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Valley Health Alliance hosts virtual panel to discuss insurance options Wednesday

The Valley Health Alliance invites small businesses and individuals who buy health insurance to Health Insurance 2022, a virtual panel and Q&A event set for noon to 1 p.m. Wednesday.

The panel discussion is to be broadcast on Facebook Live from the Facebook pages of five area chambers of commerce and the Valley Health Alliance.

The hour-long event includes a panel discussion and Q&A on the new health insurance plans available for small businesses and individuals between Aspen and Parachute.

Panelists include representatives from insurer Rocky Mountain Health Plans, Glenwood Insurance, Carbondale Chamber of Commerce, Mountain Family Health Centers, Aspen Skiing Co. and Roaring Fork Family Practice.

“For the second year in a row, we have two choices of insurers in both the small group and individual health insurance markets, and we understand premiums for many plans are going down,” Valley Health Alliance Executive Director Chris McDowell said in a news release.

“It’s important to get folks thinking about health insurance as the year comes to a close,” he said.

The event will be broadcast through the Facebook pages of the following organizations: Aspen Chamber Resort Association; Glenwood Springs Chamber Resort Association; Carbondale Chamber of Commerce; Basalt Chamber of Commerce; Western Garfield County Chamber of Commerce; and Valley Health Alliance.

Visit any of these pages at noon Wednesday, and click on the video link.

Doctor’s Tip: One doctor’s path to learning about the power of food

There is a wealth of scientific literature about the power of unhealthy food to cause disease and of healthy food to prevent, treat and reverse disease. Unfortunately, doctors aren’t given this information in medical school, postgraduate training or in typical medical conferences (the majority of which are sponsored by the pharmaceutical industry).

I recently met a bright young urologist at Valley View Hospital, Aashish Kabra, M.D., who was raised in a vegetarian household but who became totally plant-based a few years ago after happening upon the aforementioned literature. Kabra told me he works plant-based nutrition into the conversations he has with most patients, because food plays a key role in many urologic disorders. He also told me about his “new favorite book,” called “Fiber Fueled, The Plant-Based Gut Health Program for Losing Weight, Restoring Your Health, and Optimizing Your Microbiome,” by gastroenterologist Will Bulsiewicz, M.D., MSCI (Master of Science in Clinical Investigation — in other words, he’s an expert in analyzing and interpreting clinical studies).

The next few columns will be based on “Fiber Fueled,” but first it’s important to know Dr. Bulsiewicz’s story. He attended Vanderbilt for undergraduate school, then graduated from Georgetown University School of Medicine, was chief medical resident at Northwestern Memorial Hospital in Chicago, and chief gastroenterology fellow at The University of North Carolina Hospitals. He earned the MSCI degree from Northwestern, and did an epidemiology fellowship (where you look at large populations of people, see what they eat, what diseases they get, and what they die from) at University of North Carolina School of Global Public Health. He has written over 20 articles in top American gastroenterology journals.

Dr. Bulsiewicz notes that the average American eats 3 pounds of food a day, 1,000 pounds per year, and about 80,000 pounds of food during an 80-year lifespan. So it’s no wonder that what we eat affects our health. As he puts it: “You could nourish your body with life-giving food and reap the rewards of better health. Or you can punish your body with poisons disguised as food that actually take health away with every bite.”

Dr. Bulsiewicz admits to being a junk food addict growing up. Like most physicians, he received minimal training about nutrition in medical school. During the subsequent 10 years of training to become a board-certified gastroenterologist, nutrition was never mentioned again. Toward the end of his training, although he was able to drag himself to the gym a few times a week, he was 50 pounds overweight and felt tired, overworked and just plain lousy.

Then he met his future wife, who happened to be on a plant-based diet, and he began to realize there was a better, healthier way to eat. He lost weight, no longer had “post-meal hangovers,” and felt more energized and stronger. His mind had “more stamina for work,” his mood became more positive, and he looked better.

He began to wonder why he hadn’t heard about plant-based nutrition during his years of medical training and figured there probably weren’t good studies to support it. Having an advanced degree in clinical investigation, he spent some time in the medical library, and found “a mountain of evidence to support the way I was feeling.” He found “study after study providing a uniform, consistent result. Plants are good for our health.” Plants have the most nutrients per calorie of any type of food. They have “vitamins, minerals, antioxidant compounds called polyphenols, and unique medicinal chemicals found in only plant food, called phytonutrients.” Furthermore, Dr. Bulsiewicz found out why fiber is so important. He learned that only plants have fiber, which he came to believe is “the single most important missing piece in the American diet.” This led to his book, “Fiber Fueled.”

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Doctor’s Tip: Should you sign up for Lifeline Screening?

Recently there have been pink inserts in local newspapers advertising health screening by a company called Lifeline Screening, which has been coming to our area for years. People are asking doctors if they should sign up for this testing, which costs $181 and is not covered by insurance or Medicare.

It is always best to prevent disease, and it’s estimated that 80% of the chronic diseases that Americans suffer and die from would be prevented if everyone simply ate more vegetables, fruit, whole grains, nuts and seeds and moved about more. Next best is catching disease early, when it can be treated and often reversed. Given that heart attacks and strokes, caused by atherosclerotic plaque in arteries, are the No. 1 cause of death in the U.S. (at least in non-COVID-19 years) — and given that almost all these deaths are preventable— it’s particularly important to screen for early disease in arteries. Let’s look at the tests offered by Lifeline Screening, none of which involve radiation:

CAROTID ARTERY (PLAQUE) SCREENING: The carotid arteries bring blood from the heart to the head and brain. They are located just under the skin on each side of the windpipe, so are easily accessible for evaluation by ultrasound. When disease is present in these arteries, it is virtually always present in other arteries as well, including the coronary (heart) arteries. The Lifeline Screening test picks up significant plaque, which if present should be a red flag for primary care physicians to determine and treat causative factors such as obesity, hypertension, high cholesterol, diabetes, inflammation, smoking, sedentary lifestyle, unhealthy diet and sleep apnea. A more sensitive test, which picks up earlier, more subtle disease, is carotid IMT, available at Compass Peak Imaging.

SCREEN FOR ATRIAL FIBRILLATION: This arrhythmia is dangerous, because clots can form in the atria (the small, upper chambers in the heart) and go to the brain, resulting in an embolic (caused by a clot originating somewhere else) stroke. Most people with AFib know they have a heart irregularity, but not all. If the Lifeline Screening test shows AFib, you should see your physician right away; if it is not present, it could be because the arrhythmia occurs off and on.

ABDOMINAL AORTIC ANEURYSM SCREENING: The left ventricle of the heart pumps blood through the aorta, the largest blood vessel in the body. In some people, a weak spot develops in the abdominal portion of the aorta, resulting in a bulge called an abdominal aortic aneurysm (AAA). Most people with this condition don’t realize they have it until it bursts, at which point it’s too late to do anything about it because of massive acute blood loss — and some 30,000 Americans die every year from a ruptured AAA. If the bulge is caught early through a screening ultrasound, the weak spot can be repaired. Medical guidelines for screening vary, but in their book “Beat The Heart Attack Gene,” Bale and Doneen recommend that everyone have a screening ultrasound for AAA at age 50, and at age 40 if they have risk factors such as smoking, hypertension or a family history of AAA.

PERIPHERAL ARTERIAL DISEASE (PAD) SCREENING: PAD is atherosclerotic plaque in the arteries of the legs, which can result in leg pain with walking. Surgery to bypass the blockages, and even amputation, are sometimes necessary. Furthermore, if disease is found in leg arteries, it is bound to be present in other arteries such as those in the heart and brain.

OSTEOPOROSIS RISK ASSESSMENT: Thinning of the bones is common as people age — especially women. However, osteoporosis is not normal, and it increases the risk of fractures, which can interfere with quality of life and shorten lifespan. The Lifeline Screening test is an ultrasound of the shin bone. Although this test may be useful for screening, the gold standard test is a densitometry, which checks bone density in the wrist, hip and lower spine.

To answer the question of whether you should sign up for Lifeline Screening, if you’re younger than 40, any benefit is unlikely. If older than 40, the screening could be helpful, and the price is right compared to doing these tests individually, especially given that it would be unlikely that your insurance would pay.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Doctor’s Tip: Shortness of breath is a common complaint

A frequent complaint that brings patients to primary care doctors is shortness of breath. Often the cause is weight gain or poor aerobic conditioning. This column is about more serious causes.

Lung infections: Pneumonia usually occurs as a complication of a viral upper respiratory infection such as influenza. Classic symptoms in addition to shortness of breath are moderate to severe cough, fever, chills and sometimes chest pain with a deep breath. Symptoms may be less severe in “walking pneumonia,” but pneumonia can be serious, and people still die from it. Viral pneumonia does not respond to antibiotics, but bacterial pneumonia does. If you have any symptoms of pneumonia, the sooner you get diagnosed and receive appropriate treatment, the better.

One of the hallmarks of severe COVID-19 disease is low oxygen, which causes shortness of breath. Again, the sooner you’re diagnosed and treated, the better. Even better is prevention, through immunization and, when appropriate, social distancing and masking.

Asthma is an inflammatory condition that causes spasm of the breathing tubes in the lungs, resulting in wheezing and shortness of breath. Asthma can be fatal, so if you think you might have it, seek professional help.

Emphysema is caused by loss of alveoli (small, delicate air sacs in the lungs where oxygen enters the blood). Smoking, second hand smoke and air pollution all play a role in this chronic and progressive disease. Exertion causes oxygen levels to drop, resulting in shortness of breath. You can check your oxygen level by buying a finger oximeter at any pharmacy and wearing it while walking briskly up some stairs (normal oxygen level is greater than 90% at all times).

Coronary artery disease (atherosclerotic plaque in your heart arteries) can cause shortness of breath. Especially in women, shortness of breath with or without exertion can be a symptom of a pending or actual heart attack.

Heart arrythmias: In atrial fibrillation and other heart irregularities, the heart beats irregularly and/or very fast. This results in inefficient delivery of oxygen to organs and tissues, causing shortness of breath with exertion and sometimes at rest.

Congestive heart failure occurs when the heart muscle becomes weakened by conditions such as atherosclerosis or tight or leaky heart valves. Blood and fluid back up into the lungs, causing shortness of breath.

Blood clots in the lung: The medical term for this is pulmonary emboli, which can cause shortness of breath at rest or exertion. Usually they are associated with chest pain, but not always, and they can be fatal.

Anemia refers to a low red blood cell count. The most common cause is iron deficiency, from loss of iron due to conditions such as heavy menstrual periods in premenopausal women; or loss from the GI tract from bleeding ulcers, colon polyps or colon cancer. Red blood cells carry oxygen to organs and tissues, and a low red count causes shortness of breath with exertion.

Mental health factors: A common symptom of anxiety is the feeling that the sufferer can’t get a deep enough breath. In severe anxiety such as panic attacks, people start to breath rapidly, which causes the level of carbon dioxide in the blood to fall, which in turn causes numbness and tingling in extremities. Although nobody dies from panic attacks, the sufferer feels like they’re going to die. Treatment is to breathe into a paper sack, which brings CO2 levels back to normal.

The take-home message is this: Many causes of shortness of breath are serious. If you have this condition, see a medical provider on an urgent basis.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Valley Life for All column: Helping the TBI incarcerated

Anna Sage
Annie Uyehara

Editor’s note: The Post Independent, in conjunction with Valley Life For All, continues a monthly series of profiles to increase awareness of the value of people of all abilities.

NOTE: This is the second installation of a two-part series on people with brain injuries. Last month, we wrote about the Brain Injury Alliance of Colorado and the challenge of having a brain injury.

Imagine telling a judge that you have no recollection of doing anything wrong but still find yourself behind bars.

This may sound like an excuse, but people with brain injuries often do not recall what they’ve done or even that it’s criminal, yet they end up incarcerated.

“A lot of the incarcerated have had a brain injury, so it can be very frustrating for the judicial system to understand what [people with Traumatic Brain Injury (TBI) are] going through,” said Audrey McNeely, navigator and advisor at the Brain Injury Alliance of Colorado. “For those with brain injuries to say to a judge, ‘I can’t remember,’ doesn’t seem adequate, and it’s not met with understanding. There’s a big challenge then in the legal system.”

Brain Injury Alliance of Colorado — which offers therapy, support groups, skills building and other resources for those with TBI — is available to judicial systems, but McNeely emphasizes that Brain Injury Alliance of Colorado cannot diagnose nor give legal representation for the TBI incarcerated. “We can educate the lawyers, courts, judges and detention centers, but they have to reach out to us. We are very open to offering them information and professional training to better understand TBIs within the incarcerated population. The more educated we are, the better off they are.”

Behavioral health therapists also work within the judicial system, such as Anna Sage, who works in the Garfield County Jail. She is a jail-based behavioral services case manager and mental health professional who also does work for Correctional Health Partners. Her caseload includes two incarcerated clients with TBI.

Sage helps the TBI incarcerated with resources, therapy and coping skills. The most frequent mental issues she sees are anxiety, depression and confusion. “People with TBI don’t remember things well. I also see a lot of anger issues, because they process things differently,” Sage said, explaining why some may find themselves in jail. “They need someone who is patient and will repeat information for them. Sometimes, I just listen to them and let them vent; it helps them process their feelings, especially if they’re not expecting to be incarcerated. They may not even understand the charges against them.”

Like McNeely, Sage believes education is key: The better educated people are, the better chance the TBI incarcerated have of being understood by the judicial system and the general population.

“It’s not something people talk about; they’d rather sweep it under the rug — if we can’t see it, it doesn’t exist,” Sage said is a common response to people with TBI.

Yet there are blessings working with the TBI incarcerated, she said. “I remember a recent experience when a client was able to finally calm down and think a little better. Or I will get a little smile back, a little thank-you, and that’s really welcoming, that’s where I see what I’m doing is working.”

For more information about training and education on TBI within the judicial system, contact Liam Donevan at Brain Injury Alliance of Colorado: 303-562-3298. For Correctional Health Partners, contact 1-866-932-7185.

Local nonprofit Valley Life for All is working to build inclusive communities where people of all abilities belong and contribute. Find us at ValleyLifeForAll.org or on Facebook.

Doctor’s Tip: Food as medicine for chronic kidney disease and high cholesterol — a patient story

The two kidneys are the shape of beans but much larger. Around 1 million microscopic filters in each kidney get rid of waste products in the blood, via urine. In addition to glomeruli, kidneys are made up primarily of blood vessels.

Over half of American adults currently age 30-64 are expected to develop chronic kidney disease, most of which is caused by atherosclerosis (hardening of the arteries). Because kidneys are so vascular, they are particularly sensitive to atherosclerosis. Causative risk factors include hypertension, smoking, sedentary lifestyle, obesity, diabetes, high cholesterol, inflammation, and a diet rich in animal products.

According to Dr. Michael Greger in his book “How Not to Die” and his website NutritionFacts.org, researchers have found three specific dietary components associated with a decline in kidney function: animal protein, found in meat, poultry, seafood, eggs and dairy; animal fat; and cholesterol (all animal products including seafood contain cholesterol). Animal protein harms kidneys primarily because it causes acidity and inflammation. A fourth substance that harms kidneys is phosphate additives in cola drinks and meat, used for color enhancement.

Kidney function is determined by the following: serum (blood) creatinine, with normal 1.22 or less; GFR (glomerular filtration rate), with normal being greater than 60. Results of these two kidney function tests are part of chemistry panels done in doctors’ offices, hospitals and health fairs.

Another important test for kidney health is a urinalysis, which is not done at health fairs due to collection and storage issues. Any protein in the urine is abnormal. The most sensitive test for urine protein is the microalbumin/creatinine ratio, with normal being 7.5 or less in a female and 4.0 or less in a male.

If you have protein in your urine; an elevated microalbumin/creatinine ratio; a blood creatinine of greater than 1.22, or a GFR of less than 60, you have chronic kidney disease, which needs to be evaluated and treated (treatment involves treating the risk factors for atherosclerosis in the second paragraph). There are various degrees of chronic kidney disease. For example, a GFR between 15 and 29 is classified as severe, meaning heading in the direction of dialysis or kidney transplant.

Now, an illustrative patient story: A.S. is a man in his 70s who was referred to the Center For Prevention and Treatment of Disease Through Nutrition/The People’s Clinic by a friend of his. He presented on July 12, accompanied by his wife. For years he had been on a high sodium diet recommended by physicians for low blood pressure (note that sodium not only raises blood pressure but also directly damages the endothelium organ system that lines our arteries). He has also been on the Paleo diet for over three years, which is high in kidney-damaging animal protein. He was diagnosed with chronic kidney disease a year before last month’s visit, at which time a kidney ultrasound was normal (usually the pathology causing chronic kidney disease does not show up on an ultrasound). He was not given any advice about diet but made the decision on his own to increase his daily intake of animal protein even more.

A.S.’s lab results on June 23 showed a serum creatinine of 2.63 and a GFR of 25, putting him in the severe class of chronic kidney disease, heading in the direction of dialysis or kidney transplant. His total cholesterol was 232 (“normal” being < 200 but ideal < 150); LDL or bad cholesterol 173 (“normal” < 100 but ideal < 50).

The patient was encouraged to go on a total plant-based, whole food diet, with no sugar, salt or added oil. With the support of his wife, he did so. Repeat lab on July 31, after two weeks on the diet, showed a creatinine of 1.55; GFR of 46; total cholesterol 181; and LDL 132. So just with these dietary changes for two weeks — although his kidney function isn’t normal and his cholesterol isn’t ideal — he’s out of the woods regarding both issues. Hopefully with time, both problems will improve further and possibly resolve.

Unfortunately, the medical system in the U.S. isn’t geared towards prevention or treatment of disease through simple measures such as lifestyle changes. Medical schools fail to teach students about the power of unhealthy food to cause disease; or of healthy food to prevent, treat and often reverse disease. And most practicing physicians aren’t aware of the extensive medical literature out there that supports food as medicine.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Doctor’s Tip: Food as medicine — turmeric

Turmeric is known for its antioxidant, anti-inflammatory and DNA- protective effects, and is sometimes called a “wonder spice.”

Plant-based foods with intense flavor (herbs and spices) or with intense color are known for their special health benefits. Turmeric is both intensely flavored and intensely colored. It is used in Indian cooking and gives curry its yellow color. Turmeric is thought to be the reason that India has one of the lowest rates of cancer in the world. (They have one of the highest rates of heart disease, though, thought to be due to ghee, the processed butter they use in cooking).

According to Dr. Greger’s book “How Not to Die” and his website NutritionFacts.org, over 5,500 scientific studies have been published on turmeric over the past few years. Some of these have been lab and animal studies, which can’t be assumed to translate into what happens in humans. Following are the results of some human turmeric studies that were done according to the gold standard: blinded and placebo controlled. Unless otherwise specified, turmeric was given using the oral route.

• Turmeric was shown to help reverse pre-diabetes and diabetes.

• It was as effective in treating inflammatory bowel disease (ulcerative colitis and Crohn’s disease) as the expensive drugs that are usually used, and without their potential side effects — some serious.

• Rural India has one of the lowest rates of Alzheimer’s dementia in the world, and in small studies turmeric helped lessen and even reverse mild to moderate Alzheimer’s symptoms.

• Turmeric reversed a serious inflammatory eye disease called uveitis.

• It reversed a type of eye tumor.

• It was shown to heal colon cancer when applied directly on it via the oral or rectal route (enemas). It improved breast cancer when it was applied directly to cancer that had spread to the overlying skin.

• It improved endothelial function in arteries (endothelium is the organ system that lines our arteries).

• Turmeric improved kidney damage caused by the autoimmune disease lupus.

• Arsenic is a heavy metal that causes DNA damage, resulting in higher incidence of cancer; turmeric helps prevent and repair this DNA damage, thereby decreasing the risk of cancer.

• It treats, and in some cases even reverses, rheumatoid arthritis.

• It lessens joint pain in degenerative (osteo) arthritis.

• Turmeric helps prevent and reverse DNA damage associated with aging, radiation and smoking.

• It shortens recovery from surgery.

Turmeric versus curcumin: Western medicine is always trying to find the silver bullet in foods with medicinal properties, in order to put it in capsules or pills and sell it. Curcumin is thought to be the active ingredient in turmeric, but it turns out that there are several additional ingredients in turmeric that have medicinal benefits. Therefore, it is important to use whole turmeric and not curcumin supplements. Cooked turmeric (in curry or hot tea) is best for prevention and repair of DNA damage; raw turmeric is best for inflammation.

If some turmeric is good for you, is a lot even better? Dr. Greger notes that in India, the amount of turmeric typically consumed daily in curry is 1/4 to 1 teaspoon — the dose used in most of the aforementioned studies — and that’s the dose he recommends. Turmeric root is available at Natural Grocers, and if you want to grate your own, 1/4 of an inch is approximately equivalent to 1/4 of a teaspoon of turmeric powder. Both forms are available at Natural Grocers.

Are there people who should avoid turmeric? The oxalates in turmeric can cause kidney stones, so people with a history of stones should avoid it. Turmeric causes the gallbladder to contract, so people with gallstones should use it cautiously.

A sprinkle of black pepper on turmeric decreases the metabolism by the liver, resulting in blood levels 2,000 times higher than turmeric without pepper. The safety of such high levels is questionable, and there have been reports of liver damage with high blood levels of turmeric. Furthermore, very high levels of antioxidants can cause instead of prevent oxidation. The same concerns exists with supplements that combine turmeric with other herbs that work synergistically with it, which perhaps is why blinded, placebo-controlled human studies on such supplements have failed to show benefit.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market and cooking classes. Call 970-379-5718 for appointment or email gfeinsinger@comcast.net.

Doctor’s Tip: Worried about Alzheimer’s? Don’t count on recently approved Aduhelm

Six percent of Americans suffer from Alzheimer’s dementia. Aging Americans fear getting this memory-robbing disease more than any other age-related condition.

Alzheimer’s is associated with amyloid plaque in the brain, which is different than the atherosclerotic plaque that occurs in arteries and is the cause of heart attacks and strokes. However, association is not the same as causation. Most of the information in this column was obtained from The Prudent Prescriber, an email newsletter that is sent out monthly to Colorado physicians by Rocky Mountain Health Plans, based in Grand Junction.

It would seem logical that removal of brain plaque would improve Alzheimer’s symptoms. However, as is so often the case in medical science, when studies are done, what seemed logical is proven to be false. Over the last few decades, several drugs have been developed that decreased brain plaque, but all of them were rejected by the FDA because they failed to improve Alzheimer’s symptoms.

The latest such drug is Aduhelm (aducanumab), developed by Biogen. This drug reduces Alzheimer’s-associated brain plaque, but whether it improves the disease is controversial at best. Aduhelm was approved by the Federal Drug Administration on June 7, under an accelerated approval pathway. Almost all experts feel that the approval was premature, rushed and not based on science.

The FDA is a governmental agency under the Department of Health and Human Services. It was established in 1906, with its mission being protecting public health through overseeing food safety; regulating prescription and over-the-counter drugs; and regulating vaccines — among other things. The FDA has done a good job for the most part, although in the past they have sometimes been criticized for being too cautious and slow in approving new drugs; and at times for being influenced by Big Pharma and politics.

Biogen did two clinical trials on Aduhelm, both of which have been criticized for their quality. They stopped the studies in 2019 because although plaque burden improved, patients’ symptoms did not. Biogen later claimed that on further analysis, one of the studies did suggest mild clinical improvement (the other clearly didn’t) and resubmitted their application to the FDA for approval. Obviously, a third study was needed. The 11-member FDA expert advisory committee voted 10 to 0 to recommend denial of approval (the 11th member abstained), but the FDA took the unusual step of ignoring their advice. Furthermore, the FDA approved Aduhelm for all Alzheimer’s patients, no matter the severity of their disease, even though the participants in the two trials were limited to those with mild disease. Three members of the advisory committee quit in disgust, one of them saying “the FDA’s decision was probably the worst drug approval decision in recent U.S. history.”

This is not a cheap drug. A year of monthly infusions of Aduhelm costs $56,000, with an additional $30,000 for required MRIs and PET scans. There are also safety concerns, with side effects including headaches (27 percent of patients), brain swelling (35 percent), brain bleeds (19 percent) and death.

There will be other negative fallout from the premature release of this drug. Patients and families are desperate for a cure, and there will be pressure on physicians to prescribe it against their better judgment. There will be pressure on Medicare and private insurance companies to approve use of this unproven drug, which will result in a huge financial burden. In addition, the FDA’s action will cause the public to lose trust in the agency.

Hopefully, some day there will be a drug to prevent and reverse Alzheimer’s, but it doesn’t appear that Aduhelm is it (although it’s possible that further studies will paint a more positive picture). If you’re concerned about Alzheimer’s, stick with what we know helps: 1) Engage in intellectual and social activity as you age. 2) Eat a diet rich in vegetables, fruit, whole grains, nuts and seeds. 3) Engage in regular aerobic exercise. 4) Control cardiovascular risk factors, which are the same as the risk factors for Alzheimer’s: obesity, hypertension, high cholesterol, diabetes, inflammation, smoking and stress. (There are cases of people with normal brain function who have brain plaque but healthy brain arteries, and it’s possible that Alzheimer’s will prove to be a vascular disease). 6) Get seven to eight hours of sound sleep a night. 7) Consider daily turmeric. In a study group of 40 patients with mild to moderate Alzheimer’s symptoms, all 40 returned to normal after taking a teaspoon a day of powdered turmeric. (Search turmeric and Alzheimer’s on nutritionfacts.org).

Greg Feinsinger, M.D., is a retired family physician with a special interest in heart disease and diabetes prevention and reversal, ideally through lifestyle changes. He’s available for free, one-hour consultations — call 970-379-5718.

Shop-with-a-doc

Dr. Feinsinger is offering 1½ hour grocery store shopping sessions where he shows how to make healthy food choices. By appointment; call 379-5718.

Torres column: Discipline is the secret to getting what you want

It has been a month since “Kalyn” signed up with the program. She told me that her body has been changing. Her stomach is getting smaller, and her body is getting firmer. She said she has tried different programs and gyms in the past, so I asked her what’s different this time. She answered, “Discipline.”

She said no one had taught her the power of being disciplined and dedicated. Fitness practitioners had put her on supplements and sold her other products, but they never taught her that results will come from dedication. She also said that she was exercising daily but not seeing the results she wanted.

Exercising is a good habit to adopt, but the problem is when people think it is the only habit they need to embrace. Many people exercise rigorously every day over a long period of time and still don’t see the results they want.

So here is the reason why she and many others get results.

Back when you were in school you probably noticed that there were always a couple of people who shone and were the smartest. Maybe you were one of them. You know why they were ahead of everyone? Was it genetic? Did they have special abilities? Were they born with extra knowledge? No. The reality is that they did something that others did not: homework.

People who get good grades or results do homework. They love to spend their time with productive activities that will help them achieve their goals. The reason they enjoy putting the extra time in homework is because they focus on the results they will get.

So the tool I use with my clients is homework. We come out with a detailed plan that they create and need to perform at home, with the understanding that weight loss and optimum fitness is practiced not only at the gym but at home and in many other areas of their lives.

Any decision made daily will contribute to your goal.

So very simple:

Wake up early and set aside one hour to think and plan your day, every day. Do your homework — plan your exercise routine, your meals, your cooking, your shopping, your chores and everything you can think of. Plan your week, set up monthly goals. Pretend that you have an exam that you need to pass no matter what. I’ll promise you will get results, and you will be more efficient and save time.

After a month you will see how all the things you’ve done in the gym and at home are contributing to get you fit.

Sandro Torres is owner of Custom Body Fitness in Basalt and Glenwood Springs and author of the books “Lose Weight Permanently” and “Finding Genuine Happiness.” His column appears on the third Wednesday of the month.

 

Doctor’s Tip: We need some cholesterol, but too much is harmful

Cholesterol is important in the formation of bile acids and steroid hormones, and is a component of cell membranes. It is synthesized by cells throughout the body, but particularly the liver. Some comes from dietary sources. While cholesterol is necessary for human life, high levels can cause gallstones and hardening of the arteries (atherosclerosis) — the cause of heart attacks, strokes, angina, vascular dementia, blockages in the arteries to the legs and intestines, and erectile dysfunction.

A “cholesterol test” includes the level of total cholesterol; HDL (good cholesterol — think “H” for healthy); LDL (bad cholesterol — think “L” for lousy) and triglycerides. Think of your LDL as garbage in your arteries, so if you have too much garbage you’ll have a problem with your arteries. Think of HDL as garbage trucks, so you’ll also have a problem with your arteries if you don’t have enough garbage trucks. Low HDL combined with high triglycerides signifies insulin resistance/pre-diabetes.

There are caveats with HDL, though, because some people have a low number of garbage trucks (low HDL), but the ones they have are super-charged, and these people have normal arteries. Other people have lots of garbage trucks (high HDL) but their garbage trucks are dysfunctional and cause rather than prevent problems.

There are some caveats with LDL as well. LDL particle number is more meaningful than the usually measured level of LDL. Lp(a) is a particularly harmful type of LDL that is often present in families with lots of early heart disease. And it’s best if your LDL particles are large and fluffy rather than small and dense. Measuring these things is relatively inexpensive.

National cholesterol guidelines specify that ideal lipid levels are: total cholesterol less than 200; HDL greater than 40 in men and postmenopausal women, greater than 50 in premenopausal women; LDL less than 100, and in people with a history of heart attack, stroke, or diabetes LDL should be less than 70; triglycerides less than 150. However, half of people who have heart attacks and strokes meet these guidelines. Heart attack prevention doctors feel that — given that 20 percent of heart attacks victims die — if atherosclerosis can be demonstrated in a patient by studies such as a coronary calcium score (CT scan of the heart) or carotid IMT (ultrasound exam of the carotid arteries in the neck), LDL should be less than 70.

Plant-based providers feel that normal lipid levels should be those seen in people who never develop atherosclerosis and who are therefore heart attack-proof — such as people in the Blue Zones. These people have total cholesterol levels of less than 150; LDLs in the 30s and 40s; and triglycerides less than 70.

All animal products, including seafood, contain cholesterol, so to achieve optimal cholesterol levels, these foods should be avoided. Furthermore, the saturated fat present in all animal products and in oils cause the liver to produce more LDL. Over 30 years ago Dr. Dean Ornish proved that heart disease can not only be prevented but can be reversed with a plant-based, whole food diet with no salt, sugar or added oil. This diet is also one of the few things that lowers Lp(a).

Plant foods that are especially good at lowering cholesterol include high-fiber fruits, vegetables, legumes and whole grains, ground flaxseed and certain herbs and spices including Amla (1/2 teaspoonful of powder daily, which also lowers Lp(a)) and black cumin. Red yeast rice contains a weak, natural statin that lowers cholesterol a little, but being a supplement is unregulated, so you don’t know for sure what it contains.

For genetic reasons, sometimes diet isn’t enough. For these people, and for people unwilling to change their diet, drug options are available: Statins prevent the liver from making so much cholesterol; ezetimibe prevents absorption of cholesterol; and for people who don’t tolerate statins, there are the newer but more expensive PCSK9 inhibitors, which are given by injection every two to four weeks.

Atherosclerosis can start in infancy, and the National Heart, Lung, and Blood Institute recommends that all children have a cholesterol screen between age 9 and 11, and again at 17-21. Obese children, children with a family history of very high cholesterol (called familial hyperlipidemia), and children with a family history of early heart disease are advised to be screened earlier than 9. Adults should have their cholesterol checked every five years starting at 20 — more often if their lipids are abnormal.

Greg Feinsinger, M.D., is a retired family physician with a special interest in heart disease and diabetes prevention and reversal, ideally through lifestyle changes. He’s available for free, one-hour consultations — call 970-379-5718.