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:

• A diet of minimally processed, plant-based, whole foods (no Beyond Meat here—remember, some plant-based foods can still be highly processed!), low in added sugar, refined carbs and harmful fats. Calories were unrestricted.
  
  
• Taking select* supplements. *Please consult me before divesting yourself of hard-earned money prior to taking something that may not be appropriate for your biochemistry or that interacts with medications prescribed for you.
  
  
• Moderate daily exercise, such as 30 minutes of walking or other cardio exercise, and mild strength training three times per week. Specific exercise guidelines were based on age and fitness level.
  
  
• Stress management via an hour of meditation, gentle yoga or breathwork daily.
  
  
• Support groups for participants and their spouses or study partners, 3 days a week.

 
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:
 

• these specific multi-modal intensive lifestyle interventions could affect MCI or cognitive function in cases of early dementia
  
  
• there was a correlation between the degree in lifestyle changes and the change in cognitive function
  
  
• the degree in lifestyle change affected the degree of biomarkers

 
What did they find?
 

• There were significant differences between the study group and control with regard to all four cognition and function tests, either by improvement over the control group, or less deterioration than the control group.
  
  
• There was significant correlation between the degree of lifestyle change (how closely participants adhered to the protocol, i.e. a dose response) and clinically relevant biomarkers for AD/MCI and cognition and function tests.
  
  
• Only the study group experienced positive microbiome changes.

 
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.

A reporter from MedCentral recently reached out to Dr. Anderson Halabuk to discuss why her practice transitioned to concierge medicine and how this style benefits both patients and physicians.

Some key quotes from the article:

“We decided to make the move to a concierge practice because we felt that we needed more time with patients in order to use our clinical skills and acumen to their full potential,” said Elizabeth Anderson Halabuk, MD, an internist with Paramount Care Physicians, a small group practice in Fairfax, VA.

“We wanted flexibility in scheduling that would allow us to meet the patients’ needs with things like home visits and extended office appointments,” Dr. Halabuk said. “We wanted practice autonomy different from today’s environment where physicians are more frequently viewed as expendable cogs in a corporate machine.”

Read the complete article in MedCentral by clicking here!

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, we do not offer travel vaccines and would need to refer you to a local Walgreens or CVS, 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 your concierge physician’s contact details into your phone—including their cell number and email—and remember to pack your membership card so that you can reach your provider with any medical concerns during your trip. Your physician 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 us with any questions. Safe travels!

​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. 

​"Three years ago, we were met with a global health crisis that resulted in a singular focus on the pandemic, and many of us put other health concerns on pause.

Have you kept up with your yearly physical? Is it time to do a full review of your medicine and treatment regimens?

The thorough history, physical examination, and laboratory testing of your Keys to Healthy Living physical may even help to reveal asymptomatic conditions, and early intervention may just prove to be lifesaving.

Have you gained or lost a significant amount of weight? Have you had difficulty with stress, anxiety, sleep patterns, or maintaining a fitness program?  

Your annual comprehensive examination can be used as a foundation for good health, and as a way to shift focus back to all aspects of your health and wellness.

Contact our office to schedule your annual exam, and let’s partner in ensuring your very best health! 

As always, we are available should you have any concerns or questions."

​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 spread beyond 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 (hospital acquired). 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 (an imbalance in the gut flora) 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:
 

• Daily brushing and flossing. A soft brush is your go-to on this one. A hard toothbrush is not a friend to your gums and enamel. Add a water pick if you have the counterspace for it.
• Tongue scraping
• Replacing your toothbrush every three months or if you have been sick
• Visiting your dental hygienist at least twice a year, more often if indicated or recommended
• Replacing missing teeth or broken filings
• Addressing bruxism either with a mouthguard created by your dentist or by injecting Botox into the masseter muscles
• Identifying xerostomia, which is a common side effect of many medications
• Quitting smoking if you are a smoker

 
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.