This class of antibiotics has taken quite a hit recently, and for good reason; they are associated with some serious side effects. This class which is commonly prescribed includes household names such as Cipro, Levaquin and Avelox.

We’ve known for some time that this class can lead to tendon injuries including Achilles tendon rupture. This commonly requires surgical intervention. Then there is the risk of peripheral neuropathy. 

In July of this year the FDA required manufacturers to update their labelling to warn about mental health issues, as well as reports of symptomatic low blood sugar. 

If that wasn’t bad enough, the FDA came back last week with a report linking the use of these meds to aortic dissection and/or aneurysm. This is a very serious and possibly life-threatening situation.

Now the FDA warns against using this class in those with known aortic aneurysms, hypertension, the elderly and certain genetic disorders that involve connective tissue such as Marfan’s syndrome. But unless you have chest x-rays, echocardiograms and abdominal ultrasounds on a given patient, how would you know?

This is a very potent class of antibiotics, commonly used by urologists, ENT specialists, pulmonologists and even family practitioners treating travelers’ diarrhea. 

When treated for pneumonia several years back I myself was prescribed Levaquin. With a short course of therapy, I developed a serious case of triceps tendonitis which took weeks to heal.

We all know that antibiotics are prescribed way too often in this county. We need to be ensured that the benefits clearly outweigh the risks. Furthermore, alternatives to the quinolone class should be used wherever possible.

You can read the original article from MedPageToday by clicking HERE.

WHAT A DIFFERENCE A MONTH CAN MAKE! Last month I attended Current Concepts and Controversies in Cardiology presented by Cedars-Sinai Medical Center. It was fabulous with national leaders from the cardiology community . But the focus was on pharmaceuticals, procedures and evidence based medicine . Lacking was any talk on lifestyle including diet, nutrition, supplementation, exercise , sleep or stress management .

I just returned from the annual American Academy of Anti-Aging Medicine meeting in Las Vegas . There was no emphasis on drugs

Hot topics : intermittent fasting and FMD ( Fasting Mimicking Diet ) which I have written about previously here.
Also : peptides , the power of gut health , the genome and epigenetics , the obesity epidemic with 70% of adult Americans overweight and nearly 50% obese. Then there was maintaining cognitive function as we age and how to prevent Alzheimer’s and lots o n the therapeutics on cannabis ( Can you believe it’s still Schedule 1 on level as ecstasy and heroin ?) REALLY?!!

Terrific conference .. I love focusing on what’s positive and possible !

There seems to be no end to this question. Cooking with the wrong oils could do the body harm as they are pro-inflammatory in nature. The confusion seems to be in the term vegetable oils. (eg. cottonseed, corn, grapeseed, safflower or sunflower oils).

Vegetable oils tend to be highly refined, comprised mostly from polyunsaturated fats. Such fats are prone to oxidation and free radical production. As a result, once ingested the process of inflammation begins.

We know that inflammation is the bane of our existence when it comes to aging. This can lead to heart disease, cancer and other degenerative diseases.

Why the American Heart Association (AHA) still endorses the use of these oils continues to elude me.  

What are healthy options?  Whole food sources such as nuts and seeds are a good choice, especially in the raw or unroasted state. Despite the ongoing controversy of saturated fat, such fats are generally healthier for cooking. They are more stable and less inflammatory. Also recommended  are extra virgin cold pressed olive oil for cooking at low temperatures. These are monounsaturated and moderately stable. I also favor avocado oil and macadamia not oil.

Natural oils are an excellent form of fat. Just be sure to avoid vegetable oils that are highly processed.

Read Original Article HERE

Having just attended Cedars-Sinai 's CONTROVERSIES & ADVANCES IN CARDIOVASCULAR DISEASE, I applaud the incredibly gifted presenters as well as everyone involved in making this 2 day symposium possible.

Lipids, cardiac imaging, heart failure,hypertension, coronary interventions,the latest devises , structural heart disease, gender differences as it relates to presentation, treatment and prognosis,genetic testing ,and the future of remote monitoring via smart phone or watch were among the topics discussed.

What I found most interesting was the discussion on some of the recent heart trials. Does a particular fish oil by Big Pharma really have a survival advantage in those with coronary disease ? Do these new generally unaffordable PCSK9 inhibitors make a difference in survival when compared to traditional cholesterol lowering meds like statins in those with known heart disease? How about the use of immunosupressive agents like methotrexate to combat inflammation and decrease progression in coronary disease?

Now being an integrative cardiologist practicing functional medicine, I must voice my disappointment that essentially nothing about diet, exercise and lifestyle interventions was included in these presentations.

For example,take this whole idea of inflammation.We all know it is the bane of our existence when it comes to aging. Why are we going straight to immunosupressive agents with all the attended side effects without even addressing the causes of inflammation and the potential of more natural remedies ?

Lets be real here. These trials are expensive to conduct. It's as if we are going straight to meds rather than encouraging our patients to practice prevention.

I am all for developments in medical technology, devices and drugs.But we need to see how a more functional approach can play a contributing role.

I’m generally a true fan when it comes to new medical devices, especially as they relate to cardiovascular disease. If you happened to hear the hoopla surrounding the new mitral valve clip (MitraClip), you might walk away believing this was the best thing since sliced bread. After all, a device that can be inserted via the groin, thereby avoiding open heart surgery in a very sick population would be gladly welcomed.

The COAPT trial was recently reported in the prestigious New England of Medicine. But one has to dig deeper to comprehend the seemingly positive results. 

COAPT leaves out a lot of details. Take the cost of the device. It’s $30,000 . But nothing was mentioned about the cost of hospitalization, operating room time, anesthesia and physician’s fees.

The only doctors quoted were those involved in the actual study. There was barely mention of a different trial that showed no significant benefit. Furthermore, very few patients with heart failure actually benefit from this device. Oh, and by the way, the study was funded by the clip’s maker, Abbot.

There are literally millions of people living with severe heart failure with limited options. If this devise was affordable and there was valid  comparison  data, who wouldn’t hail this advance? But it’s simply too premature to tout the clip’s efficacy. 

Read Original Article HERE

How important is salt restriction when it comes to heart health and blood pressure control? This topic comes to my attention more often than not, so here’s my take on the results of the recent PURE study.

                 Recently published in the prestigious journal THE LANCET, sodium consumption made little difference when it came to blood pressure control. That is unless we are talking about consuming more than six grams of sodium daily.    

It’s been assumed for years that any approach taken to reduce blood pressure will translate into fewer cardiovascular events such as heart attacks and strokes. However, the claim that salt plays a role in blood pressure control has never been proven. 

In this study the associations between sodium intake and cardiovascular events did not change when adjusted for age, sex and blood pressure, suggesting that sodium intake plays little role in event rate.

Interestingly, major cardiovascular outcomes decreased with increasing potassium intake. 

I don’t mean to imply that it’s ok to consume sodium to excess. Indeed there is a small population that may be truly salt-sensitive. But clearly they are in the minority. 

There are some inherent limitations of the PURE study. It is a large epidemiology study involving more than 130,000 subjects from 49 different countries. 

But one point is clear; eat your veggies! This study confirms the heart healthy benefits of eating fruits and vegetables 

Read Original Article Here https://www.medpagetoday.com/cardiology/prevention/74507?xid=nl_mpt_DHE_2018-08-10&eun=g565590d0r&pos=11&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-08-10&utm_term=Daily%20Headlines%20-%20Active%20User%20-%20180%20days

I just completed my 3rd consecutive month of this 5 day plan pioneered by Dr. Valter Longo from USC. Although each round has had its challenges, this time around was clearly the best. Not once did I suffer any significant fatigue or brain fog. I amazed myself by maintaining my sense of propriety on day 2 when I was challenged by 2 social events where folks around me ate and all I did was sip herbal tea.

On days 3 and 4 I experienced true hunger pangs ,but they were manageable. Day 5 was clearly the highlight.I experienced new found energy and my work out at the gym did not falter one bit. I topped it all off today with my weekly ice bath!

BOTTOM LINE : Although not for everyone (and you should get the ok from your doctor), I am truly a believer in this diet.

I've reviewed the research. in 5 days what's possible is
* boosting stem cell renewal
* triggering cellular optimization through autophagy
* positively altering the biomarkers of aging

This is serious business. We all know that obesity has risen significantly over the past 15-20 years despite the high carb, low-fat craze that we witnessed in the 90's .Death from liver cancer is also on the rise. Hepatitis B and C were the former culprits but these can often be treated today. I say often because the cost is outrageous , and treatment may not be accessible to all who need it.

The major culprit today is non-alcoholic fatty liver disease.With the degree of obesity seen today, essentially related to bad dietary choices, the liver can't handle the load. Excessive carbs get converted to fat within the liver, and what's left gets dumped in the circulation as triglycerides.

This is what we see in metabolic syndrome and type 2 diabetes. Treating liver cancer is less than successful. The death rate is high. The truly sad fact is that this can often be prevented by diet, weight loss and exercise.

Read original article here: https://www.medpagetoday.com/hematologyoncology/othercancers/74072

As a cardiologist I continue to do all that I can to promote the heart health of my patients as well as myself.After all, heart disease remains the number one killer in the Western World.

But let's face it: who wants a healthy heart with a sick brain? Alzheimer's disease continues to rob us of a long and productive life. Traditional medicine has clearly been unable to put a dent in the treatment and prevention of this devastating disease. Medications by themselves will never be the magic cure or panacea simply because this disease is mutifactorial in extent and requires a multi-pronged approach to treatment.

In this article, integrative neurologist Dr. Pearlmutter talks about the importance of brain energetics. If the brain can't utilize glucose efficiently, it will eventually malfunction. Glucose is necessary for energy production and the brain ,which has to function 24/7 is an energy guzzler. But without insulin, glucose can't be transported to the brain.

But insulin can also be a problem. Insulin regulates glucose and fat metabolism as well as cell growth. Insulin resistance (which we see in metabolic syndrome and diabetes) can lead to the brain's unresponsiveness to the effects of insulin. This eventually can lead to memory deficits and a whole lot more when it comes to cognitive dysfunction.

Combating insulin resistance is where it's at. Lifestyle changes reign high here: lowering the carbs in your diet, increasing healthy fat as an energy source for the brain, along with weight loss and exercise.

Lifestyle changes remain the mainstay when it comes to preserving cognitive function. No medication can do as good a job.

Read original Article here: https://www.drperlmutter.com/energy-medicine-fundamental-in-alzheimers/?inf_contact_key=cec6d4946c2899f45696f960a9db93995f64993ca6005c5858be052662fe2872

We all know how important exercise is when it comes to heart health. I've been touting this for years ,before the American Heart Association (AHA) elevated physical inactivity as important a risk factor as smoking, high blood pressure and elevated cholesterol. We also are well aware of the perils of the air we breathe.

Well, this may come a surprise : a recent Danish study comprised of over 50.,000
subjects showed that exercise decreases the risk of first and recurrent heart attacks regardless of air quality.

Great news. Again the power of exercise reigns. But I would caution exercising in heavily polluted areas. Air pollution in itself is a cardiac risk factor.

Besides ,how can you compare the air quality of Copenhagen with that of Los Angles or New Your City ?!

Here are the results of an interesting small randomized,placebo-controlled trial from South Korea whereby hormonal therapy slowed a decline in mild cognitive impairment.This wasn't just any HRT(Hormone Replacement Therapy) but what was used was topical estradiol gel and oral micronized progesterone.This is similar to what we utilize in bio-identical HRT. Those of us practicing anti-aging medicine have truly embraced the idea that women look better, feel better and think more clearly while on HRT. This study,albeit quite small is giving credence to this timely topic.

Read original article here: https://www.medpagetoday.com/obgyn/hrt/73214

ROUND 2 FMD (Fasting Mimicking Diet)

Having completed my 2nd monthly round of FMD (created by Dr. Valter Longo of USC), I can say that the experience was a bit different, but the end results as good or even better. As a reminder, this diet is all about caloric restriction of a significant degree for 5 consecutive days of a given month. Last month I struggled on day 1 transitioning from my pretty clean but unrestricted diet calorie-wise. On Day 2 major fatigue set in.This time around I experienced no difficulty in transitioning from my normal diet to FMD. I also experienced little to no fatigue this time around. But day # 3 was brutal. I was literally hungry the entire day. I had no specific cravings, but there was true physical hunger. Fortunately the hunger pangs dissipated on days 4 and 5. I was dreading a dinner meeting on day 4.It was my first social event on FMD. Despite the savory smells and everyone eating around me, it didn't much matter. Again, my energy soared the last day.

It's quite a journey, and again it isn't for everyone or for the faint at heart. It takes an amazing amount of focus and desire to change to fully embrace the FMD.

There has been discussion that while fasting and caloric restriction may indeed prolong our life spans, it may also decrease the gray matter in our brain.I haven't review the science behind this claim, and it may or may not be conjectured. But again, who wants a longer life span with a crummy brain ?! NOT ME !

What I can say in defense of this diet is that the period of fasting is a mere 5 days.We aren't talking about a long term fast. I doubt we will see any significant long term brain dysfunction through lowered caloric intake over a 5 day period.

One last point : The fast itself helps rid the body of old worn out cellular debris which is important. But it's through the refeeding process that stem cell proliferation and the hopeful anti-aging effects abound.

We tend to think that migraine are headaches typically seen in women. Indeed the incidence of migraines is 3 times more common in women. But they also occur in men .Here is a new study from the Netherlands that found that migraine in men may well be associated with high estrogen levels.

As men age, high estrogen levels are not uncommon. Along with decreasing testosterone levels , we tend to see aromatization or conversion of testosterone into estradiol (estrogen). We know that elevated estrogen in men is not a good thing. It can lead to premature heart attacks and strokes, prostate enlargement, water retention and fat gain. Now we learn that it can be a culprit in migraine. The reason; men tend to gain fat as they age. Our fat cells secrete an enzyme called aromatase, which is responsible for the conversion.

What's the big deal ? Most physicians practicing traditional medicine rarely, if ever obtain estrogen levels in male patients. Those of us practicing anti-aging medicine do this on a routine basis.

Bottom Line : Men , ask your doctor to draw your hormone levels, and make sure estradiol is included.

Read Original Article Here: https://www.medpagetoday.com/neurology/migraines/73741

I think it's fair to say that most practitioners in functional medicine as well as most health enthusiasts embrace the importance of our microbiome, I'm talking about the trillions of organisms that colonize our gut. 80% of our immune system comes from the gut. It is becoming increasingly appreciated that the gut-brain connection is equally important. Your moods may well be affected by what organisms are found in your gut, which in turn can affect your neurotransmitters. This is not a small deal because of the magnitude of mental illness in the Western world. Why we just recently lost two successful celebrities, Kate Spade and Anthony Bourdain to suicide.We know that meds are not the complete answer. The research on the gut-brain connection is emerging. Because the microbiome varies from one individual to another, taking probiotics in mass may not be enough. One day we may be able to select which probiotics and prebiotics work best for a given individual with a given mood disorder.

Read Original Article Here: https://www.menshealth.com/health/a20646914/probiotics-benefits-gut-mental-health/

Europe does not wholly endorse the stringent Blood pressure (Bp) guidelines recently released in late 2017 by both the American Heart Association (AHA) and the American College of Cardiology (ACC) . The European guidelines are a bit more pragmatic. Their primary goal is to get the systolic Bp below 140 mm Hg.

I concur that getting all patients below 140 mm Hg should be a first goal. Sure getting everyone below 130/80 might be ideal but at what cost? and with how many meds? Furthermore, such guidelines could be detrimental to the elderly and infirm.

Guidelines have their place, but they don't replace sound medical experience and judgment.

See Original Article Here https://www.medpagetoday.com/cardiology/hypertension/73384

Most folks remember the results of the WHI (Women's Health Initiative) released in 2002. Basically there was an increase in cardiac risk, blood clots and breast cancer in those using estrogen.However, what you might not remember is that the average age of the women in this study was 61 (making them clearly postmenopausal),an age where one would certainly expect to see heart disease. Also, the hormones used were equine estrogens,derived from the urine of pregnant horses. Most importantly all these estrogens were administered orally. Oral administration ensures that all drugs undergo the " first pass " effect in the liver, it's been shown that many of these estrogens metabolize in the liver to inflammatory compounds..NOT GOOD

This study which has one disadvantage in being observational in nature, studied over 45,000 women over a period of 7 years. There was no increase in breast cancer , stroke or heart disease.

This is promising news. I have always prescribed topical /intra-vaginal estrogen for many years. Using bio-identical hormones, seeking hormonal balance, and knowing how to test HRT in an ongoing fashion is the key to safe hormone administration.

Read Original Article Here: https://www.medpagetoday.com/meetingcoverage/nams/68526

We all know how beneficial exercise is on several levels.Not everyone embraces exercise with the same gusto as me. But make no mistake about it; regardless of what you think about exercise,a recent study demonstrated that one hour 3/week clearly made a difference in cognitive function, most notably processing speed and executive function. Interestingly enough, these functions are the first that go with aging. It can be aerobic activity, strength training and/or yoga.All such activities are helpful . This is no surprise, as one of the benefits of exercise is that it increases blood flow to the brain.

So forget about what you have always thought about exercise.If mental clarity and cognition are important to you,"just do it".

Read original article here:  https://www.medpagetoday.com/neurology/dementia/73179

TOTAL BODY FLUSH OUT

What an exhilarating experience! Who would’ve thought that caloric restriction could be so meaningful?
Remember we are talking about 1200 calories on day 1 and 700 cal a day on days 2-5.

I felt Day 1 to be the most difficult because the transitioning from a normal diet to something so restrictive is plain tough . Day 2 started off with morning fatigue, but that improved with moderate strength training. Day 3 and 4 I did absolutely no exercise whatsoever. By day 5 I felt completely empowered and transformed. The last two days my cravings completely disappeared. I felt strong, clearheaded, and healthy.

With this 5 day plan done on 5 consecutive days each month, we are aiming for a total body cleanse or wash out. At least that is what it felt like to me. Getting rid of old cellular debris that no longer serves us, while stimulating stem cells and complete body rejuvenation .

WHAT DID I LEARN :

1) we eat much more than we need
2) we can learn to differentiate true hunger versus emotional hunger, urges, or social overeating
3) we can really hone in on our basic needs ( call them primal ) once we clear our minds of emotional clutter .

I’m a convert and I will clearly be back next month for my second.round

I don’t use it as a standalone, however. I use other anti-aging strategies such as a special concentrated form of deep breathing prior to undergoing cryotherapy and my daily cold showers,and IHT ( INTERMITTENT HYPOXIC TRAINING)

My bottom line : One key to successful aging could be training our bodies to need a little less food, a little less oxygen , and lower temperatures.

A special thanks to Dr. Valter Longo of USC who has published data on this diet, and my friend and coach Tony Molina of Rewire Project who has mentored me along the way

WORD OF CAUTION : This diet is not for everyone. I always recommend you obtain your physician's approval. .

Many of you have commented on my experience with FMD (Fasting Mimicking Diet), My experience was very positive. I will clearly repeat this for 5 consecutive days next month. There is a plethora of material out there on FMD as well as numerous YouTube videos. Here is a short article showcasing the founder. Dr. Valter Longo.

https://news.usc.edu/135551/fasting-aging-dieting-and-when-you-should-eat-valter-longo/

NUTRITIONAL GENOMICS : THE FUTURE IS NOW

I recently attended an amazing seminar on the role of genetics and its relationship to our health . Make no mistake about it . This clearly fills a missing niche . Can’t figure out why you can’t lose weight no matter what? Why you suffer from severe brain fog? Why you can’t handle certain medications ? hormones ? Why your immune system is faulty ? Why you are sick and tired of always being tired ?

It’s taking the information from 23andMe and/ ancestry.com and applying it to an individual patient .

I’m the first to say that diet and lifestyle are paramount to wellness . But there may well be some confounding factors that are thwarting your best efforts . The answer may lie in your genome . Once this information is uncovered , we may well be able to implement changes in diet , exercise and supplements to help you achieve your health and wellness goals .

HeartWise Fitness & Longevity Center will be introducing new programs in the next few weeks . Stay tuned !