD. "Accordingly, the AAP would recommend against such routine ECG screening," the statement concludes.

AAP Recommendations

The AAP makes the following recommendations:

• Careful assessment of all children, including those starting stimulants, using a targeted cardiac history (eg, patient history of previously detected cardiac disease, palpitations, syncope, or seizures; a family history of sudden death in children or young adults; hypertrophic cardiomyopathy; long QT syndrome) and a physical examination, which includes a careful cardiac examination (evidence quality: C; strength: recommendation). If patient history, family history, or physical exam is suggestive of cardiac disease, further evaluation is advised, with input from a pediatric cardiologist.
• Given current evidence, the AAP encourages primary care and subspecialty physicians to continue currently recommended treatment for ADHD, including stimulant medications, without obtaining routine ECGs or routine subspecialty cardiology evaluations for most children before starting therapy with these medications (evidence quality: D; strength: option).
• More research is needed on risk factors for sudden cardiac death among all children and adolescents, including those with ADHD who are treated with stimulant medications. Better methods of detecting hidden cardiac disease in children should be another focus of such research efforts.

Nissen Disagrees with AAP

But cardiologist Dr Steven Nissen (Cleveland Clinic, OH) says the AAP statement is misguided. He commented to heartwire: "It suggests that as many as 8% of children should be treated with amphetamines or related stimulant drugs. These drugs increase blood pressure and have not been studied in long-term trials. The statement asserts that sudden death is not more common in children receiving these drugs. However, the FDA has issued a warning for all of the ADHD drugs that states that they can cause sudden death at usual doses. It is irresponsible for a professional medical society to recommend to its members that they ignore an FDA-mandated warning. This is the second time in a few weeks where the AAP has issued poorly thought out guidelines that promote inappropriate drug use in children. The previous statement promoted statin use in children as young as 8 years of age."

Ghostwriters for medical research criticized, reforms urged

By LINDSEY TANNER, AP Medical Writer 27 minutes ago

Two new reports involving the painkiller Vioxx raise fresh concerns about how drug companies influence the interpretation and publication of medical research.

The reports claim Merck & Co. frequently paid academic scientists to take credit for research articles prepared by company-hired medical writers, a practice called ghostwriting. They also contend Merck tried to minimize deaths in two studies that showed that the now withdrawn Vioxx didn't work at treating or preventing Alzheimer's disease.

Merck called the reports in Wednesday's Journal of the American Medical Association false and misleading. Five writers of the articles were paid consultants for people who sued Merck over Vioxx's heart and stroke risks; the sixth testified about Merck and Vioxx's heart risks before a Senate panel. Merck says those connections makes the reports themselves biased.

While Merck is singled out, the practices are not uncommon, according to JAMA's editors. In an editorial, they urge strict reforms, including a ghostwriting crackdown and requiring all authors to spell out their specific roles.

Dr. Catherine DeAngelis, JAMA's editor-in-chief, said those are already policies at JAMA but not at many other journals.

"The manipulation is disgusting. I just didn't realize the extent," she said.

The practices outlined in JAMA can lead editors to publish biased research that can result in doctors giving patients improper and even harmful treatment, she said.

DeAngelis said doctors, medical researchers and journal editors bear some responsibility for those harms.

"We're the ones who have allowed this to happen. Now we've got to make it stop," she said.

Drug studies involve several steps, including designing and performing the research, analyzing the results and writing them up for submission to a medical journal. Pharmaceutical companies sometimes pay for a study but have independent scientists perform all those steps. Sometimes companies and their own scientists are involved in some or all the steps, and those were the studies scrutinized in the JAMA reports.

The articles are based on reviews of company documents from court cases over Vioxx, which was pulled in 2004 because of its heart and stroke risks. Merck agreed to pay $4.85 billion last November to settle thousands of lawsuits.

One JAMA report says internal company data showed in 2001 that Vioxx patients in two Alzheimer's studies had a higher death rate than patients on dummy pills. Merck didn't publicize that "in a timely fashion" and provided information to federal regulators that downplayed the deaths, the report said.

But Jim Fitzpatrick, a Merck attorney, said "it's completely not true" that Merck tried to minimize those deaths. He said a Merck analysis found the excess deaths were not related to Vioxx.

The other JAMA article says one Alzheimer study was designed and conducted mainly by Merck scientists. But when published, the lead authors listed were academic scientists not named in a study draft.

Peter Kim, head of Merck Research Laboratories, said those authors "were intimately involved in the studies." One was New York University Alzheimer's specialist Steven Ferris. He also disputed the implication that he had little to do with the study, and said Merck paid him for his work.

Fitzpatrick acknowledged that Merck has hired outside firms to write drafts of other studies that later list scientists as first authors. In those cases, the scientists are expected to review the manuscript and can suggest changes, he said.

The Alzheimer study was published in 2005 in the journal Neuropsychopharmacology. Its new editor, Dr. James Meador-Woodruff, said the journal's policies have been strengthened to ban ghostwriting.

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On the Net:

JAMA: http://jama.ama-assn.org

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If we did not trust the pharmaceutical industry before, how can we now?

Can we believe the hype and advertising that comes from this industry?

For those of you who know me well, I am not a big fan of medication. I prefer to use the least amount possible, and only after exhausting other options. I always prefer to find the cause of the problems and treat the cause with lifestyle adjustments first.

It sometimes take a little longer to come up with the solution, but it may save you both medication side effects and the cost of expensive medications.

If you think you are taking too much medication, please schedule an appointment so we can truly the assess their need, their benefits and their possible risks.

Always remember, that I work for you! Not for your insurance, not for the government!

You will get individualized and personal care and advice. That is what Family Practice is all about!!

Dr Steven Horvitz

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For past issues of my newsletter please click here.

For more information on my office please visit my website at www.DrHorvitz.com

MED MIX-UPS HURT 1 IN 15 KIDS

Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method, according to a new study published in the medical journal Pediatrics.

Other findings:

• Researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children.
• That compares with an earlier estimate of two per 100 hospitalized children, based on traditional detection methods.
• The rate reflects the fact that some children experienced more than one drug treatment mistake.
• The new estimate translates to 7.3 percent of hospitalized children, or about 540,000 kids each year, a calculation based on government data.
• Simply relying on hospital staffers to report such problems had found less than 4 percent of the problems detected in the new study.

The new monitoring method developed for the study is a list of 15 "triggers" on young patients' charts that suggest possible drug-related harm. It includes use of specific antidotes for drug overdoses, suspicious side effects and certain lab tests. By contrast, traditional methods include non-specific patient chart reviews and voluntary error reporting.

The researchers said their findings highlight the need for "aggressive, evidence-based prevention strategies to decrease the substantial risk for medication-related harm to our pediatric inpatient population."

Patient safety experts said the problem is likely even bigger than the study suggests because it involved only a review of selected charts. Also, the study didn't include general community hospitals, where most U.S. children requiring hospitalization are treated.

Source: "Med Mix-Ups Hurt 1 In 15 Kids," USA Today, April 7, 2008.

For text:

http://www.usatoday.com/news/health/2008-04-07-chidlren-medicine_N.htm

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Hospitals are dangerous places for children as well as adults.

The best way to prevent hospital errors is by avoiding hospitals. But to avoid hospitals you need to stay healthy.

Getting yearly wellness exams , learning about how your body works, learning about lifestyle modifications you can make to stay healthier will all help to achieve that goal.

How many of you are at an ideal body weight? If not do you know a healthy way to achieve it?

How many of you smoke and can't find a way to quit?

How many of you have had recent physical exams with proper laboratory testing to gauge your risks?

How many of you have sat with your doctor and talked about your families medical history and how it relates to you?

There are many things you can do to stay healthy. Truly knowing the status of your health and promoting continued well being is the foundation that gets you there.

If you have not done so already, set up a wellness physical. The time you spend will be well worth the good health you will enjoy!!

Steven Horvitz, D.O.

Founder Institute for Medical Wellness

For past newsletter editions please click here.

Change for our Healthcare system, but what kind?

I read an interesting article today written by a senator from Oklahoma who also happens to be a physician. From his position he can see the two disparaging ends of our present healthcare debate, government versus private control. You can read his article at http://www.nysun.com/article/72610.

I am a strong proponent of an individuals rights, especially when it comes to choices in healthcare. This is one of the driving forces behind my practice transition.

Many of my patients have asked why I took this "risk" of change.

Let me state a few of the reasons:

Health insurers intrusion into patient care- The past few years has seen more and more power given to the health insurers to delay or deny needed medical care. Health insurers are for profit companies. They make profits by NOT spending on your healthcare. That puts the doctor at a disadvantage when trying to help you access the care you need.

Increased Overhead- Insurance rules and regulations add enormously to business overhead driving up the cost of providing you healthcare. All of these regulations would take my office staff hours each day, and take them away from helping you. Let me list a few of these onerous burdens which I consider nonsensical to your care:

• Insurance Referrals


• pre-certifications


• pre-authorizations


• Medication formularies


• Pay for performance

All of these regulations are added by insurers to make it difficult to obtain necessary care and more importantly to increase the profits for insurers. By removing these regulations, my office has more time to spend with you and for you! I want and need to spend more time with you and less with paperwork. This enables a more open discussion of your problems and helps with better treatment plans. Would you rather spend 8 minutes with your physician or 20 minutes?

That brings me to costs. Healthcare does not have to cost a lot. My fees are listed for all to see, so there will be no sticker shock. Ask a doctor who participates with an insurance company to tell you their true fees. They probably do not even know! And almost all my present patients still have health insurance to cover their big ticket costs such as hospitalization and emergency care.

So far this year, there has been no health insurer intrusion into my patients care, my practice overhead has dropped considerably, we spend more time with patients, we have many available and affordable payment options, and fees are known upfront. We are also able to stress wellness and preventive care and advise of lifestyle modifications to prevent further illness. All the positives in a medical practice that gives choice and price transparency to patients.

I agree that change is needed in our healthcare system. The change I forsee is to a system that provides affordable access, high quality and innovative care, and rewards prevention. This can be best accomplished with freedom and choice, transparency of costs, and where patients are once again put back in charge of their healthcare dollar.

Steven Horvitz, D.O.
Founder Institute for Medical Wellness

Who should make the decisions? Your health insurer or your doctor?

March 2, 2008: This article from Yahoo news brought to you as a service from Dr. Steven Horvitz and the Institute for Medical Wellness.

Aetna postpones sedation policy change

By STEPHEN SINGER, AP Business WriterWed Feb 27, 6:00 PM ET
Aetna Inc. said Wednesday it will delay a proposed policy that would stop covering the cost of using anesthesiologists during colonoscopies. The policy had been opposed by a group of New Jersey doctors who said denying coverage of anesthesiologists to anxious patients would lead to fewer cancer screenings.
The Hartford-based insurer's policy was to take effect Apri1 1. Aetna said it will now be implemented after the U.S. Food and Drug Administration approves other forms of sedation.
"Implementation of our policy on April 1 would inconvenience our members ... and potentially depress cancer screening rates in the short term," said Dr. Troyen Brennan, Aetna's chief medical officer.
Aetna initially announced its policy in December in an attempt to address questions about the medical necessity of an anesthesiologist's services during routine upper and lower endoscopic procedures, such as colonoscopies. Aetna would still cover anesthesiologists for high-risk patients.
The change was opposed by the Medical Society of New Jersey, which said patients should be assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.
A call was placed to the group seeking comment.
Aetna has said moderate sedation works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.
Aetna said it hopes delaying the policy will allow adequate time for new "attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services" to be approved by the FDA.
New medical devices, as well as new sedatives, are expected on the market during the late summer and are in review with the FDA now, Aetna said.
Once that occurs, Aetna will implement its policy, Brennan said.
Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.

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This is another example of health insurance companies dictating treatments for patients, against their doctors wishes. Aetna's motives were solely to cut costs and increase already soaring profits. For more on Aetna's 2007 earnings, totaling over 1.8 Billion dollars please click here.

Can you imagine how many of the uninsured could be helped with 1.8 billion dollars?

How about lowering your health insurance premiums with some of the 1.8 billion dollars?

So to believe that Aetna's decision not to pay for colonoscopy anaesthesia was good for patient care is disingenuous. After reading the above article, the questions you must ask are who you want to help you in making medical decisions, your doctor or your health insurance carrier? I vote for doctors making the decisions!

One of the main reasons I dropped out of insurance networks was to be able to offer all my patient's unbiased yet affordable family medical care without any third party interference. By not contracting with these billion dollar profit making health insurers, I can truly be your best advocate to get you through this healthcare system.

As we are now two months into our new insurance-free system, I ask all of my patients for comments on how I can make my practice work better for you both today and in the future. Any and all comments are appreciated.

I also ask for suggestions on future newsletter topics. I try to get recent newsworthy items of interest and read between the lines to put it into proper unbiased perspective. Please send any suggestions to me by email at DrHorvitz@DrHorvitz.com.

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness
Your Partner in health!

Just 1 in 4 know heart attack signs

February 23, 2008 - This article from Yahoo news is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Just 1 in 4 know heart attack signs

By MIKE STOBBE, AP Medical WriterThu Feb 21, 9:02 PM ET

Only about 1 in 4 Americans know the warning signs of a heart attack and what to do first, according to a new government report. That's a decline in knowledge since the last survey in 2001, which showed nearly 1 in 3 to be well informed.

The study's lead author, Dr. Jing Fang, called public awareness in the new survey "alarmingly low." Fang is with the Centers for Disease Control and Prevention, which surveyed residents of 13 states and the District of Columbia.

Heart attack warning signs can include one or more of the following five symptoms: shortness of breath; pain or discomfort in the chest; discomfort in the arms or shoulder; a feeling of weakness or lightheadedness; and discomfort in the jaw, neck or back.

Chest pain is the most common symptom. Women are more likely than men to experience some of the other symptoms, particularly shortness of breath and back or jaw pain, according to the American Heart Association.

Anyone experiencing these symptoms should call 911, the heart association advises.

The groups best informed of heart attack warning signs and what to do about them tended to be white, highly educated, and women. Also scoring well were residents of West Virginia, which has some of the nation's highest heart attack death rates.

Each year more than 900,000 Americans suffer a heart attack, and about 157,000 of them are fatal. About half the deaths occur within an hour of symptoms occurring, experts say.

Because different people experience different symptoms, it's important to be aware of all of them, doctors say.

"It's not always massive chest pain," said Wayne Rosamond, a University of North Carolina epidemiology professor and expert on heart disease statistics.

Of course, knowing is not the same as doing: Although most of those who got the heart attack symptoms right said they would call 911, other studies show that only about half of heart attack victims go to a hospital by ambulance, Rosamond noted.

Patients' concerns about lack of health insurance status or other matters may explain why so few go to a hospital, said Rosamond, who was not involved in the new study.

The CDC's findings were based on a random-digit-dial telephone survey of about 72,000 people in 2005.

In West Virginia, more than 35 percent of respondents from that state knew all five warning signs and that they should call 911, compared with 27 percent in the overall study population.

Iowa and Minnesota also were at the top of the list. The gap between West Virginia and the two other states was not statistically significant.
West Virginia consistently ranks among the states with the highest heart attack deaths rates, and also is a leader in smoking, obesity, high cholesterol and other heart disease risk factors. But it's not clear whether personal experience was the reason the state's residents were so well informed. Public health education campaigns or other factors may also explain the result, experts said.


It is very important to know the warning signs of a heart attack. But heart attacks are only one cause of medical illness. My first job as your physician is not to treat you for your heart attack but to teach you how to prevent it and many other medical illnesses. This is different from alot of the medical community today, the majority of which are geared towards treating your lab values, and then giving you more and more medications to make your numbers look just right. They do not always take into account that treating numbers is not the same as treating disease.

Case in point. People with total cholesterol levels above 200 are responsible for 50% of the heart attacks yearly. What does that mean? It means people with total cholesterol levels below 200 are responsible for the other 50% of heart attacks. So where do you want your total cholesterol to be?

One of my goals for 2008 is to help my patients with prevention and wellness. Patients enrolled in my wellness or retainer programs will be shown many different ways to prevent illness. I will use lab numbers as an indicator of risks, but I prefer to help my patients with lifestyle adjustments as opposed to just using medications. For example, if we lower our risks through proper diet and exercise, and be proactive on other personal risk factors revealed through a comprehensive wellness program, then I feel I am doing my job correctly.

Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness

Open Letter to my patients

February 20, 2008

We near the end of February, nearly two months into the transition of my practice. Many of my patients, peers, friends and family have asked how the transition is going.

So far, so good.

The goals I have set for my practice are being met.

Please allow me to list a few of these:

1. Same day appointments- If you are not feeling well and need an appointment, the last thing you need to hear from your doctor’s office is that they can schedule you in three days. That just does not work! We have always offered same or next day appointments, and now if you call our office before noon on a workday, you will be offered a same day appointment. My father was also a family physician in a solo practice. He would always tell me, “Make sure you get patients into your office when they are sick, because if you wait a few days they may not be sick anymore.” I have followed my father’s advice.

2. Longer appointment times- When my office participated with health insurance companies, the large overhead expense forced us to try to see more patients per day. This would often cut into the length of time available per patient. Average appointment time prior to my transition was 12-15 minutes. Now we are scheduling for at least 20-minute appointment times, and longer for Wellness exams and physicals. My goal is that each patient gets the time they need for a full and comprehensive evaluation.

3. Less waiting time- With longer appointment times, I have finally been able to run on schedule. No one is perfect, but I have been doing a much better job of seeing patients at their scheduled appointment times. Another side benefit is less crowded waiting rooms and less time in the waiting room. In fact I am considering canceling some of my magazine subscriptions as no one is finding time to read them.

4. Creating a medical home for my patients- When contracted with health insurance companies my office staff and I would usually spend 4-6 hours per day on bureaucratic paperwork, referrals, precertifications and other health insurance nonsense that should have no place in our healthcare system. Well, no longer!! We now have time to serve as your sounding board to medical advice and treatment rendered by other caregivers and specialists. My office staff also has the time to help with the facilitation and coordination of your healthcare. This includes scheduling diagnostic tests and also referring and scheduling appointments with specialists.


I would like to restate my practice mission statement, as the words below are the standard of care that my office pursues.

To provide outstanding family medical care to our patients with a focus on comprehensive wellness and prevention.

To inform you of healthcare options that your health insurance carrier may not want you to obtain or know about.

To be an advocate for your medical care without regards to the health insurance bureaucracy.

Where patients go to be treated as a person and not as a commodity.

Where patients go to have a Physician who listens carefully and respects what the patient has to say and encourages the patient to say what is on their mind.

To give patients the ability to see their own Doctor and to make appointments without unreasonable waits.

To provide this care with an open mind, and to make your healthcare a team effort between Dr. Horvitz, his office staff, and you, the individual.


I appreciate the trust and confidence that my patients have shown in me. I take my job and my profession very seriously and I strive to treat every patient as I would want to be treated myself, and as I would treat my own family. I will always do my best to make every office visit or phone conversation worthy of your time.

If you have any suggestions or comments on how I can make my practice work better for you, please call or email. I will be happy to hear from you!

Steven Horvitz, D.O.
Founder Institute for Medical Wellness

Help with picking office payment plans

I have received many patient calls about which of my office plans to choose. There are four different options. I will try to clarify the differences below and help to recommend which plan is right for you.

Individual Wellness Plans:

· Adults ages 25 and over: $300/year with office visits starting at $25/visit.
· Adults and children ages 24 and younger: $200/year with office visits starting at $25/visit.

Family Wellness Plans:

· $1000/15 months with office visits starting at $25/visit

All Wellness Plans include a once yearly Comprehensive Wellness Exam. Included in this exam is a full history and physical, review of labwork, heart testing for adults ages 25 and up, and lung testing for all ages. Other add on tests, procedures, etc will be offered at a discount to our regular price. This exam at any other medical office would cost much more than $200-300 that we charge. And no other office sharply discounts remaining follow up care. We can offer this value due to lower overhead costs which results directly from not having to deal with insurance company regulations.

Wellness Plans are excellent values for the following types of patients.

· Patients who are proactive in their health, and who like guidance for prevention and wellness.
· Patients with high deductible health insurance, health savings accounts and flexible spending accounts.
· Patients who put off coming to the office for evaluation due to expected high office fees. As the majority of office visits will be $25, you no longer need to fear coming to the office.
· Patients who visit the office 4 or more times a year. The savings difference of the office visit costs between self pay and wellness plans start adding up on average by the fifth office visit for adults and by the third or fourth office visit for children and young adults. The savings happens even sooner if one of the visits is for a yearly physical exam or for patients who need extended office visits.

Retainer Plan:

· $750/year per individual, $2000/year for families – A complete wellness exam is included in the retainer plan. No fee for office visits unless as a housecall. The only other fees are for immunizations which are given at cost, and for legal work.

Retainer plans are excellent values for the following types of patients.

· Patients who are proactive in their health, and who like guidance for prevention and wellness.
· Patients with high deductible health insurance, health savings accounts and flexible spending accounts.
· Patients who put off coming to the office for evaluation due to expected high office fees. There are no office fees in the retainer plan.
· Patients who visit the office ten or more times a year.
· Patients who need more frequent follow-up care. This would include people being treated for hard to control high blood pressure and diabetes.
· Patients wanting more help with obesity who need more frequent guidance.

Self Pay:

· For established patients, office visits start at $65.
· For new patients, office visits start at $75.
· Self pay is for new and established patients who do not come to the office much, but still want value in their medical care.

Medicare:

· Our office is still participating with Medicare, but not Medicare Advantage plans. For patients enrolled directly with Medicare our office will remain business as usual.

My office is open to any further questions concerning the above options. Stop by and talk to Dr. Horvitz or call us at 856-231-0590. We will be glad to help in any way!

Flu season, and vaccine, looking worse

February 16, 2008 - This article from Yahoo news is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Flu season, and vaccine, looking worse

By MIKE STOBBE, AP Medical Writer

The flu season is getting worse, and U.S. health officials say it's partly because the flu vaccine doesn't protect against most of the spreading flu bugs. The flu shot is a good match for only about 40 percent of this year's flu viruses, officials at the U.S. Centers for Disease Control and Prevention said Friday.

The situation has even deteriorated since last week when the CDC said the vaccine was protective against roughly half the circulating strains. In good years, the vaccine can fend off 70 to 90 percent of flu bugs.

Infections from an unexpected strain have been booming, and now are the main agent behind most of the nation's lab-confirmed flu cases, said Dr. Joe Bresee, the CDC's chief of influenza epidemiology.

It's too soon to know whether this will prove to be a bad flu season overall, but it's fair to say a lot of people are suffering at the moment. "Every area of the country is experiencing lots of flu right now," Bresee said.

This week, 44 states reported widespread flu activity, up from 31 last week. The number children who have died from the flu has risen to 10 since the flu season's official Sept. 30 start.

Those numbers aren't considered alarming. Early February is the time of year when flu cases tend to peak. The 10 pediatric deaths, though tragic, are about the same number as was reported at this time in the last two flu seasons, Bresee said.

The biggest surprise has been how poorly the vaccine has performed.

Each winter, experts try to predict which strains of flu will circulate so they can develop an appropriate vaccine for the following season. They choose three strains_ two from the Type A family of influenza, and one from Type B.

Usually, the guesswork is pretty good: The vaccines have been a good match in 16 of the last 19 flu seasons, Bresee has said.

But the vaccine's Type B component turned out not to be a good match for the B virus that has been most common this winter. And one of the Type A components turned out to be poorly suited for the Type A H3N2/Brisbane-like strain that now accounts for the largest portion of lab-confirmed cases.

Over the years, the H3N2 flu has tended to cause more deaths, Bresee said.

This week, the World Health Organization took the unusual step of recommending that next season's flu vaccine have a completely different makeup from this year's. The U.S. Food and Drug Administration is expected to make its decision about the U.S. vaccine next week.

H3N2 strains are treatable by Tamiflu and other antiviral drugs, but the other, H1N1 Type A strains are more resistant. Of all flu samples tested this year, 4.6 percent have been resistant to antiviral medications. That's up from fewer than 1 percent last year.

"This represents a real increase in resistance," Bresee said. __

On the Net:

The CDC's flu season update: http://www.cdc.gov/mmwr

Unfortunately it appears that the powers that be who chose the strains for the flu vaccine had an off year. Influenza is a nasty illness that can cause high fevers, sore throat, chills, cough and muscle aches. It lasts anywhere from 3-7 days, and in susceptible people can contribute to pneumonia. I have treated patients with the flu and they all say they never, ever , ever want to feel that sick again.
The flu vaccine is still an option for prevention of influenza. But it is not perfect and it is obviously not for everyone. This past week I have seen almost a dozen cases in my office, and spoke to more via telephone who felt too sick to come in to the office.
For patients who want some extra protection from the flu, I have been recommending extra Vitamin D as there are theories that suggest Vitamin D can help protect against this horrible illness. For more information on Vitamin D and Influenza please click here.

Dr. Steven Horvitz's practice transition

When I started my family medical practice in 1998, the majority of patient visits and hence the revenues that came into my office was for sick care. At the time, it was what my patients and the public were demanding and what I was glad to provide. But today, with the baby boomer generation getting older, and healthcare costs skyrocketing, demand has increased for medical programs to help patients stay well.

But physicians today are forced to practice under an outmoded system that rewards frequent, extensive and expensive medical care for the very sick, but does not reward for the teaching and teamwork that goes toward prevention of illness. The government in its wisdom, throws more and more money into this system which gets worse year by year. The tremendous amount of government regulations and insurance industry greed and profits has doomed our healthcare system. The present healthcare scenario will not survive as is. The government can not save it. The health insurance industry can not save it. Only patients and physicians first taking individual responsibility, and then forming a partnership in their medical care can.

In January 2008 I started my transition towards a practice that is more patient centered and patient focused. I terminated my contracts with all health insurers except Medicare. With this practice conversion, I am now able to:
1. Improve access to medical care by offering same and next day appointments.
2. Improve communication with patients through longer appointment times, easier telephone access, and internet communication via email and our new and improved website.
3. Help patients to be better managers of their care via stronger coordination of the healthcare services they obtain outside my office. Many physicians are so busy seeing 30+ patients per day that they do not have the time for this coordination of medical care. In my new practice model, We Do!!

Thus far, I have been able to turn the healthcare system upside down, by engaging patients in this team concept of wellness and prevention. I tell all my patients, “ Put your effort into true health wellness and prevention, and I will treat your illnesses for a discount, without any health insurer or third party interference.” My patients who have teamed with me for their healthcare needs by enrolling in my wellness plans, get discounted fees, usually equal to or less than their insurance copay for all their sick care at my office. I am no longer restrained by health insurer contracts what I can offer and what I can advise. By terminating my relationships with the health insurers, I can again become my patients #1 advocate in their care.

One of the nicest comments I ever received was in 1991, from a fellow medical school student who happened to be a patient in my fathers family medical practice in Philadelphia. He told me the main reason he went to medical school was because of the personal connection and trust he and his family received in their medical care from my father while growing up. This trust shaped this students life and career aspirations. Do people still have this same sense of trust in their doctors today?

Sometimes moving forward is not the answer. Sometimes we need to look backwards, to a system that worked in the past. To a system where you picked your doctor based on quality and trust and not by looking at an insurance directory filled with names of physicians you do not know. My practice will move forward and grow by looking backwards. The basic qualities of the doctor-patient relationship will be emphasized again. My patients will choose my practice for the basic qualities of a true family physician such as expertise, sincerity, personal connections, and trust.

I look forward to 2008 and all the challenges that it brings. I value each and every individual in my practice and hope to continue to offer the best family medical care possible.



Steven Horvitz, D.O.
Founder of the Institute for Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590 Fax 856-294-0311

Email DrHorvitz@DrHorvitz.com

Website www.DrHorvitz.com

The side effects of statins: Heart healthy and head harmful?

February 14, 2008 - This article from the heart.org is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

The side effects of statins: Heart healthy and head harmful?

February 12, 2008 Michael O'Riordan

New York, NY - The cognitive side effects, especially memory loss, associated with statins resurfaced again this week with an article in the February 12, 2008 issue of the Wall Street Journal, in which some doctors voiced concerns that the cholesterol-lowering medications, specifically atorvastatin (Lipitor, Pfizer), might be helping patients' hearts but actually putting their memory in jeopardy [1]. To date, evidence for this effect is only anecdotal.

In the article, Dr Orli Etingin, vice chair of medicine at New York Presbyterian Hospital, is quoted as saying that atorvastatin, the best-selling drug on the market, "makes women stupid." Etingin told the Journal that 24 of her female patients taking atorvastatin lost the ability to concentrate or recall words. While tests showed nothing irregular, the women regained full cognitive capacity when the statin was stopped, and some women did better on other statins.

The examples cited by Etingin, founder and director of the Iris Cantor Women's Health Center (New York), are anecdotal, but she said more studies are needed to assess the cognitive effects of statins, especially in women.

These concerns, despite their observational nature, are not new and have surfaced in medical journals and meetings, as well as the mainstream media, for a number of years. As the Journal notes, "Lowering cholesterol could slow the connections that facilitate thought and memory. Statins may also lead to the formation of abnormal proteins seen in the brains of Alzheimer's patients."

The evidence, however, linking statin use to declines in cognitive function or to the development of diseases such as amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, as well as to the possible protection from Alzheimer's and Parkinson's, are scattershot at best. In the Journal, reporter Melinda Beck notes that Pfizer, the maker of atorvastatin, states the drug has been tested in 400 clinical trials, with no evidence establishing a causal link between atorvastatin and memory loss. Cardiologist Dr Antonio Gotto (Weill-Cornell Medical School, NY) believes the benefits of the drugs outweigh the risks, telling Beck that he "would hate to see people frightened off taking statins because they think it's going to cause memory loss."

Dr Michael Miller (University of Maryland Medical School, Baltimore) commented to heartwire that he has heard anecdotal reports of cognitive declines with statin use but pointed to a recently published paper in Neurology, with lead investigator Dr Zoe Arvanitakis (Rush University Medical Center, Chicago, IL), showing that in nearly 1000 patients the use of statins was not related to incident Alzheimer disease, changes in cognition, or continuous measures of Alzheimer's pathology or infarction [2]. Numerous other articles, many covered by heartwire, show conflicting data supporting and not supporting a link between statin use and cognitive decline.

Speaking with heartwire, Arvanitakis said that her study involved both men and women and the results do not contradict the observational findings but simply do not support the anecdotal evidence seen in clinical practice.

"There is a lot of interest right now with respect to statins and cognitive decline and Alzheimer's, so we need to be aware of the anecdotal evidence," she said. "There are some people who do believe that statins have a negative effect on cognitive function, and others who believe it has a beneficial or protective effect, but right now we just don't know. . . . The bottom line is that the evidence is mixed."

Asked about the cognitive side effects, Dr Roger Blumenthal (Johns Hopkins University Medical Center, Baltimore) told heartwire he has had some patients "who think that they are not as sharp mentally on statins, but the numerator is very small and the denominator is very large." If there is a good reason to treat a patient with a statin, he'll try another drug or every-other-day dosing, but he noted that he does not need to do this frequently, as 90% or more patients "have no problems with statins."

Still, anecdotally, "the chronology can be very telling," Dr Gayatri Devi (New York University School of Medicine) told the Journal. She has treated six patients with memory loss traceable to statin use, with the changes occurring within six weeks of starting the cholesterol-lowering drug. "It's a handful of patients, but for them, it made a huge difference."

While cognitive declines occur in men, too, women are affected particularly harder because they are losing estrogen in menopause, something that can also cause changes in cognitive function, writes Beck. She quotes Women's Heart Program director Dr Nieca Goldberg (New York University School of Medicine) who prescribes statins only to women with elevated LDL cholesterol and who have already had an MI. For others, including those with high LDL cholesterol but no risk factors, Goldberg recommends dietary changes and exercise.

With the evidence all over the map and with observational reports not going away, studies are being conducted to examine the effects of statins on "thinking, mood, behavior, and quality of life," writes the Journal. The researchers, led by Dr Beatrice Golomb (University of California, San Diego), are collecting anecdotal experiences of patients on statins. Muscle aches are the most commonly reported side effect, thus far, with memory problems the second most common side effect, in approximately 5000 reports to date.

Sources

Beck M. Can a drug that helps hearts be harmful to the brain? Wall Street Journal, February 12, 2008. Available at: http://online.wsj.com/public/us.
Arvanitakis Z, Schneider JA, Wilson RS, et al. Statins, incident Alzheimer disease, change in cognitive function, and neuropathology. Neurology 2008; DOI:10.1212/01.wnl.0000288181.00826.63. Available at: http://www.neurology.org.


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Yet more information now being released about possible side effects of statin drugs which lower cholesterol. The experts mentioned above claim that there is only anecdotal evidence about statins and memory loss. I have seen memory loss in a small number of patients on these drugs. I have also seen other side effects, the most common being muscle aches and pains.

Statins are not the panacea to heart disease that the pharmaceutical industry has claimed. In the years to come I believe we will be using less of these medications as we find their effectiveness at preventing heart disease has been overstated.

Previous newsletters have discussed this topic.

February 6, 2008 : Cholesterol May Help Build Muscle

January 15, 2008 : Cholesterol Drug Zetia Doesn't Cut Heart Attack Risk: Study

I would also recommend www.spacedoc.net for more information on statin side effects.

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Cigarette Smoking Causes Sleep Disturbances

February 12, 2008

This medical news about health and wellness is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Below are excerpts from an article in Medscape concerning smoking and your health.

Cigarette Smoking Causes Sleep Disturbances

February 7, 2008 — Smoking cigarettes impairs sleep quality, possibly due to nicotine withdrawal, according to a study in the February issue of Chest, the journal of the American College of Chest Physicians.

• The results of this study could represent "yet another motivating factor" to convince smokers to quit the habit, said Dr. Punjabi. "From a preventive health perspective, I think it's very important that we now add sleep disturbance to the armamentarium of issues related to smoking."
• Smokers spent more time in light sleep and less time in deep sleep than their nonsmoking counterparts.
• The study shows that cigarette smoking "can alter sleep architecture independent of factors such as age, gender, race, anthropometric measures, caffeine and alcohol consumption, medial comorbidity, and mental health status," the authors conclude.
• The direct effects of smoking on sleep seen in this study should provide further ammunition for public health campaigns to reduce smoking. "The people who smoke are not getting a restful sleep, and that has ramifications for them on a daily basis; they're tired, they're going to be tired the next day, and most likely they will have diminished level of alertness," said Dr. Punjabi. "Those are direct effects that poor sleep quality will have on their daily living."

Chest. 2008;133:427-432.

Pauline Anderson is a freelance writer for Medscape.
Medscape Medical News 2008. © 2008 Medscape

We are learning more and more every day that people that do not get restful sleep, have more medical issues than those who get the necessary sleep. Sleep apnea, another medical disorder that causes non restful sleep, has already been linked to high blood pressure and heart disease. We have known for years that cigarette smokers have a higher risks of both these illnesses. Whether cigarette smoking directly causes high blood pressure and heart disease, or whether it may be secondary to poor sleep quality as possibly implied by the article above will stir much future debate.

But we can leave the debating to the scientists and the politicians. What we need to take from this article is that cigarette smoking causes many effects on the body, very few of which are healthy. I will again advise all my patients to refer to my battle plan for quitting smoking. It can be found by clicking here.

Steven Horvitz, D.O.
Board Certified Family Medicine
Founder of The Institute for Medical Wellness

Cholesterol May Help Build Muscle

February 6, 2008

This medical news about health and wellness is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

Cholesterol May Help Build Muscle

Low cholesterol levels may be good for your heart, but cholesterol levels that are too low may negate exercise-related muscle gain, says a Texas A&M University study of 50 men and women, ages 60 to 69.

Participants took part in a 12-week exercise program that included stretching, riding a stationary bike and weightlifting. They all ate similar meals, CBC News reported.

The most impressive gains in muscle strength occurred in those with the highest cholesterol levels, rather than those with the lowest levels.

The study authors said cholesterol may play an important role in muscle tissue repair, which is critical in building muscle mass, CBC News reported.

"As you exercise, your muscles can become sore because they are rebuilding muscle mass. More cholesterol may result in a more robust inflammatory response. We know that inflammation in some areas, such as near the heart, is not good, but for building muscles it may be beneficial, and cholesterol appears to aid in this process," lead investigator Steven Riechman, assistant professor of health and kineisiology at Texas A&M, said in a prepared statement.

The study was published in the Journal of Gerontology.

The hypothesis that cholesterol is bad for your health and should be lowered at all costs is starting to unravel. As many of my patients know, I have not been a fan of cholesterol lowering medications. I view cholesterol as a marker for human health and disease, but not as a cause of disease.

Cholesterol is made by our body, in our liver, whether we eat cholesterol and fat in our diets or not. Obviously cholesterol must have some positive actions in our bodies. The article you just read appears to be one positive action. Hopefully in the near future more medical studies will be conducted and published showing more beneficial actions of cholesterol.

Achieving good cholesterol levels is important. But how you achieve those levels is more important. Using medications to improve your cholesterol levels is like painting a car with a rusty engine. The cholesterol and paint will look wonderful, but the car engine, heart and vascular system do not always benefit. A good analysis of cholesterol lowering medications was written and appears in Business Week magazine, Jan 28, 2008 edition.

I would like to provide a link to another site that reviews cholesterol lowering treatments with a slightly different analysis than you usually hear on the news. I am providing this link as fuel for thought and I would welcome any comment or feedback.

Steven Horvitz, D.O.
Board Certified Family Medicine
Your Partner in Health!

Cholesterol Drug Zetia Doesn't Cut Heart Attack Risk: Study

January 15, 2008 - Drug Warning from new study released - This new study is brought to you as a service from Dr Steven Horvitz and The Institute for Medical Wellness.

The long-awaited results of a trial of Zetia, a cholesterol-lowering drug prescribed to about a million Americans, shows the drug confers no medical benefit to users. If you are on this medication and need further information please call our office at 856-231-0590.

Cholesterol Drug Zetia Doesn't Cut Heart Attack Risk: Study

Date updated: January 14, 2008
Content provided by Health Day

MONDAY, Jan. 14 (HealthDay News)-- The long-awaited results of a trial of Zetia, a cholesterol-lowering drug prescribed to about a million Americans, shows the drug confers no medical benefit to users.

In fact, the pace at which artery-clogging plaques formed within vessels almost doubled in patients taking Zetia (ezetimibe) along with another cholesterol-lowering drug, Zocor (simvastatin), compared to those taking Zocor alone, the study found.

The two medications -- ezetimibe plus simvastatin -- are also marketed in one prescription pill, called Vytorin. About 60 percent of U.S. patients who are taking Zetia now receive the drug as part of Vytorin.

But the new two-year trial of 720 patients sheds doubt on whether it makes any sense for people battling cholesterol to take Vytorin versus Zocor alone, experts said. The study was funded by the two companies that make Zetia, Merck and Schering-Plough.

"This wraps it up," said Dr. Steven E. Nissen, chairman of cardiology at the Cleveland Clinic. "That's all there is. There just isn't any evidence that adding ezetimibe to simvastatin produces any advantage."

No one is disputing that Zetia can lower levels of LDL "bad" cholesterol by 15 percent to 20 percent -- that had been shown in previous trials. However, whether that reduction led to any greater lowering of heart attack or stroke risk had remained unclear.

The new ENHANCE trial -- which involved patients with a genetic condition that causes abnormally high levels of blood cholesterol -- found no such added benefit. According to a statement released by the two drug companies Monday, researchers found no statistically significant difference in heart attacks or stroke among trial participants who took Zetia plus Zocor, a widely used cholesterol-lower drug, versus those who got Zocor alone.

The study also noted that the speed at which arteries thickened with plaque almost doubled among those on the two-drug regimen compared to those taking Zocor alone.

Safety profiles were similar for Zetia/Zocor versus Zocor alone, the team added.

"These results are very important considerations on how we treat patients with elevated cholesterol and will very likely impact the way we choose drugs to lower cholesterol and eliminate plaque," said Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardio-Vascular Disease at New York University Medical Center, New York City, and clinical associate professor at the NYU School of Medicine.

"ENHANCE found that plaque got slightly worse when the drug combination was used," Weintraub noted in a statement. "But, the real take-home message here is that getting LDL down is important, and that's not something that should be lost as a consequence of this study."

The ENHANCE study was completed in April 2006, but the results were only released Monday by Merck and Schering-Plough after continual prodding by medical professionals. According to The New York Times, the companies had initially planned to release the findings by March 2007, but then missed several self-imposed deadlines, blaming the delay on the complexities of necessary data analysis.

Now that the results have arrived, Zetia and Vytorin should be viewed as "drugs of last resort," for patients not helped by standard statin therapy, Nissen said. Only if you can't tolerate full doses of simvastatin should you take ezetimibe, he said.

"This is one of the most widely advertised and widely used drugs out there, so it's obviously good to get these study results," Nissen added.

Another group questioned why patients should be prescribed more expensive cholesterol-lowering drugs, such as Vytorin, versus cheaper, generic statins such as Zocor.

"We already know that millions of people who take these brand drugs probably don't need to; they could be taking a less expensive generic instead. This study lends support to that cost-saving strategy for the health system and for consumers," said Steven Findlay, managing editor of Consumer Reports Best Buy Drugs, a public information and education project of Consumers Union, publisher of Consumer Reports.

"If there is no apparent clinical benefit, why take a drug that cost three or four times more?" Findlay said in a statement. "Most people do not need that magnitude of cholesterol reduction anyway."

Sales of Zetia and Vytorin totaled $3.7 billion in the nine months ending Sept. 30, up 33 percent from a year ago. Analysts estimate that about 70 percent of Schering-Plough's earnings depend on the drugs, the Times noted.

I have questioned at times the use of any cholesterol lowering medication. While they do lower cholesterol, how much does the cholesterol lowering actually benefit each individual. Most of the cholesterol lowering studies have shown dramatic decreases in total and bad (LDL) cholesterol, sometimes up to 50% reductions. However the actual percentage of patients who benefit by not having a heart attack, stroke, or cardiac death averages out to about 6%. 6% means that for every 16 people you treat, one person will benefit. While we never know who that one person will be, and we all hope that it will be ourselves, what about the other 15 patients who have had no benefit? In my practice I explain all options to my patients about cholesterol, the good, the bad, and the indifferent. Together, we make a decision as to whether medication for cholesterol is an advantage or not.

Steven Horvitz, D.O.
Board Certified Family Medicine
Your Partner in Health!

Dr Jennifer Phillips, Naturopathic Physician and part of the Institute for Medical Wellness network has these thoughts:

“Lately the fear of cholesterol has almost become an obsession. What many people do not realize is that cholesterol is necessary for the body to function. Problems begin when the body has too much cholesterol, but there are many natural therapies to bring down cholesterol levels. The human body manufactures 60 - 75% of its total cholesterol for its own use. The body uses cholesterol as glue to keep cell membranes from falling apart. It also is one of the building blocks for many of the body’s hormones such as estrogen, testosterone and cortisone.

Besides reducing intake of overall dietary fats and SUGARS, another way to lower cholesterol levels is to increase its elimination from the body. Oat bran and apples are especially good absorbing agents, but evidence suggests that increasing fiber of any kind in the diet will decrease cholesterol levels. Half-a-cup serving of cooked pinto or navy beans daily can lower LDL cholesterol levels by 20%.

Coffee, both regular and decaf, has been implicated in high cholesterol levels and reducing its consumption is suggested.

Exercise can dramatically increase the HDL’s and to some extent, decrease the cholesterol-depositing LDL’s. The best kind of regimen would be 30-45 minutes brisk walking, cycling or swimming three to four times a week.

Certain fish and plant oils will reduce cholesterol in some people. Niacin can lower LDL’s and increase HDLs significantly and has been proven to decrease the risk of heart attack. Lecithin has been shown to significantly lower LDL cholesterol while raising HDL. Garlic tablets can also lower cholesterol. Onion and garlic can be used liberally in your cooking as well.

High levels of cholesterol are associated with many life-threatening diseases but there are a number of dietary measures that can lower and/or control levels. If periodic checks are made by a doctor and common-sense dietary changes are made as needed by the patient and kept up over time, atherosclerotic disease can be reduced and the problems it cause prevented and possibly even reversed.”

Jennifer Phillips, ND

For more information on Naturopathic medicine please visit Dr. Phillips website by clicking here.