With Thanksgiving approaching, my heart is filled with immense gratitude and warmth. I want to take a moment to express just how thankful I am for each and every one of my concierge members. Your decision to join my concierge program and prioritize your health is something I deeply appreciate.
In an era where healthcare often feels like a series of rushed appointments and impersonal interactions, I knew I needed to forge a new approach to patient support and enhance the service my team and I provide. My concierge program became the solution, helping us to build a more personalized patient environment, fostering a mutual dedication to improving health outcomes. This journey has been incredibly rewarding for me, not just as a physician, but as a partner in your health. I’ve seen firsthand the positive changes and improvements that come from a more engaged and proactive approach to healthcare. It’s been inspiring to witness your progress and to work with you to maintain and improve your health over time, with greater continuity and understanding. Together, we are not just managing health. We are thriving. The opportunity to make a real difference in people’s lives is truly fulfilling, and I thank you for making that possible. Practicing Gratitude for Your Health “The heart that gives thanks is a happy one, for we cannot feel thankful and unhappy at the same time.” -Douglas Wood In the spirit of Thanksgiving, I encourage you to identify all that you are thankful for and to develop a regular practice of gratitude. Gratitude is like a personal trainer for your mindset—just a few reps a day can boost your mood and strengthen your outlook! Your practice doesn’t have to be hokey or complicated. It can be as simple as writing one line in a journal each day or keeping a note in your phone to share something that happened that day for which you are grateful. For example, you can start by writing a note that states, “Good things always happen to me.” Then, throughout the day, look for positive things that occur and write them down. When we regularly acknowledge and appreciate the positive aspects of our lives, we shift our focus away from stress and negativity, which can help lower levels of the stress hormone, cortisol. This shift not only improves emotional resilience but also supports better mental health by reducing symptoms of depression and anxiety. Furthermore, gratitude can enhance physical health by encouraging healthier lifestyle choices, such as improved sleep quality and more consistent exercise, which contribute to a stronger immune system and better cardiovascular health. A Final Note Thank you once again for reminding me why I chose this profession, and for being a major contributor to my gratitude practice each day. As we move forward, I remain dedicated to ensuring your membership exceeds your expectations. Your feedback and experiences are invaluable, and I encourage you to share them with me and my team so that we can continue to improve and adapt to better serve your needs. I wish you and your loved ones a wonderful Thanksgiving.
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As the primary fat in the Mediterranean Diet, olive oil has been studied extensively for its health-promoting benefits. Regular consumption, defined as 1.5 - 4 tablespoons a day, has been observed to reduce the risk of total and cause-specific mortality. But not all olive oils are created the same. Thus, a study comparing the health benefits of EVOO to OO recently caught my eye.
Extra virgin olive oil (EVOO) is distinguished from olive oil (OO) by the extraction process. OO is produced via chemical extraction and processing, whereas EVOO is produced by crushing the olive thereby retaining and preserving the phenol content of the fruit (yes, olives are classified as a fruit!). It is the phenol content of the EVOO which is thought to impart the health-promoting benefits, not the fatty acid content (aka MUFAs). The study participants In the study comparing the two, 12,161 participants were assessed for variables such as sociodemographic factors, self-reported health conditions and medications, and diet, specifically their adherence to the Mediterranean Diet and type of olive oil consumed each day. Participants were followed for a mean 10.7 years. The findings Researchers found the risk of all-cause mortality and cardiovascular mortality was lower in those with the highest reported daily EVOO consumption, and this association was not replicated in those reporting OO consumption. When total daily olive oil consumption was combined (i.e. adding together both OO and EVOO consumption), the risk of mortality was also reduced—but not as low for those with higher daily EVOO consumption (not combined with OO). Interestingly, deeper reductions in all-cause mortality were noted in those reporting both higher EVOO consumption and physical activity, indicating a synergistic effect between the two, the mechanism of action for which is not fully understood. How do we interpret this study? We can start by noting it is not a randomized clinical trial (RCT). Instead, this study is strictly observational, meaning we can observe the results, but we cannot draw conclusions. Had the researchers randomly assigned half the participants to EVOO consumption and half to OO, we would have more conclusive results. So, I dug a little more into the research in PubMed. A review article of 34 studies in which EVOO was compared to other fats found EVOO superior in a variety of biomarkers and health outcomes—this was again believed to be imparted by the phenol content. Where does this leave us? It would seem that EVOO might have benefits above and beyond that of other fats, including plain old olive oil. Specifically, a serving of 2 tablespoons of EVOO a day appears to be beneficial. It’s important to also remember the statistically observed synergy between EVOO and physical activity—so keep moving! Buying EVOO When purchasing, remember to read the label to make sure it says EXTRA VIRGIN olive oil and if you can find it unfiltered that’s even better! Check the expiration date, as phenol content wanes with time. Pesticide residue studies of European olive oils do not indicate contamination above threshold levels, thus if purchasing European olive oils, it may not be important to choose an organic version. And be sure to keep your EVOO away from heat (not next to or above the stove or oven) and away from light. There exists both controversy and contradictory research results regarding the degradation of phenols with cooking. It seems prudent to save the pricey EVOO variety for salad dressings and for finishing/topping soups and vegetables for flavor and mouthfeel. If you have questions about your specific EVOO recommendations in relation to your personal health, please reach out for a chat. You may also feel free to share this blog with your friends and family. SOURCES: Ambra R, Lucchetti S, Pastore G. A Review of the Effects of Olive Oil-Cooking on Phenolic Compounds. Molecules. 2022 Jan 20;27(3):661. doi: 10.3390/molecules27030661. PMID: 35163926; PMCID: PMC8838846. Donat-Vargas, C., Lopez-Garcia, E., Banegas, J.R. et al. Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort. Eur J Clin Nutr 77, 226–234 (2023). https://doi.org/10.1038/s41430-022-01221-3 Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Fitó M, Gea A, Hernán MA, Martínez-González MA; PREDIMED Study Investigators. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018 Jun 21;378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13. PMID: 29897866. Flynn MM, Tierney A, Itsiopoulos C. Is Extra Virgin Olive Oil the Critical Ingredient Driving the Health Benefits of a Mediterranean Diet? A Narrative Review. Nutrients. 2023 Jun 27;15(13):2916. doi: 10.3390/nu15132916. PMID: 37447242; PMCID: PMC10346407. Gaforio JJ, Visioli F, Alarcón-de-la-Lastra C, Castañer O, Delgado-Rodríguez M, Fitó M, Hernández AF, Huertas JR, Martínez-González MA, Menendez JA, Osada J, Papadaki A, Parrón T, Pereira JE, Rosillo MA, Sánchez-Quesada C, Schwingshackl L, Toledo E, Tsatsakis AM. Virgin Olive Oil and Health: Summary of the III International Conference on Virgin Olive Oil and Health Consensus Report, JAEN (Spain) 2018. Nutrients. 2019 Sep 1;11(9):2039. doi: 10.3390/nu11092039. PMID: 31480506; PMCID: PMC6770785. Guasch-Ferré M, Li Y, Willett WC, Sun Q, Sampson L, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Hu FB. Consumption of Olive Oil and Risk of Total and Cause-Specific Mortality Among U.S. Adults. J Am Coll Cardiol. 2022 Jan 18;79(2):101-112. doi: 10.1016/j.jacc.2021.10.041. PMID: 35027106; PMCID: PMC8851878. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean die t, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004 Oct;80(4):1012-8. doi: 10.1093/ajcn/80.4.1012. Erratum in: Am J Clin Nutr. 2005 May;81(5):1181. PMID: 15447913. Background
Over the past 20 years, medicine has made incredible advances, and those of us in practice can attest to the incredible ways in which we can extend the life of our patients, beyond what we could have ever anticipated in medical school. But with longer lives comes the spectrum of cognitive decline and neurodegenerative diseases, namely dementia—an umbrella term for a number of neurodegenerative diseases, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In early June, a rare, albeit small (n=51), randomized clinical trial was published in Alzheimer’s Research & Therapy that determined the effectiveness of lifestyle changes on the progression of MCI and AD, and I am inspired by the findings. It is estimated that 40% of global dementia cases are related to 12 modifiable risk factors. (Many of which also impact heart disease. Remember, what affects the heart affects the brain!). Several previous, small studies have shown the effectiveness of intensive lifestyle changes on the progression of MCI and early AD, but none had a control group nor were they randomized. That is what sets this study apart. What did the study address? Over the course of 20 weeks, participants and their spouses or study partners adapted the following lifestyle changes:
In the study, all interventions were supported via 4-hour Zoom sessions three times a week for the participant and spouse or study partner. The study aimed to determine if:
What did they find?
Interestingly, in one of the biomarkers, the degree of change was similar to that affected by the clinical trials for new intravenous medications! My takeaway This study provides yet another reason for us to eat real food, move more, breathe better and connect more—all of which have multiple benefits to our health and wellbeing. Let’s continue to work together on the path toward better health and wellness. Don’t forget, my concierge members also have access to the Concierge Choice Physicians Motivated Mondays program which provides a year’s worth of mini-resolutions focused on the prevention of cognitive decline through lifestyle changes. To sign up for the weekly emails, please contact CCP’s Erica Rios: [email protected] Click here to visit past editions of Motivated Mondays. Study source: Ornish, D., Madison, C., Kivipelto, M. et al. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial. Alz Res Therapy 16, 122 (2024). https://doi.org/10.1186/s13195-024-01482-z American dietary guidelines for cholesterol limits were established in the 1960s and, in the three decades that followed, an entire food industry was born as low-fat food products dominated grocery store shelves. Americans became fat-obsessed, eschewing nutrient-dense foods high in cholesterol, such as eggs, shrimp and cheese. Unfortunately, though, the daily cholesterol guidelines were not based on data but on consensus; and in 2015 dietary cholesterol guidelines were eliminated. But many people remain afraid of fatty foods with the idea that dietary cholesterol increases serum cholesterol (e.g. type of body fat or lipid, representing the amount of total cholesterol in our blood) and thus, they continue to avoid nutrient-rich, high cholesterol foods. Today, let’s settle this issue once and for all.
For most people, consuming foods high in cholesterol does not lead to an increase in serum cholesterol. Why is this? Isn’t it intuitive to think that what is consumed would be reflected in a blood test? The human body is remarkable in its pursuit of homeostasis. Meaning, physiologically speaking, the body seeks to keep all variables in balance. Cholesterol serves a great many functions in the body: it is the foundation for the production of steroid hormones and Vitamin D, it is a critical component of cell membranes (the outer shell) and it is involved in the creation of bile, which helps digest fat. You might be surprised to know your brain holds the greatest concentration of cholesterol in your body! Plainly stated, the body needs cholesterol and uses an enzyme to make cholesterol—it isn’t purely sourced from the diet. When dietary cholesterol is high, this enzyme is suppressed, maintaining homeostasis. Like I said—the human body is remarkable! The notable exceptions to this rule are diabetics and cholesterol hyper-responders—which make up an estimated 10-30% of the U.S. population. The information above does not apply to these individuals, who should continue to adhere to physician orders regarding dietary cholesterol. We can further this discussion in the context of your specific health history at your next annual concierge exam. Please be sure to contact my office if your exam is not already on the schedule. I hope you enjoyed the holidays and have had a fresh start to the new year.
Now that it is nearly the end of January, I wonder: have you set wellness resolutions and health goals for 2024? Are you struggling to achieve those health goals or stick to those wellness resolutions? Are you surfing the internet for help? Are you falling down the rabbit hole in your search for a leg up in reaching your goals and resolutions? If so, you are not alone. The internet has created a shift in patient care. Consumers can now gather health-related information for themselves and come primed to the healthcare encounter with a level of knowledge not seen by previous generations of physicians. In some ways, this is healthy empowerment for patients who have long felt a lack of control over their care. And it is indeed helpful when patients have a general understanding of their condition/s as it can facilitate the conversation and encourage compliance with the plan of care. Yet, in other ways, access to online health information has undermined the doctor-patient relationship. Patients now come to the encounter prepared to lead their care in a direction that may not be in their best interest according to science. This is partly because the information on the internet is not monitored for accuracy. This is especially evident in the “blogosphere,” where influencers shell out health advice without a background, education or training in their subject matter. There are several ways to determine if the medical advice you’re reading is sound. One of the greatest tip-offs to inaccurate or misleading information relates to your wallet. If the sale of supplements, services, subscriptions—or anything—comes along with the purported medical advice, think twice. Here are a few additional questions to ask yourself before believing what you read:
There was a time when we could say traditional media sources (newspaper, radio, TV) were OK. That is rapidly shifting in an era of “advertorials” and “infomercials.” Two health-related sites that are conservatively OK are the NIH and WebMD. However, even that content can be taken out of context, misconstrued or simply not applicable to you, as the context of your whole health history is not considered in those articles. Instead of consulting Dr. Google, I urge you to consult me, your actual doctor, instead. One of the wonderful benefits of concierge medicine is the time we can spend together which is often not available in other settings. Send me an email with your health goals and wellness resolutions. If you have already combed the internet and have found information you would like me to vet, include it in the email. Then schedule an appointment. I will come to our encounter prepared to understand what you need during that visit, and we can have a dialogue about your questions or interest. You may also wish to consider participating in Motivated Mondays, which is a reputable source of information for many of your typical wellness resolutions. Contact your Motivated Mondays coach, Michele McCambridge, MPH, to participate. Cheers to your best health in 2024. Dear Concierge Members:
I trust this email finds you in good health and spirits ahead of the Thanksgiving holiday. As your dedicated healthcare provider, I wanted to take a moment to express my sincerest gratitude for the privilege of being a part of your wellness journey. Throughout our interactions, whether for routine check-ups or times when you've sought my guidance, I have been continually impressed by your commitment to your health and honored by the trust you have placed in me. Your dedication to making positive changes has not only reflected on your own well-being, but has also inspired me in my profession. It's patients like you who remind me why I chose to be a physician—to make a positive impact on lives, to provide care, and to be a source of support. Your openness in sharing your concerns and your active participation in healthcare decisions have truly made our doctor/patient relationship a remarkable one. Please remember that your health and well-being remain my top priority. If you ever have questions, need guidance, or simply want to discuss an aspect of your health, please don't hesitate to reach out. I am here to provide you with the best service possible. As we continue this journey together, I am excited to witness your progress and support you in achieving your health goals. Thank you once again for allowing me to be a part of your healthcare team. Wishing you a Happy Thanksgiving. Warm regards, Dr. John Johnson This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking. What is the mechanism by which the relationship between oral hygiene and systemic health exists? In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can translocate systemically via the damaged periodontium to damage other organs and systems. In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection. If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes. A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity. There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
It has been said that the oral cavity is the mirror reflection to one’s overall health. If you have concerns, please schedule a visit with me for a discussion. I am happy to collaborate with you and your dental team to shine that mirror. A Scary Look at Data Misrepresentation in Nutritional Science
As consumers of information, we are barraged daily with conflicting information, nowhere is this more evident than in nutrition research where the information seems to change from week to week. Why is this the case? We can start with how people eat: are the people in the fake headline above just eating ice cream? Likely they are eating the usual ice cream companions like cones, sprinkles, whipped cream and hot fudge. People follow patterns of eating behavior. It is virtually impossible to take a reductionist view of what people eat and limit it to a single food or nutrient. Then, we can look at how the data is collected. Most often, nutrition research asks people to recall what they ate over a given period of time in the past. Do you recall how much ice cream you ate last summer? Last month? Last week? Was it soft serve or hard? What flavor was it? Was it dairy or dairy-free? Did you add toppings? Was it served in a cup or a cone? What type of cone? …Just how accurate do you think the information collected is? Next, we can examine the participants in the study. How many participants are needed before one can make the observation in our fake headline? 3? 30? 300? What were the demographics of the participants? Was it a diverse group of people (age, ethnicity, socioeconomic status, geographical location, etc.)? If all the participants in our fake headline were 80-year-old Caucasian females living in the Bronx, then it would be nonsensical to the extrapolate trends from this data to anyone other than 80-year-old Caucasian females living in the Bronx. Then, ask yourself, is observation causation? The answer is no. That is a fundamental issue with study design. Much nutrition research is observational. We observe “associations” between variables, but we cannot control unforeseen variables. Let’s take our fake headline: What if the participants in the study ate their ice cream on a sugar cone? How do we know the shark bite wasn't due to the cone and not the ice cream at all? By not measuring the sugar cone as a variable we have made a false association between ice cream and shark attacks. In addition, it is rare in nutrition research to see a “gold standard” randomized control trial (RCT) in nutrition whereby people are randomly assigned to an intervention and a control group. In our fake headline, one group would eat ice cream, one group would not (the control group) but they would both go swimming at the beach. Then we would be able to draw comparisons between the two groups about a shark attack. Sometimes the research comes up flat and nothing of interest is found. These negative results are important! They add to the body of knowledge on a subject. However, negative results aren’t highly sought after and are rarely published. This is referred to as publication bias. What if 10 previous studies found no association between eating ice cream and shark attacks, but because this was a positive result it was the only one published? The body of knowledge suffers as does the information disseminated to the public. It is sad but true, that much research is funded by industries. The nut industry funds much of the research on nuts. The cacao industry funds much of the research on chocolate, and so on. Again, positive findings are more likely to be published, negative findings are repressed. Unfortunately, these positive findings are then used by the government to make nutrition guidelines and recommendations. Researchers are human, they have egos and pride. The careers of scientists are built on their hypotheses, and, like industries, they have a vested interest in positive findings. Disappointingly, research is replete with insidious behavior meant to protect and promote careers. Finally, there is the media; their job is to promote ratings. They are not obligated to properly vet the research (study design, participants, funding, etc.). Additionally, the media fails to properly explain the implication behind the headline (i.e. what does this mean to you?) Where does this leave us, the consumers of information who want to make smart nutrition choices? Do we throw the baby out with the bathwater? Throw our hands up and eat Oreos for breakfast? Pringles for lunch? Not exactly. However, we do have a responsibility to take a look behind the headlines before making dietary decisions that impact our health. Sometimes that may mean getting the original research and using the above to decide if the study is valid for us. Feel free to email Concierge Choice Physicians ([email protected]) with your questions or even send a headline or study to us, and we will be happy to answer your questions. After a few years of a very uncertain travel market and amid subsequent changes to the industry, many of us are resuming regular travel and taking much needed vacations. But before you hit the roads and skies for travel, be sure to prepare yourself and pack your bags for medical scenarios.
Importantly, make sure to refill all your prescriptions ahead of your trip at least one week in advance of your departure and always bring at least a few extra days’ worth of medication with you. With the state of the travel industry, there is a high probability of your return not going quite as planned. You should always pack your medications in your carry-on—not in your checked suitcase—just in case your luggage is lost. The Pack Smart Guide from the CDC offers a checklist to help you prepare for a healthy trip, including prescriptions, medical supplies, over-the-counter medicines, supplies to prevent illness or injury, first-aid kits and important documents. Many items in this list would be especially helpful if you are heading off the grid or traveling to an exotic location where medical supplies are not conveniently available at a local drugstore. Also, keep in mind, I do not offer travel vaccines and would need to refer you to a travel clinic, so, please plan ahead. The CDC offers a complete list of destinations with travel health notices, recommended vaccines and precautions to consider for your specific destination. Finally, make sure to enter my concierge contact details into your phone—including my cell number and email—and remember to pack your membership card so that you can reach me with any medical concerns during your trip. I can potentially offer a telemedicine visit, call in a prescription or, based on your destination, help to arrange a visit with a local Concierge Choice Physicians provider if needed. As always, feel free to reach me with any questions. Safe travels! End-of-life care planning is important while we’re still healthy, and the pandemic has made it clear that illness and disability are not reserved for the elderly. Do your loved ones know your thoughts and wishes should a situation arise? According to the National Institute on Aging, 1 in 3 people guessed incorrectly when asked how their loved one would want their end-of-life care handled. It can be an uncomfortable subject to discuss and, in some families, maybe even a taboo subject. However, advance care planning empowers our loved ones when it comes time to handle our end-of-life care and decisions and helps make sure that our preferences and arrangements are known and honored.
One primary aspect of advance care planning includes legally designating a person to make healthcare decisions for you if you are unable to communicate these decisions yourself. This designated person is known as a healthcare proxy (or durable power of attorney healthcare agent, surrogate, representative, attorney-in-fact, or patient advocate). A healthcare proxy decides the types of medical care, procedures, treatments, or services you receive, as well as who provides that care and where. If not otherwise predetermined in advance care directives, they may also make decisions about autopsy, tissue and organ donation, and what happens to your body after death. The American Bar Association has a helpful guide for selecting a healthcare proxy. Your appointed healthcare proxy will have access to your medical records. If you are a Medicare recipient, Medicare will need to know about this individual which can be communicated by completing their Authorized Representatives form. It is important to note a separate document is required to assign a person to handle your finances. Your healthcare proxy can only make medical decisions for you. Contact your lawyer for more information on a power of attorney for your finances. I encourage a discussion about assigning a healthcare proxy and opening the conversation of advance care planning—including a Living Will—at your next visit. For Medicare patients, this is a covered service under Medicare Part B during your Annual Wellness Visit. For non-Medicare patients, feel free to call my office to schedule an appointment, or speak with me about your advance care planning thoughts and goals at your next annual concierge physical exam. |
AuthorJohn B. Johnson, MD is a primary care specialist with Batesville Medical Specialties Archives
October 2024
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