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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

For details please contact Mary at: 562.945.3753

A HAPPY HEART MONTH TO ALL !

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

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

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

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

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