​Ready to Care: Useful Considerations for Caregivers
 
As our loved ones age, the reality of their evolving needs comes into view and that may include playing an advanced role in their care. You may already know from personal experience that family caregivers are essential contributors to the healthcare system. In fact, it is estimated that 1 in 5 adults in the U.S. provide unpaid care to a family member or friend, many of whom are given little to no advanced notice. In order to help manage stress, expectations and provide the best care possible, you can anticipate the call to care by considering the following tips, resources and self-care advice.
 
Becoming A Caregiver
 
Patience is often the most important—and toughest—practice in caregiving. Keep in mind your loved one’s emotional needs and focus on/promote their dignity and independence as much as possible. Be an active listener and be attentive to your loved one’s verbal and non-verbal cues. Researching their diagnoses and speaking with their doctors (when appropriate) about their condition can help you to better understand what is needed from you in the management of their care.
 
Assess what is needed in terms of time management and organizational needs, including coordinating doctor’s office visits and household maintenance. If your loved one has more than one caregiver, define the roles of each contributing person, keeping in mind distance, time, resources and skills/experience. This can help you prioritize and anticipate the management of certain items and avoid future conflicts.
 
Document everything, including your loved one’s routines, diagnoses, medications, healthcare professional care team, emergency contacts and other important phone numbers, and upcoming appointments. You may consider keeping a care journal to organize these items. In addition, it will be important to organize medical records and legal documents (such as power of attorney documents, medical directives and wills) in one place.
 
Among the approximately 53 million Americans in caregiving roles, 70% offer unpaid elder care assisting adults aged 65 and older. However, in certain circumstances, one can be paid to provide caregiving to a family member.
 
Adult daycares and home healthcare programs may be available to support the person you are caring for. Medicare, Medicaid, veterans' benefits or private health insurance may pay for a portion or all of the costs depending on income, degree of disability and other factors.
 
You may also be able to enroll the person you’re caring for in long-term care insurance, which covers the costs of care for individuals who are no longer able to care for themselves and/or have cognitive impairments. Long-term care options may include home care, assisted living, skilled nursing care facilities or residential facilities. Consult with your loved one’s insurance agent to determine if they qualify for long-term care insurance.
 
For end-of-life care, hospice is excellent at providing durable medical equipment (DME) and nursing (in some instances, care time may be limited). Patients usually incur little-to-no out-of-pocket costs for Hospice care, but insurance coverage varies across networks and among individuals, so be sure to research costs.
 
Organizing Yours and Your Loved One’s Affairs Ahead of Time
 
It is not uncommon to find your loved one’s affairs in disarray or organized in a fashion that is only meaningful to them. You can get ahead of the entanglement of affairs with Advance Care Planning. The National Institute on Aging has an excellent resource to aid in advance care planning, with checklists and information to help you get organized before caregiving becomes necessary. We also addressed advance care planning in greater depth in our June 2023 blog, which you can find in our blog archives.
 
An often-overlooked consideration for caregivers is access to password-protected devices and social media accounts. If you do not secure those early on, you may need a court order to access them in the future. Apple devices allow a legacy contact designation.
 
And if you anticipate becoming a loved one’s Power of Attorney, research or speak with an attorney about the laws in your state regarding Power of Attorney designations.
 
Taking Care of Yourself
 
As with the oxygen masks on an airplane, we must prioritize our own wellbeing in order to properly care for others. Studies show the degree of a caregiver’s psychological, emotional and physical stress varies by gender and age, with women and caregivers 50 and under experiencing greater stress. Depending on your personal circumstances (like distance from the person you’re caring for, your employment and finances, for example) as well as the severity of disease or disability of the person you are providing care for, caregiving can take many forms and have varying impacts. Being prepared and staying organized can help you to manage the stressors you may encounter.
 
In addition to the usual self-care advice to sleep, move, eat right and keep your doctors’ appointments (be sure to schedule your exam with us each year and contact us for any other health concerns that arise!), decide what you need for yourself to keep going. Whether it’s a daily walk, a phone call with a friend or a coffee date with friends, try to schedule time for yourself each day. Planning that “me time” into your schedule will help you to actually take the time for yourself, and it may help to reduce any associated guilt you may otherwise experience.
 
Moreover, friends and family members may offer you help. While, for many, your first inclination may be to say, “No, thank you,” we would implore you to consider a genuine offer of help. Accepting help with remedial tasks that take up time and energy (like driving to doctor’s appointments, picking up prescriptions, cooking hot meals, walking the dog, etc.) could help to ease your mental or physical burden.
 
Looking for outside support to help you cope with a loved one’s new diagnosis and/or your new role as their caregiver? Take this quiz to discover the endless free and fee-based resources available, ranging from mental health professionals, group therapy sessions, faith leaders and senior centers, to the VA or AARP. And, of course, feel free to contact us with any questions or concerns about your own health and wellbeing.
 
Becoming a caregiver can be incredibly rewarding yet exhausting. To manage your stress, it can be helpful to focus on the tasks at hand, taking it one day at a time, and determining the best way to break down priorities with a special focus on your loved one’s safety, health and emotional needs, as well as your own.

Springing Forward Without Losing Sleep: Your Guide to Daylight Saving Time


Each year, we spring forward into Daylight Saving Time (DST) the second Sunday in March and we fall back to Standard Time the first Sunday in November. The intention of the extra hour of daylight is to conserve energy, but it has a number of adverse health effects.
 
Beyond a sleep deprived society losing yet another hour of sleep when we spring forward, what is the reason DST is so disruptive to our internal clocks?
 
In essence, every cell in your body has an internal clock that controls your biology on a 24-hour schedule. This is known as the circadian rhythm (CR). The primary driver of the CR is our exposure to lightness and darkness. For optimal functioning, our CR requires exposure to bright light during the day, which keeps us alert and gives us energy during the day, and reduced amounts of light in the evening, which induces drowsiness to get a good night’s rest. However, the opposite happens after DST when it is darker in the morning and lighter in the evening. Your body’s natural CR becomes mismatched with the clock. A misaligned CR will leave you groggy in the morning hours and alert before bed, much like jet lag if you travel west to east.
 
A misaligned CR will not only interfere with your sleep patterns, but also disrupt the appropriate timing of the release of hormones which impact hunger/satiety, mood, immunity, and metabolism.


Many agree we should skip the bi-annual time change, and just change the clocks once per year. There are several national petitions circulating to stop “falling back” but most scientists agree eliminating “spring forward” would make more sense, because Standard Time is more closely aligned with our CR.
 
As of now, no changes have been made so we will be switching to DST next weekend, so how can we prepare for Daylight Saving Time?
 

• Starting Tuesday night, March 4th, go to bed 15 minutes earlier each evening than the night before until the change happens. This will make that initial hour-long loss of sleep less challenging.
  
  
• Consider a lighter schedule on Sunday, March 9th  and Monday, March 10th  to allow your body to adjust.
  
  
• On Sunday and Monday limit naps to 20 minutes in duration. This will help to avoid a bad cycle of not sleeping and trying to catch up on sleep and then again not sleeping,
  
  
• From the time you rise until just after dinner, get as much exposure to daylight as possible.
  
  
• Monitor caffeine consumption. How quickly you metabolize caffeine is genetic, so you know best if it stimulates you and keeps you awake at night. If it does, make your last dose of caffeine 8 hours from your planned bedtime, as half of it should be metabolized by then. Did you know? There is little actual caffeine in chocolate. If you find chocolate stimulating, it is likely the effect of theobromine, a component of the cacao bean and in highest concentration in dark chocolate.
  
  
• Avoid alcohol at night. It may help you to fall asleep faster, but you likely won’t stay asleep through the night, interfering with the deep restorative stages of sleep.
  
  
• Exercise! Just avoid it close to bedtime when it might interfere with sleep.
  
  
• In conjunction with your concierge physician, consider eating within a restricted window of 8 hours a day (optimized if those 8 hours are during daylight hours).
  
  
• Lastly, as the night draws to a close, start to dim the artificial lights. This means dimming the overhead lights, reducing screen time/adjusting brightness and logging off 1-2 hours before bedtime, and ditching the TV. Consider a paperback book or a journal for entertainment before bed instead.

 
With these tips and tools, you can adjust your circadian rhythm and conquer the fog and grog of Daylight Savings.
 

​New Years Resolution Tips for Success
 
Well, we’ve made it halfway through what has been an undeniably challenging decade. Hopefully, the second half compensates with some relative peace and quiet. We know many of our members report developing or slipping back into some less health-promoting habits and are looking to make some changes in the New Year. That’s right, the often-joked-about New Year’s resolutions.
 
Rather than rehashing the trite SMART goals, let’s talk about some statistics and the more unusual approaches to succeeding at your resolutions, which can help put things into perspective for you.
 
Resolution Stats

• Those who make resolutions are ten times more likely to change their behaviors than people who do not—so make one!

 

• Resolutions that incorporate new behaviors are more likely to succeed than those which avoid old behaviors.

 

• People who choose one resolution are more likely to succeed than those who set multiple goals.

 

• Those who anticipate and plan for obstacles are more likely to succeed than those who do not.

 
Approaches

• For built-in motivation, align your resolutions with your values. For example, if your resolution is to sleep more, tie your resolution to the pitfalls of excessive social media consumption or TV use. If you watch less TV and spend less time scrolling at night, you are more likely to hit the hay earlier.

 

• There is no reason to swallow the elephant whole. Take smaller bites! In other words, break the resolution down into smaller resolutions. For example, one study found that those who resolved to volunteer 200 hours a year were more likely to reach and even exceed that goal if they broke down that resolution into volunteering 4 hours a week, instead.

 

• Tie the resolution to a reward so it’s associated with pleasure and not seen as a chore. If you resolve to hit the gym 5 days a week, plan a small donation to your favorite charity if you successfully hit your goal.

 

• On the flip side, tie a “punishment” to a backslide, so it’s associated with pain. Using the example above, if you miss your weekly gym goal, make a donation to a charity not aligned with your belief system—ouch!

 

• Some say misery loves company. Hold yourself accountable to another person by setting the resolution with a friend or a group (can be virtual). You will be less likely to backslide if you know you are there to support others. Camaraderie is a great motivator!

 

• Think like a Marine – Improvise, Adapt and Overcome. Life rarely goes as planned, so pivot when challenged, as there is usually more than one path to victory. Using our gym example, what happens if your car is in the shop, and you cannot drive to the gym? Go walking for the time you would spend at the gym so that you’re still getting exercise, just in a different environment.

 

• Moreover, if you journal your progress, you will be able to reflect upon and learn from past successes or challenges.

 

• Seek professional guidance—there is no harm in hiring a coach! Consider the cost your financial accountability partner!

 
And, of course, we will use this opportunity to remind you of the Motivated Mondays program available to you via our partnership with Concierge Choice Physicians. If you were enrolled last year, you will be auto enrolled for 2025. If you are a new member or have not previously participated in Motivated Mondays, then you’ll soon receive an email inviting you to participate.
 
Good luck and, as always, feel free to comment below or reach out directly with any personal questions or concerns.

​Exploring the Health Benefits of Extra Virgin Olive Oil vs. Plain Old Olive Oil
 
 
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 our 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, we 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.

Modifiable Lifestyle Changes Can Help Stave Off Cognitive Decline

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

​ Dietary Cholesterol vs Serum Cholesterol
 
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 alrea

How to Make the Most of New Years Resolutions as a Concierge Member
 
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:

• Does the sponsor of the information have relevant credentials in that topic?
• Do they provide references to back up their claims?
• What do they have to gain with your buy in?

 
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. Peter Charap and Dr. William Suozzi

Oral Hygiene and Overall Health
 
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:
 

• 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.
 
 

​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.